What Causes Severe Leg Pain Despite Being Negative For Lyme Disease?
Possible Vascular disease of lower limb?Need confirmation.
Detailed Answer:
Hi Sir.
I understand your concern.
You possibly seem to have Chronic thrombotic venous disease/dvt of the lower limbs.
This can bring frequent pain both during rest as well as exercise.
This form of DVT is of high suspicion considering your age and frequent hospitalizations and history of CHF.
Lyme is extremely unlikely in presence of negative screen.
Lyrica is of no use in the current scenario.
I advise you to get an Duplex Colour Doppler study of both lower limbs,if any thrombus is detected,further action can be taken.
Further management with drugs like Low mol wt Heparin is based on test results.
Post your further queries if any.
Thank you.
Get B12 levels checked
Detailed Answer:
Hi Sir,
I understand your concern.
In case if many vein tests are negative,it usually points to neuropathic cause.
For this I advise you to get a Vit B12 and Vit D levels.
Low B12 levels will cause neuropathic symptoms.
A trial of Inj B12 1000 mcg once everyday for 7 days followed by Tab Methylcobalamin 500 mcg one tab orally daily for 3 months will help to improve the symptoms to a large extent.
Simultaneously tapering the dose of tab Morphine or Oxycodeine will help to reduce the restlessness or uneasiness which is a predominant side effect with their use.
Post your further queries if any.
Thank you.
HRCT lungs will throw additional light
Detailed Answer:
Hi Sir,
I understand you concern.
Chest related breathing symptoms can be thoroughly evaluated if you have HRCT scan of your lungs.
This can assess the degree of any restrictive lung disease.
CHF cannot be determined by angiogram alone.
You need FFR study and thallium scan of the heart to document accurate functional status .
B12 levels cannot be correlated based on community findings.
You need to have a blood screen for this vitamin in context of your leg symptoms to rule out this deficiency.
Thank you.
You take your chances every time you get out of bed in the morning. You could lesson those chances by preforming all kinds of tests, but then you'll be late for work??? They have done that already, been kicking it around for 6 years... But then, we don't measure time the same way, do we??? I'd like to see you converse with anyone, if you were sitting on my mushroom.... Ha
Tests are ordered to assess the stage of the pathology rather than time.
Detailed Answer:
Hi Sir,
I understand your concern.
Elevated red blood cell count in your case indicates secondary polycythemia.
This indicates chronic lung pathology usually.
Pathological process vary with time,hence its important for an appropriate and timely set of investigations.
In your case,possibility of cor pulmonale is high hence a repeat of investigations is logical.
Therauptic principles vary with both time and stage of disease.
Management protocols doesn't always solely depend on clinical picture of the patient.
Hence it is prudent to undergo the set of investigations I mentioned.
Post your further queries if any,
Thank you.
You are a brave man.
Detailed Answer:
Hi Sir,
Gone through your response.
Extremely disheartening to see that you have gone through this chronic rough patch in your life.
At the same time I would like to appreciate your courage in handling these issues.
You have been an awesome character and source of inspiration for many.
It is my honour to have a hand shake with you.
Thankyou
:-)
You are welcome Sir.
Detailed Answer:
Hi Sir,
Good to have you back.
Ultimate fools are the real tough ones to crack.
You are the Mountain Man.
Your philosophy towards life is unmatchable.
Take care Sir,
Have a Nice day.
Wishing you a great health.
Detailed Answer:
Hi Sir.
Good to have you back.
Yes obviously I and this entire team of HCM are at your health service.
I personally wish you a great health ahead without any limitations.
We are friends.
No apologies.
Thank you.