Problem: Mrs. Rodriguez, a 45-year-old woman, complains of intermittent mild bilateral feet and ankle swelling for the past two months, but worse on her right leg. She denies leg pain, but she does describe her legs as feeling heavy at times and reports standing for long periods worsens the swelling. She notes that the veins in the legs are getting more significant. For the past eight months, she has been experiencing intermittent numbness in her feet and reports her left knee has been achy. She is a server at a busy restaurant and sometimes works 10-hour days. She denies any fever, earth, erythema, or trauma.
Past medical history: Obesity, Type 2 diabetes
Medication: Metformin
Physical examination: vital signs within normal limits, exam unremarkable except bilateral tortuous vein in both lower extremities, which worsens on the right leg, and decreased sensation in both legs.