Podiatrist or primary care provider?

[billethkid]

When at the podiatrist getting my nails cut I asked about the chronic slight swelling of my right ankle and toes. Without a question about the situation his immediate response was to follow up with my primary care doctor!

My reaction then and continues, maybe I have the wrong podiatrist.

I have not followed up with my primary.

Fortunately the swelling incidences are not significant (I don't think).

What is your experience with a similar situation?

[Whatnext]

If you are spending a lot of time sitting around, you may have a build up of fluid.
I would heed podiatrists advise, and speak with your doctor.
Better safe than sorry.

[Stu from NYC]

Speak to your pcp

[villagetinker]

I am GUESSING this might be something out of the podiatrist area of expertise and he suggested seeing PCP in case the swelling (etc) is due to something else. I agree with above see your PCP.

[JMintzer]

I am GUESSING this might be something out of the podiatrist area of expertise and he suggested seeing PCP in case the swelling (etc) is due to something else. I agree with above see your PCP.

Precisely!

As a soon to be retired Podiatrist (with over 39 years in practice), listen to the DPM you saw.

CHRONIC swelling is not typically due to a foot problem, but a cardiac or circulatory problem. An ACUTE swelling (especially when combined with redness) is a different story. That could be gout, arthritis, or an infection, which I will certainly treat.

I'll typically suggest a pair of mild compression socks for maybe a month, but if that doesn't solve the problem, you may need a diuretic.

I am hesitant to start this type of medication regime, especially when the patient cannot remember all of his meds. Their PCP (or cardiologist) is much more familiar with your overall medical status and is the one who should be treating that type of CHRONIC condition.

Hope this helps.

[golfing eagles]

Precisely!

As a soon to be retired Podiatrist (with over 39 years in practice), listen to the DPM you saw.

CHRONIC swelling is not typically due to a foot problem, but a cardiac or circulatory problem. An ACUTE swelling (especially when combined with redness) is a different story. That could be gout, arthritis, or an infection, which I will certainly treat.

I'll typically suggest a pair of mild compression socks for maybe a month, but if that doesn't solve the problem, you may need a diuretic.

I am hesitant to start this type of medication regime, especially when the patient cannot remember all of his meds. Their PCP (or cardiologist) is much more familiar with your overall medical status and is the one who should be treating that type of CHRONIC condition.

Hope this helps.

I'm an internist/PCP and I approve of this message

[Kelevision]

When at the podiatrist getting my nails cut I asked about the chronic slight swelling of my right ankle and toes. Without a question about the situation his immediate response was to follow up with my primary care doctor!

My reaction then and continues, maybe I have the wrong podiatrist.

I have not followed up with my primary.

Fortunately the swelling incidences are not significant (I don't think).

What is your experience with a similar situation?

You have a very good podiatrist and should listen to what they say.

[La lamy]

Just reading your "chronic slight swelling of my right ankle and toes" makes me think: make that doctor call now! So many of us wait too long to deal with health issues. The sooner you address it, the easier it is to treat IMHO.

[Dan T]

When at the podiatrist getting my nails cut I asked about the chronic slight swelling of my right ankle and toes. Without a question about the situation his immediate response was to follow up with my primary care doctor!

My reaction then and continues, maybe I have the wrong podiatrist.

I have not followed up with my primary.

Fortunately the swelling incidences are not significant (I don't think).

What is your experience with a similar situation?
I went to a podiatrist for the same thing and she sent me for a Venus ultrasound. Turns out I have deep vein reflux.

[Gunny2403]

IMO the Doc is doing his job. There are probably many reasons for the ankle issue. One is venous insufficiency. There are vein specialists that can determine if you have a worry. Not a big deal.

[Susan1717]

I totally agree with most of the comments here! Call your primary asap! When I get yearly physicals, a main question is always, is there any swelling in your legs ankles or feet!!! There’s too many possible causes and none are good. Do NOT ignore this! The podiatrist was correct to refer you.

[Steban]

You will get better advice from your Podiatrist and PCP than random people on Social Media.

