DEAR DR. ROACH: I am a 70-year-old woman in excellent health. For the past few years, I have had a creeping, bloody discoloration of my feet, starting at my ankles and going toward my toes. When you touch one of my feet it is momentarily normal but quickly goes back to looking bloody even sometimes purple. For the past year and a half, I am also experiencing edema of my ankles and feet. I have no heart issues and have had an endovascular doctor do testing on my veins and arteries. Everything is flowing like it should. My primary care, cardiologist and endovascular doctors find NOTHING wrong and have no explanation for my symptoms, which continue to persist. Any ideas? -- L.S.
ANSWER: A foot, or any part of a foot, that turns blue and cold suddenly is a surgical emergency. It usually means that a major artery is blocked either by blood clot or by cholesterol plaque. That's NOT what you have, but I understand why you are concerned about the appearance of the foot.
I suspect your problem is vascular congestion, which is commonly seen in both men and women in their 70s, usually associated with foot swelling due to "leaky" valves in the veins. The swelling constricts the network of very small blood vessels, causing the feet to look alarmingly blue. As in your case, arterial testing (that's what your vein specialist did) is normal.
Fortunately, as alarming as it looks, it is not dangerous. Elevate your legs for 10 minutes or so at least three times daily. In addition, light compression stockings worn daily will help with the swelling, which is why the blood has pooled in the feet.
DEAR DR. ROACH: What good is HIPAA law if everyone can know my health problems? I recently called my doctor to ask a question. The nurse informed me about all of my recent past appointments and test results. She also told me that I had appointments scheduled with other doctors and when they were scheduled for. She told me that I should come in to see this doctor on a certain day and at a certain time. Why is she allowed this information? I am not happy about someone besides my doctor having my (I thought) private information. My husband is not even allowed this information. -- U.P.
ANSWER: The Health Insurance Portability and Accountability Act (HIPAA) limits how health care providers and businesses share private medical information. However, the Privacy Rule allows doctors to share your private information for the purpose of clinical care without express written authorization of the patient. So, if I, as a primary care provider, refer my patient to a cardiologist, I can talk to the cardiologist about why I've made the referral. However, the act requires that covered entities (like doctors) disclose only the minimum necessary information.
A nurse in a doctor's office IS providing treatment and is entitled to know the appropriate clinical information about a patient. Indeed, a nurse needs to know a patient's medical condition and history. A nurse isn't a secretary calling to set up an appointment. In your case, she may have been discussing your details with the other doctors so they knew how to schedule you (such as how soon and for what kind of appointment).
Any protected health information should not be disclosed to a family member without first getting permission from the patient. Some discussions between a patient and a doctor that should not be disclosed to anyone else. It is my practice not to write these down into the chart.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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