Suggest Treatment For Pain And Swelleing In Arms And Lesg Due To Neurological Issues

Posted on Sat, 22 Mar 2014

Question: Dear XXXXXXX Sir (Bhaiya), I am one of your junior from KV-2. I am writing this message in regard to need of consultation for my mother who lives in Bokaro and having some neuro problem (it appears). She is going through some treatment in Bokaro and over time, doctor has changed medicines...It helps when she is taking those medication, but gradually effect of medicine is slowing down. Until last year she was fine. Suddenly, she started getting sudden pain in her hand/arm, leg/feet and sometimes there is swelling. She can barely lift her hand when there is pain/swelling.. or walk when she has pain/swelling there. The pain/swelling sometimes increases when she takes nap during the day. But things get normal, after one or two days.. and then stay normal and then she gets these attacks again and again. The affected areas are generally either one of the knee, elbow, feet, leg/arm, fingers... Sometimes it starts at one location and keeps moving to different locations. Pain at one location ends and pain at other location starts. I hope to hear from you soon. I live in Boston, USA, and I thought this website to easy to pay for the consultation. Thank you so much for your help. Warm Regards XXXX

Answered by Dr. Sudhir Kumar (12 minutes later)

Brief Answer: Correct diagnosis needs to be made. Detailed Answer: Hi XXXXXXX Nice to hear from a fellow KVite! Thank you for sharing your mother's problem. I have noted her complaints over the past year and have also seen the long list of medicines tried on her. The success of treatment would depend on the accuracy of diagnosis and the correct medications. I am not sure whether the disease has been accurately identified or not until now. A clinical examination followed by certain investigations would help us to make a diagnosis. As of now, I need information on the following: 1. Blood pressure, and use of any BP medications, 2. Blood sugar level, 3. HbA1C- which gives the average blood sugar level over the past three months, 4. Thyroid profile 5. Serum vitamin B12 level, 6. Serum vitamin D level, 7. Hemoglobin level, 8. Serum creatinine 9. Liver function tests (LFT) All above (2-9) are simple blood tests and can be done at Bokaro. If the results are available, please upload them, or otherwise, ask them to get them done and then send them to me. I am sure she would improve with correct medications. I hope my reply has helped you. I would be pleased to answer, if you have any follow up queries or if you require any further information. Best wishes, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (25 hours later)

Dear Dr. XXXXXXX My apologies if it is more than one response to your email. I thought I sent you message today. But it is not showing up here, I am wondering if it didnt go through. First of all thank you so much for your response. My mother is getting all the blood test done which you suggested. My parents have received few results though verbally right now, they will get official report once all the test results are back. Here are the current results available. Blood pressure: 90/130 Hemoglobin: 9.0 Serum Creatinine 0.8 LFT: One test SGPT has value 77. Since, SGPT came very higher than normal, I wanted to ask if there need to be further test done, or we will have to wait for other results. Thank you so much for your help. Best Regards XXXX

Answered by Dr. Sudhir Kumar (2 hours later)

Brief Answer: My reply is below. Detailed Answer: Thank you for getting back with some reports. Among these, two are abnormal. First is low haemoglobin, a condition called as anemia. For this, she should be started on an iron supplement, such as LIVOGEN tablets. She can take one tablet in the morning after breakfast for one month. Second is elevated SGPT, which suggests inflammation of liver. This can happen due to pain-killer medicine use, however, we should exclude other causes. Additional tests required for further evaluation of liver are: 1. Ultrasound scan of abdomen, 2. HBsAg 3. HCV antibody The last two are blood tests to exclude any viral infection of the liver (viral hepatitis). I hope it helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (9 hours later)