[Stu from NYC]

You have gotten good advise from two medical pros above.

[MrLonzo]

When at the podiatrist getting my nails cut I asked about the chronic slight swelling of my right ankle and toes. Without a question about the situation his immediate response was to follow up with my primary care doctor!

My reaction then and continues, maybe I have the wrong podiatrist.

I have not followed up with my primary.

Fortunately the swelling incidences are not significant (I don't think).

What is your experience with a similar situation?

I don't have a similar experience, but I do have experiences where the doctor fails to adequately communicate their advice. Did you ask the podiatrist to explain WHY he wants you to see your PCP? If you're not comfortable with his communication with you, then yes, you should find a different doctor. But remember, communication goes both ways. I would have simply asked, "does it look like an infection? or more of a systemic or circulatory problem? what do you think, Doc?" If again the podiatrist tells you to ask those questions to your PCP, I'd do so, but also find a new podiatrist since he wasn't even willing to rule out a foot problem.

[Lisanp@aol.com]

Issues with feet/ankles are associated with many serious conditions especially Diabetes. You should see your PCP.

[JMintzer]

You will get better advice from your Podiatrist and PCP than random people on Social Media.

I've been called a lot of things over the years. "Random" has never been one of them...

[JMintzer]

Issues with feet/ankles are associated with many serious conditions especially Diabetes. You should see your PCP.

Methinks the pt IS a diabetic if Medicare is paying for Nail care...

But the description of his symptoms wouldn't set off my "diabetes" alarm...

[Stu from NYC]

Methinks the pt IS a diabetic if Medicare is paying for Nail care...

But the description of his symptoms wouldn't set off my "diabetes" alarm...

In any case off to see an MD.

[Reynoka]

When at the podiatrist getting my nails cut I asked about the chronic slight swelling of my right ankle and toes. Without a question about the situation his immediate response was to follow up with my primary care doctor!

My reaction then and continues, maybe I have the wrong podiatrist.

I have not followed up with my primary.

Fortunately the swelling incidences are not significant (I don't think).

What is your experience with a similar situation?
My primary care doctor knows about my rare genetic disease, because I gave her a thick stack of information. She took the information and asked to reschedule our intake evaluation for two weeks so she could read up on it. She did and came back with a list of specialists and tests needed for baselines. She is aware of the medical protocol for my condition, sends me out to specialists when suggested by what she learned about my condition, but she is my go to person for deciding what to do with all the information. We make informed decisions together. With so much going on medically for me, some areas are priority and others are back on the shelf until the priority is taken care of. I like to take care of myself but not spend my life in doctor offices! We try to balance the medical interventions needed around my life, rather than wrapping my life around constant medical appointments and procedures. My heart doctor is who is currently working on managing my swollen ankles! I frankly believe it’s gotten worse once starting medication to help it! But I talked about that with my doctor and found the swollen ankles wasn’t the area of swelling he was working on! Talk to your doctors and listen! My primary care is still my primary doctor to go to. She caught that with the new medication my heart doctor prescribed, I needed to stop a supplement I was taking or I’d be interfering with the prescribed medication.

[blueash]

I think your podiatrist handled this poorly. You asked a specialist who is already treating you whether a symptom you have is something podiatric. I would have wanted an entirely different approach from my podiatrist.

Perhaps yours believes that when treating nails and being paid for treating nails that the only question you can ask is about your nails. Any other topic requires a new appointment for that problem

If there are podiatric causes for your symptom the podiatrist is supposedly able to diagnosis the presence or absence of those causes without needing some other specialist to rule in or out other reasons.

We have had a podiatrist opine here about how he has a specific recommendation for swollen ankles, socks then a diuretic. But how can he be saying that if treating swollen ankles from fluid retention is not in his diagnostic skill set? Why would a podiatrist ever prescribe a diuretic? He has also told us that diabetes would not cause this.

I would want my podiatrist to ask me a couple questions to see if your symptoms and progression fits a podiatric disease. He said he would be happy to treat gout or arthritis or an infection but apparently is incapable of asking the questions and doing the exam to be diagnosing whether gout or arthritis or an infection is your problem.

I would want my podiatrist to rule in podiatric disease and if he does not find any podiatric disease then tell me to see my PCP. If I see my cardiologist with a complaint of shortness of breath I would hope she would ask questions and do an exam to rule out cardiac causes not tell me that it could be non-cardiac so I should go back to my internist to rule out lung cancer, asthma, TB, anxiety, and every other non-cardiac cause before she can do any evaluation.

What does the Cleveland Clinic say a podiatrist can do?

Podiatrists can treat any common issue that affects your feet and toes, including
..
Swelling of the lower extremity.

Apparently your podiatrist does not feel competent to diagnose a chronic swollen ankle. I'd want one who would have the skills to ask questions and do an exam before sending me to another specialist like an internist. I'd want my podiatrist to do his evaluation then tell me, yes this is a podiatry problem and here is my plan, or this is not and you need to see your internist for further evaluation.

[golfing eagles]

I think your podiatrist handled this poorly. You asked a specialist who is already treating you whether a symptom you have is something podiatric. I would have wanted an entirely different approach from my podiatrist.

Perhaps yours believes that when treating nails and being paid for treating nails that the only question you can ask is about your nails. Any other topic requires a new appointment for that problem

If there are podiatric causes for your symptom the podiatrist is supposedly able to diagnosis the presence or absence of those causes without needing some other specialist to rule in or out other reasons.

We have had a podiatrist opine here about how he has a specific recommendation for swollen ankles, socks then a diuretic. But how can he be saying that if treating swollen ankles from fluid retention is not in his diagnostic skill set? Why would a podiatrist ever prescribe a diuretic? He has also told us that diabetes would not cause this.

I would want my podiatrist to ask me a couple questions to see if your symptoms and progression fits a podiatric disease. He said he would be happy to treat gout or arthritis or an infection but apparently is incapable of asking the questions and doing the exam to be diagnosing whether gout or arthritis or an infection is your problem.

I would want my podiatrist to rule in podiatric disease and if he does not find any podiatric disease then tell me to see my PCP. If I see my cardiologist with a complaint of shortness of breath I would hope she would ask questions and do an exam to rule out cardiac causes not tell me that it could be non-cardiac so I should go back to my internist to rule out lung cancer, asthma, TB, anxiety, and every other non-cardiac cause before she can do any evaluation.

What does the Cleveland Clinic say a podiatrist can do?



Apparently your podiatrist does not feel competent to diagnose a chronic swollen ankle. I'd want one who would have the skills to ask questions and do an exam before sending me to another specialist like an internist. I'd want my podiatrist to do his evaluation then tell me, yes this is a podiatry problem and here is my plan, or this is not and you need to see your internist for further evaluation.

Here's a shocker---I have to disagree.

Yes, the podiatrist should rule out an etiology that is within the scope of podiatric practice, and after that suggest starting with the patient's PCP. As you already know there are hundreds of causes for peripheral edema, some more obscure than others. We've already had amateurs weighing in with their Dr. Google diagnoses on this thread. You and I can think up causes that they would never find on the internet without spending hours wading through information they couldn't understand. Dr. Mintzer---I hope your patient didn't contract Wucheriasis :1rotfl::1rotfl::1rotfl:

[blueash]

Hey GE it seems like you are agreeing with me, not disagreeing. The podiatrist could/should have evaluated for a podiatric cause before turfing the patient.

[golfing eagles]

Hey GE it seems like you are agreeing with me, not disagreeing. The podiatrist could/should have evaluated for a podiatric cause before turfing the patient.

Oh, No--Agreeing with you!!!! What is the world coming to? :1rotfl::1rotfl::1rotfl:

As you know, just put 10 doctors in the same room and you'll get 10 different opinions!

[jimjamuser]

When at the podiatrist getting my nails cut I asked about the chronic slight swelling of my right ankle and toes. Without a question about the situation his immediate response was to follow up with my primary care doctor!

