to think DP should see the doc urgently!

[Equallength]

One leg has been swollen for a while. It comes and goes and a few years ago he had cellulitis in the same leg. He’s scratched it today in the garden and it’s bleeding a bit but more worryingly is leaking fluid! I know there’s an association with congestive heart failure, which has worried me a bit as he has a low heart rate to begin with.

Hes 54 and otherwise fit bit recently gets a bit out of breath. WWYD?

my lymphodema is genetic. didnt start until I was in my 30s, but didnt really get going tol 40s, and then into second leg in late 40s

I have friends however who have had lymphodema due to injury or medical treatment - theirs seems to resolve

can you press into the swelling and does it leave a 'pit' that remains - that distinguishes lymphodema from other types. But ultimately nobody here can confirm that this is the problem, or what is causing it.

Well it’s A & E- your DH has a chronic issue and should have gone to the GP to be referred onto a specialist as the issue isn’t new. . Sounds like you thought A &E was the place for multiple tests and a diagnosis for a minor issue that could have waited. The A & E department isn’t there to manage your health anxiety. It’s an over stretched service filled with many who should have gone to a GP or pop to the local pharmacist for advice The sheer number of kids and adults sat for hours complaining they have to wait- yep because you have been triaged and are not a priority over the person who is in resuc - I mean come on- your DH cut his leg and it has leaky fluid and you have come on MN and folks have set you off thinking he is in the road to imminent death. He was checked over by the doctor and sent on his way- he wasn’t chucked out the door . Without being seen.

Wondering whether you read the post properly, because you seem to be castigating the OP for going to A&E with a ‘minor’ issue.

It wasn’t a case of trying to jump the queue for ‘multiple tests and a diagnosis’, it was genuine concern that something might be seriously wrong. It wasn’t a simple cut and leaky fluid - the leg was swollen and leaking, and his heart rate was slow, so it could very easily have been a DVT, and potentially fatal. And I didn’t see any complaint from the OP about the wait until 4.30am - more that it was a waste of time actually going to A&E in the first place. He wasn’t actually ‘chucked out the door without being seen’ as you so charmingly put it - he was examined by a doctor and discharged.

You can’t win can you ? if you go to A&E you’re a drama llama, and if you don’t and it turns out to be serious, you’re criticised for not acting sooner. It may also have escaped your notice that GP services are in crisis, and that many people go to A&E as a last resort because they can’t get an appointment. The wait for where I live is 3 weeks - and that’s just for a phone appointment. Until someone comes up with a plan to fix this broken system, people are going to ‘manage their health anxieties’ at A&E more and more because not everyone has medical insurance to fall back on, and are forced to find any means they can to be seen by what is supposed to be a universal health care system, free at the point of access.

I’m sorry the reaction you got from the doctor sounds dismissive and not totally helpful, OP, although I’m glad your DH was seen.

Just to add to what @TheLadyofShalott1 said upthread….I spent the best part of yesterday sitting in my local A&E too, after agonising for hours over whether to go, and talking myself out of it numerous times. Yes, it was a long wait but the doctor who saw me couldn’t have been more delightful, assured me I’d done absolutely the right thing, and that my worrying symptoms merited a heart trace, physical exams, blood tests and an X-ray. And indeed, having sent me home with medication, he wants me back for further, more detailed tests next week. He was emphatic that 'this is exactly what we’re here for'. Had I ignored it, there might have been a bad outcome.

So, notwithstanding that we all know the NHS is in a dire place, people like me whose natural tendency is to think 'I can’t possibly go to A&E, I’ll be fine, it’s really not that bad' mustn’t be put off. And I’m lucky that all the staff I saw were great.

As a pharmacist I would have referred him to 111 or a walk in centre due to it being the weekend which is exactly what he did and then they referred him to A&E. There are no GP surgeries open on a Saturday and I wouldn’t of been happy with making patient wait until Tuesday to see his GP. His leg was visibly swollen, bleeding and weeping fluid. Any HCP would have referred to 111 and A&E on the weekend.