Dear Dr. XXXXXXX Thank you so much for your quick response. I have asked my mother to have all the other tests you have mentioned. Few things I wanted to ask you: 1. Regarding iron supplement. When I told my mother that you have prescribed iron supplement. She was worried about constipation as it seems few months back when she was taking some iron supplement, she had huge constipation issue. Hopefully, this wont be case with Livogen. But if you have any suggestion if this is the common problem with iron supplement that will be great. 2. My mother has been in lot of pain for last 20 days. She is taking those medicines which I mentioned in my first message. However, every day she gets this huge pain in some part such as last two days, it was feet, back of the feet. Even after taking pain killer, the pain subsides only after 3-4 hours. It seems like pain has been quite intolerable for her. Also, wherever it swells, by applying little pressure there, there is release of gas (burp). I wanted to mention these as these could be helpful in diagnosis of problem. 3. I wanted to mention that my mother does not have gal bladder (my apologies I forgot to mention in my first message to you). Her gal bladder was removed almost 11-12 years ago because of stone problem. Also, she had vomiting yesterday afternoon. Before yesterday, it seems she had vomiting 10 days back. In between she had some digestion issue, lot of burps.. and all food coming in the mouth.. but she told that has gone better in last few days. 4. Lastly, I wanted to ask you if you have advice for any food to be taken/avoided. On another note, I wanted to mention, my sisters and I (we all are your juniors from KV, my sisters are XXXXXXX bhaiya's batchmate) appreciate your help very much. Thank you Warm Regards XXXX

Answered by Dr. Sudhir Kumar (7 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: Regarding your queries, my replies are below: 1. Yes, constipation is an issue with iron supplements, but I hope it would be less with livogen. In any case, iron supplements are required. If she gets troublesome constipation, then, syrup Cremaffin 30 ml can be taken at nights. 2. I have noted her other symptoms. 3. There is no specific food, but generally, she has to avoid spicy/oily food. Also, she should not skip meals or delay her food. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (8 days later)

Dear Dr. XXXXXXX My mother has got all test done.. I am sending pdf of all the documents (with picture of CTscan) in your account at YYYY@YYYY . Also, below I have added summary of that report. In general, Patient (my mother) feels very weak. She is taking the iron supplement regularly. She gets cramps in leg.. (in hindi: she says: pair khichna..)..She has stopped taking the other medicine which she was taking before (as I mentioned in my first message). These days she gets some pain but has not been too bad. Also, we heard from Dr. XXXXXXX that when you visit Bokaro, you see patients.. I wanted to ask if you have plan of visiting Bokaro and if yes, where do you sit so that my parents can get appointment. Also, what is the best way of getting information about your visit to Bokaro and seeing patients so that my parents can try to get appointment and meet you in future as well (if they are in need of medical attention). Here is summary of the report: 1. Ultra sound scan of Abdomen: a) Liver: normal size - 143mm. No focal space occupying lesion is seen Liver parenchyma is of moderately increased echogenicity, Intra hepatic biliary channels are not dilated.Common bile duct 1s normal rn s1ze - 4 mm. Portal Vein is normal in size - 12 mm GALL BLADDER: . "Gall bladder is normal and distended. Lumen is echo free." "Wall is not thickened. No calculus, mass or sludge." "PANCREAS:" "Appears normal in size and echotexture. No focallesion is seen within pancreas." "SPLEEN:" "Spleen is normal in size- 94 mm. No focal or diffuse lesion seen. KIDNEYS:" "Rt. Kidney is normal measures- 90x34 mm. Echogenicity is normal. Cortical thickness is normal, Corticomedullary demarcation·is intact." "Pelvicalyceal system is not dilated. 1" "Lt. Kidney is normal measures- 91x40 mm. Eclilogenicity is normal. Cortical thickness is normal, Corticomedullary demarcation is intact." "Pelvicalyceal system is not dilated ." URETERS: Both ureters are not visualized at the time of scanning: URINARY BLADDER: Normal distended UB is noted. There is no evidence of any vesicle or SOL. Wall of UB is normal. PVRU -insignificant. UTERUS: OVARY: Anteverted Normal in size. No sac or mass is seen. Measures- 56x33x42 mm. Myometrium is of homogenous echotexture Endometrium is not thickened ET- 4 mm. Rt ovary size - 26x13 mm, Lt ovary size -18 x 14 mm. No collection in POD. Adnexae are free. RETROPERITONEUM : There is no evidence of any lympho- adenopathy. No free intraperitoneal fluid seen. No significant finding in RIF. IMPRESSION ; Moderate Fatty liver. ***** HBsAg : Negative "Haemoglobin (Hb)" "9.5" "gm / dL" "Blood Sugar Fasting" "87" "mg/dl" "Serum Creatinine" "0.8" "mg/dl" "Liver Function Test-" "" "" "" "Serum Bilirubin (Total)" "0.7" "mg/dl" "Serum Bilirubin (Direct)" "0.5" "mg/dl" "Serum Bilirubin (Indirect)" "0.2" "mg/dl" "Serum alkaline Phosphate" "11" "K. A. uts" "·serum G.P.T" "77" "U/L" "SerumG.O.T" "39" "UIL" "Serum Total Protein" "6.9" "gm/dl" "Serum Total Albumin" "4.3" "gmldl" "Serum Total Globulin" "2.6" "gmldl" ****** "Vitamin B-12 (Serum)" "712.45" "pg/mL" "ELISA" ******* "Hepatitis C Virus Antibody.,(HCV) Screening" : 0.19 "Methodology : ELISA" "Specimen : Serum" ******* "Vitamins D3": "24.75" ng/ml "25 Hydroxy (OH) VitD,Serum by EIA" ******** Serum Hormone examination "Total Tri-iodothyronine (T3)" 1.24 ng/mL" "(ECL)" "Total Thyroxine (T4)" "12.31 neuIg/dl" "(ECL)" "Thyroid Stimulating Hormone (TSH)" "1.49 neulU / mL" "(ECL)" ****************** "BIOCHEMICAL EXAMINATION" "GLYCATED (Glycosylated) HAEMOGLOBIN" "Haemoglobin Alc" "=" "6.5 %" Thanks XXXX