My reaction then and continues, maybe I have the wrong podiatrist.

I have not followed up with my primary.

Fortunately the swelling incidences are not significant (I don't think).

What is your experience with a similar situation?
Various swelling of body parts is one indicator of potential heart problems. Another common one is nocturnal urination.

[JMintzer]

I think your podiatrist handled this poorly. You asked a specialist who is already treating you whether a symptom you have is something podiatric. I would have wanted an entirely different approach from my podiatrist.

Perhaps yours believes that when treating nails and being paid for treating nails that the only question you can ask is about your nails. Any other topic requires a new appointment for that problem

If there are podiatric causes for your symptom the podiatrist is supposedly able to diagnosis the presence or absence of those causes without needing some other specialist to rule in or out other reasons.

We have had a podiatrist opine here about how he has a specific recommendation for swollen ankles, socks then a diuretic. But how can he be saying that if treating swollen ankles from fluid retention is not in his diagnostic skill set? Why would a podiatrist ever prescribe a diuretic? He has also told us that diabetes would not cause this.

I would want my podiatrist to ask me a couple questions to see if your symptoms and progression fits a podiatric disease. He said he would be happy to treat gout or arthritis or an infection but apparently is incapable of asking the questions and doing the exam to be diagnosing whether gout or arthritis or an infection is your problem.

I would want my podiatrist to rule in podiatric disease and if he does not find any podiatric disease then tell me to see my PCP. If I see my cardiologist with a complaint of shortness of breath I would hope she would ask questions and do an exam to rule out cardiac causes not tell me that it could be non-cardiac so I should go back to my internist to rule out lung cancer, asthma, TB, anxiety, and every other non-cardiac cause before she can do any evaluation.

What does the Cleveland Clinic say a podiatrist can do?



Apparently your podiatrist does not feel competent to diagnose a chronic swollen ankle. I'd want one who would have the skills to ask questions and do an exam before sending me to another specialist like an internist. I'd want my podiatrist to do his evaluation then tell me, yes this is a podiatry problem and here is my plan, or this is not and you need to see your internist for further evaluation.

Apparently, you did not comprehend what I posted...

Oh, and the Cleveland clinic hasn't a clue as to what actually goes on in a Podiatric practice. Their generic definition is useless at best.

[JMintzer]

Here's a shocker---I have to disagree.

Yes, the podiatrist should rule out an etiology that is within the scope of podiatric practice, and after that suggest starting with the patient's PCP. As you already know there are hundreds of causes for peripheral edema, some more obscure than others. We've already had amateurs weighing in with their Dr. Google diagnoses on this thread. You and I can think up causes that they would never find on the internet without spending hours wading through information they couldn't understand. Dr. Mintzer---I hope your patient didn't contract Wucheriasis :1rotfl::1rotfl::1rotfl:

Funny you should mention that. I diagnosed a patient with Wucheriasis just this week! It's running rampant in the DC area... :1rotfl::1rotfl::1rotfl:

"I've been looking on Web-MD" sends shivers down my spine when it is uttered by a new patient...

[JMintzer]

Hey GE it seems like you are agreeing with me, not disagreeing. The podiatrist could/should have evaluated for a podiatric cause before turfing the patient.

You have no idea what the pt's Podiatrist evaluated and or saw on his/her examination.

No insult intended, but patients are the absolute worst at listening to what their Dr's tell them and relating what they are treating them for or referring (trufing) them to another doctor.

I can't tell you how many time I've spent 20 minutes talking to a patient, only to have them return in a month having followed exactly NONE of my instructions.

[CoachKandSportsguy]

I can't tell you how many time I've spent 20 minutes talking to a patient, only to have them return in a month having followed exactly NONE of my instructions.

Many people don't follow doctor's directions forever, they get lazy, the incident is fully healed, whatever the reason.

My mom was a Nazi nurse: followed all doctors orders to the letter forever. My dad had a heart attack in 1984, age 60. I talked with one of his cardiologists within the last 10 years, and he said longevity then was about 5 years, maybe 10 afterwards.

My mom made my dad follow all orders, rules, forever and he hated it. He used to sneak ham subs with mayonnaise when he was away from home on the weekends.

He lived to 90+, and its all because my mom followed all diet and exercise doctor recommendations and orders forever. If it tasted good, "Spit it out now!"

Just saying, its worth listening to doctors, and actually following directions has the probability of best results. maybe the podiatrist just wants to do nails, who knows, but I suspect that the good doctors here tell us a podiatrist have the ability and should be able to help, your current podiatrist doesn't appear to be one from your description.

good luck, and follow the doctor's orders for best results

[blueash]

Apparently, you did not comprehend what I posted...

Oh, and the Cleveland clinic hasn't a clue as to what actually goes on in a Podiatric practice. Their generic definition is useless at best.

The Cleveland Clinic has a podiatric division. Hopefully those podiatrists work there have some idea of how a podiatrist should handle a patient and what conditions they are qualified to evaluate.

If I did not comprehend what you posted perhaps you didn't write clearly. You seemed to agree that the OPs DPM did exactly what should have been done. I would want my doctor to ask some questions and do an exam to r/o podiatric etiologies. Not just send me back to the internist until that minimum has been done.

[Aces4]

To the OP, your podiatrist did you a favor and I feel you can trust him. Problems with edema should be mentioned at any physical or check-up with your current physician.

Is it just me or does anyone else think a group of chest thumping doctors statements are funny to read?

Heaven forbid if one checks the internet or educates themselves in anyway regarding a medical condition for then they are a fool. I'm sure all doctors have seen their share of situations which challenged their patience and a fair share of those who would not listen to instructions but they are supposed to lead those people and not mock them.

Keep in mind the patient who may have been put on 15 different medications of which 8 turned out to be unnecessary by an inattentive Dr., or the patient who is told it's all in their head and it turned out to be a life threatening condition, or the Dr. who didn't want to be disturbed at 2:00 AM for an obstetrical delivery and has the nurse on duty administer an injection of "his bomber" to knock the patient out and stop delivery until he comes in early the next morning and the patient has to begin labor all over again. That's just the very tip of some pretty unsavory stories that people have to tell.

Doctors are only human and are under very difficult demands and expectations for their time at this point. Drs. make mistakes and people who don't advocate for themselves or have someone to advocate for them while under medical care are missing the boat. And now we are all subject to care under NP's and PA's when Dr's. schedules are too crowded to see patients needing care. That's another story all together.

I have seen some very dedicated and thorough physicians in my long life and my hat is off to them. I have also witnessed some that shouldn't have escaped medical school. Another tip of a so-so Dr. is one that will laugh or make fun of their patients after they've left the office.

It's a good idea for patients to have a perspective of a Doctor's ego. The room doesn't need two patients.:D

[JMintzer]

The Cleveland Clinic has a podiatric division. Hopefully those podiatrists work there have some idea of how a podiatrist should handle a patient and what conditions they are qualified to evaluate.

If I did not comprehend what you posted perhaps you didn't write clearly. You seemed to agree that the OPs DPM did exactly what should have been done. I would want my doctor to ask some questions and do an exam to r/o podiatric etiologies. Not just send me back to the internist until that minimum has been done.

And you have no idea if the DPM did or didn't do exactly that. I can do a thorough exam while "cutting nails" and the patient may not have a clue as to what I'm doing.

I don't announce "Now I'm checking your circulation, checking for signs of edema, etc, etc, etc. I just do it.

If I see a problem, THEN I'll discuss it with the patient.

Now, if you want to get into a p*ssing match", I suggest you do it elsewhere...

[Moderator]

...

Now, if you want to get into a p*ssing match", I suggest you do it elsewhere...



Good advise...

To all, please speak to the topic and stay away from any hint of a personal attack.

Otherwise thread will be closed.

[Stu from NYC]

Interesting thread hope it can stay open