So in this case, OP’s husband did the correct thing.

Ermmm so you go first giving your full identity!

This. Most posters are like myself, and posting from personal experience, but in the absence of medical qualifications it’s just guesswork isn’t it ? What really concerns me is the number of posters recommending compression bandages and socks. DH has Type 2 diabetes and peripheral arterial disease and had a leg ulcer last year, which took ages to heal. I did some reading up on compression treatment and we asked about it at the clinic. We were told in no uncertain terms that compression was only appropriate to venous conditions and was actually dangerous for people with arterial conditions.

My colleague got a bit of a fright with a bad cough that was hurting his chest and causing shortness of breadth (possibly anxiety) but had the good fortune to be in France at the time.

He was seen within 2 hours on a Sunday at his nearest GP clinic. Given antibiotics and went off, with an instruction to come in to be re-checked again later in the week or to call if no improvement within 2 days.

The NHS is broken. You can’t get a doctor’s appointment for weeks and when you do, you get 3 minutes. So you go to A&E and get shouted at for not trying the GP route.

111 didn’t call him back, by the way.

I'm not surprised about the A&E experience to be honest. I got told off by the triage nurse for taking my 8 year old asthmatic there when he was having an episode and still had a sore chest after 10 puffs of his inhaler. There was a one hour wait for anyone to even answer the phone at 111 so no way I was waiting for that. We got seen (doctor was helpful) and got steroids but I was appaled at the triage nurse. Luckily I am a sensible person and know when my son needs urgent attention but this might put someone off taking their asthmatic child to A&E in future which is very concerning!! I hope your husband gets proper medical assessment soon OP. NHS is dire at the minute.

The doc said she wasn’t there to be dealing with things like this

I know the NHS is under vast amounts of stress, but no way would I leave that comment without a written complaint via PALS at least, especially as he left without even a dressing.
That is a disgusting attitude to have with a patient.

Yeah I wouldn't have gone to A&E with that either. Especially not on a Saturday night when they're busy dealing with all the drunks on top of regular patients. They're spreading themselves far too thin as it is. He wasn't going to pass away in the night, so it very likely could've waited until Monday morning. Or even until this morning when you could've accessed an out of hours GP appointment (which you could in fact, have accessed at the same time of night you went to A&E... Our OOH GP service is in our hospital, behind the A&E department! So easy. I realise it won't be the case for everyone but most areas have an OOH GP service or a Minor Injuries Unit. It could so easily have been sorted without presenting as an emergency

@ChloeHel Have you never heard of Out of Hours GP service? If you were really a Pharmacist you'd know alllllllll about OOHs

He didn’t rock up on a Saturday night with a scratch and sit for 7 hours for nothing!!! It was in combination with other worrying symptoms. To access the OOH you have to be triaged via 111, who STILL haven’t called back. The GP surgery has no appointments for the next 3 weeks and so presented with bilateral oedema, a history of cellulitis and a leaking weeping cut that had gone hard, it wasn’t a good idea to just leave it.

But thanks for your somewhat simplistic perspective.

The problem with “wait to see a GP” when it’s something that’s might be serious is that the GP might then refer to hospital but that takes time and in the mean time the clock is ticking.

Swelling like that indicates the heart isn’t doing it’s job correctly in pumping fluid around the body. That’s bad. It can lead to sudden heart failure. It can also be a sign that something is blocking it - not to scare the OP but the last person I knew who had swellings like that turned out to have a blockage due to an aggressive and fast growing cancer in his abdomen - and a GP can’t diagnose that, they can only refer for scans.

A horrifying amount of cancers are diagnosed in A&E and a lot of them are due to symptoms that were tolerable day to day right up until the point where suddenly they weren’t and now it’s an emergency.

I'm sorry the A&E Dr was so dismissive. There's clearly a problem which needs urgent investigation
I hope the private GP will push for this. There may be an underlying circulatory problem which is causing this particularly bearing in mind his low heart rate breathlessness and cough too
Make sure you state these symptoms as well as his leg/ foot

The amount of denial you are in about a health service which is well past being on its knees is painful.

A few months ago I was sat in A&E in vast amounts of pain, getting gradually worse and begging doctors to see me as I hit the point where my pee turned brown which I know enough to recognise as liver issues. Damn right I didn’t care about other people at that point, I was terrified I might die right there in front of doctors. I was there eight hours and then they sent me home with painkillers. Twenty four hours later they called me back in after the blood test results. I had pancreatitis and ended up staying in three days.

Two months ago I was taken in by ambulance post surgery as I called them due to feeling very unwell and was scared I would lose consciousness and pass out whilst alone. The doctor basically shrugged and said I probably had picked up a stomach bug on the ward and I ended up desperately calling friends to get home (taxi drivers aren’t keen when you’re emptying out at both ends). A few days later the post surgery blood test revealed… severe calcium deficiency, bad enough for me to be brought back in on a drip. I probably had had a stomach bug but the “weird feeling” was due to my calcium levels dropping precipitously. I was at serious risk of heart issues those few days. But you know, let’s not go bugging doctors in a&e if we’re not SURE it’s serious.

It looks like he has lower limb oedema, probably as a result of venous insufficiency.

The fluid that normally bathes cells (tissue fluid and lymph) now has an exit point as it’s scratched and the skin is broken. That’s why it’s weeping.

It’s hard to tell from a photo but the redness might be from a soft tissue infection (cellulitis) and is accompanied by heat and pain. If not hot or painful and he’s otherwise well it might be staining from venous insufficiency - it can vary from reddish to brownish and is called haemosiderin discolouration.

His scratch needs dressing - you could buy some today - something absorbent is good if it’s weeping fluid such as Allevyn Adhesive (ask the pharmacist). He then needs an appointment with the GP and practice nurses as he needs assessing for vascular disease, and if it’s venous disease which should include a Doppler test to see if he can wear class 2 or higher compression stockings.

Did they take bloods?
How is the BP?
As for the drunks in A&E? That's a bit of a myth and if someone with that leg came in and got that sort of response, can you imagine what reception a drunk would get?

Looks very like cellulitis hope he's seen soon. I'm a nurse and work I. A nursing home I have to phone 111 a lot broken hips sepsis etc and it often takes 4 hours for a emergency ambulance to come . The paramedics often tell me they have to wait outside a&e departments for many hours as well.
Hope he's seen soon

I'm also wondering whether the admittedly rude doctor was aware of his history? Very often, they tend to ask specific questions such as 'any medical history?' I know you mentioned a very low heart rate but I can't recall whether you mentioned whether it has ever been investigated? It's possible that with his pulse at 93, the doctor wouldn't have realised how high that is for him (it's a very normal pulse at 93) and wouldn't have thrown up any red flags to her at all. Aside from the cut which needs bathing and dressing, I still think cellulitis needs to be ruled out and the heart rate is something which ideally should be investigated. Has he a high temperature or pain/chills/feeling feverish?
I'm honestly shocked that he got that response. Did she compare both legs? One is very clearly red and inflamed.

Bear in mind that hospital docs are often junior doctors and a mix of arrogance and ignorance is not uncommon.

My mum’s cellulitis + pneumonia was missed by a junior doc, I took her in as I thought she had… cellulitis and pneumonia.

She ended up being sent back by the GP, admitted, and was in hospital for a week.

Ah yes because of all things to lie about being, a pharmacist is one of them.

And the majority of OOH GP services are used through 111…so yeah, as I said, I’d of gotten him to call 111.

This sounds a bit frightening and is likely not relevant but a family member with bradycardia had swollen lower legs for a long time and had a sudden heart attack in his early thirties. He was young, fit and healthy. A combination of factors meant his coronary arteries had been furring up insidiously and due to his young age, the other symptoms were dismissed by the doctors, until he dropped down with a heart attack and arrest. It is so unlikely to be this, which is why the docs dismissed him before, but if you have private medical insurance, I’d at least ask for an investigation.