Answered by Dr. Sudhir Kumar (9 hours later)

Brief Answer: Reports are mostly normal. Detailed Answer: Thank you for getting back with all the reports. I am glad to note that they are mostly normal. In addition to low haemoglobin, she has mild vitamin D deficiency. Cramps could be related to low calcium levels. In addition to liven, she should start: 1. TAB. TAYO 60 k once a week for six weeks (these are vitamin D supplements). 2. Tab. Shelcal (Gemcal) 500 mg once daily in morning for six weeks. (these are calcium supplements) 3. Livogen should also be continued for six weeks. Calcium may cause constipation in some people. Then, syrup duphalac 30 ml can be taken at night. Please review after six weeks with her health condition. I used to visit Bokaro earlier, however, I have been unable to do that in the last 4-5 years due to lack of time. If I plan, I will let you know. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (37 hours later)

Dear Dr. XXXXXXX Thank you so much for your response and suggestion on medication. I am still not clear why those pain had happened or is happening (though little less than before).. All the results seems normal. Then why she has been suffering this much. Is it just due to deficiency of Vitamins/Iron etc? or there is something missing....I am assuming all tests which could lead to potential cause of problem is done.. I am curious what is the reason of all intermittent severe pain and swelling. Also, I wanted to ask what is the meaning of moderately fatty liver which came in the CT Scan? If you saw the CT scan report (in pdf in your email and also in the message above)... Thank you so much for willing to let me know when you visit Bokaro.. Thanks. Best Regards XXXX

Answered by Dr. Sudhir Kumar (28 minutes later)

Brief Answer: You are right. Detailed Answer: Thank you for getting back. Yes, the deficiency of iron and vitamins is leading to pain and swelling. There are no other causes to be looked at, as we have completed all investigations. I noted the fatty liver, it is grade I and does not indicate any liver disease (it is a normal finding). In any case, we have done all other tests for liver and they are normal. She would feel better in 4-6 weeks. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar