Hello. I am inquiring for a friend. He is 67 and became officially diabetic in 2008 (began taking Metformin). In 2011, he had a CABG (4 coronary arteries blocked 60/70/80 & 90%), plus an 80% left carotid artery (surgery in Feb 2012 endarterectomy). March 2012, non-medicated stent placed in LAD (the 90% artery went to 99%, and scar tissue in one of the new bypasses was opened with balloon angioplasty). June 2012 total knee replacement (3rd revision since orig. in 1996). Spring 2013, complaining of chest pain, fatigue and tiredness in legs during cardiac rehab exercises (Nov 2012-Feb 2013). June 2013 more stents in LAD and other coronary arteries (2-3?). Follow-up to this surgery, still having pain in legs. Saw a vascular surgeon. Aug 30 2013 stent in abdominal aorta 80% on left, 56% on right blocked (artery to legs/kidneys, etc). Mid August 2013 started complaining about pain in shoulders, upper arms, forearm, wrist, predominantly left side. Did not seem to be heart-related since stents were added in June 2013. Currently trying to determine cause of pain. Diagnosed with carpal tunnel in both wrists in 2006, but only had surgery on the right arm. Pain in the left shoulders and arm is the worst at night, waking him up, during the day has trouble raising arms above his head without pain in shoulder joints. Pain is described as stiffness, soreness, cannot put weight on wrists to get out of chair, numbness, no burning sensations, some tingling. Most severe during the night when trying to sleep. Was also diagnosed with PMR (polymyalgia rheumatica) in Sept. 2006 and was treated with prednisone. Symptoms were relieved within one year. In the last 4-5 weeks, he has had the following tests: CT scan of abdomen (for the aorta to legs) (Mid Aug), balloon angioplasty with dye to place stent in abdominal aorta (Aug 30), X-ray of left arm/wrist, EMG on left hand (Aug 28), MRI of left hand w and w/o contrast (Sep 11)--these tests confirmed CTS of left wrist, and MRI revealed an unidentified (small) mass on palm side of left hand between ring and little finger (which he has had since at least 2011, but causes him no pain). He has had a CRP test, but I do not know the results. How high do the numbers have to be to confirm PMR?
My specific questions:
1. Should he have one of his doctors (cardiologist, endocrinologist, rheumatologist or neurologist) perform an ESR test ? Would it be that helpful since the CRP has been done?
2. How can he determine whether the pain is muscular inflammation, diabetic nerve damage/ CTS nerve stenosis, or blood vessel blockages/ inflamation in the shoulder, arm or wrist?
3. What is the saturation point for the dye tests?
4. What about peripheral neuropathy? He is diabetic. How soon can nerve damage occur in diabetics? (# of years before it occurs) What is diabetic nerve pain like? Is is sharp, numb, tingly, dull and throbbing, achey, what?
5. How can I help him understand that it is the highs and lows that cause damage on a cellular level-that it is critical to manage the highs and lows-to try to keep the glucose level in the blood as constant as possible, when his diabetic doctor wants him to keep a log (doesn't), take the blood sugar readings more than just am and pm (sometimes skips taking a blood sugar reading AT ALL), eat healthy foods, etc., and he is doing just barely the bare minimum, thinking he is doing a lot and all of it the right things- (It's never over 120 in the am or pm-HOW ABOUT DURING THE DAY WHEN YOU NEVER CHECK IT?!!!)
6. The hand surgeon wants to correct the CTS, but can't because my friend is taking CRESTOR or PLAVIX (not sure which, and neither is he), and will not operate on him without the cardiologist releasing him from the blood thinners, and he just had the new stents put in in June, so he says he can't operate on the CTS until June 2014.
So, if the CTS is causing the pain in the left arm, he can't get that fixed because of the blood thinner problem. The cardiologist says that he is so high risk of a heart attack or stroke if he were to take him off of them, that he is reluctant to do so, but he did June 2013 so that my friend could have an infected molar pulled by a dental surgeon. My friend tends to rely on the medications to manage his conditions, and does not incorporate the 30 minutes, 3 x a day exercise (other than the work he does at his job, which is physical) that we're supposed to do every week, or eat balanced, healthy meals to help reduce the plaques in his heart and arteries, or try to change his high-stress lifestyle. He is 3 weeks out from the abdominal aorta stent tomorrow 09/20, so has been feeling better on the leg tiredness.
7. We don't feel that the arm and shoulder pain is heart-related. How do we narrow it down? What other tests might be effective in finding out? What about a Nerve Conduction velocity (NCV) test? Could he have a partial blood clot in the brachial artery? Getting desperate for answers at this point. He has had the arm pain for at least 6-8 weeks. Also very concerned about contrast media. He has had a lot of dye in his system within the last 4 weeks, and is concerned about his kidneys (he had kidney stones in 2009/2010). How many times can you inject that medium safely? I know it builds up in the kidneys. I'm sorry for the length of this query, but I cannot ask his doctors since I am not family and do not have all the specifics of where stents are located, or prescription drugs being taken, etc., and because of the HIPPA regs. My friend is frustrated, and tired of talking to doctors, and being questioned, but I don't want him to give up trying to get back to a more normal life, where a discussion of his health isn't part of our every day conversations. Thank you for listening. What should he do next? He is seeing his diabetic doctor tomorrow morning. He wants to take steroids to see if they will relieve the arm pain ( a possible indicator of PMR if they relieve the pain), but the hand surgeon can't prescribe them without the cardiologist and the diabetic doctor approving them. So, that's where we are. Please help me SAVE HIS LIFE. Getting information for him is the only way I can contribute--whether he chooses to read or listen to that information is up to him. Once again, THANK YOU.