Is it normal to have cutting like pain in and around veins while suffering from Dercum's disease
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Hello Doctor. Over the last months my Dercum's Disease symptoms have increased dramatically. In the process I have had around 2-3 doctor appointment each week and getting some help. However, with my confusion of symptoms I have not had hands on medical examinations. I have mentioned my concerns about pain and exhaustive fatigue in my calves and thighs, and that I have very unusal cramping with some permanent feeling of cramping despite a comparative flexibility and magnesium... supplementation. With this is cutting like pain in or around veins, which I have wanted to assume is related to tiny lipomas. I can tentatively pinch them, but to touch them softly aggravates a sharp, cutting like pain. There are many of these posts in my calves and a number in my thighs (more inner than outer). I have had varicose veins since age 16. I am now 57. My varicose veins were 'cut n stripped' when I was around 30 in the wishful search to reduce sciatic (firey, burnign pain) present since age 16 as well. I had been told that I did not have varicose veins despite no physical examination in front of my wife - not that I was worried about them. When I has the varicose opp it was a stab in the dark, and another 2 years before I was diagnosed with Congenital Lumbar Stenosis from L1-L5. My Dercum's has been 'present' for 20 yrs - not the issue in this discussion that I can now tell. Anyway, my varicose veins have worsened again over time - only an occassional painful fatigue problem from them depending on general symptoms... Recently all these leg symptoms started and in the last 3 weeks I have some issues with being able to drive any distance due to the very rapid change in my calves. I mentioned this to my Doctor yesterday - without an examination - and we agreed to balancing my narcotics which I take with an antihistamine as it can be quite awkward with public itching. Now, the venious issue seems to be becoming distinguished from any suggestion of lipomas being at the root - I am personally am not sure of anything I say, just reporting as best I can. Bruising is popping up, and longer redishness along veins, with some disolouration of ankles and change of skin appearance; swelling due to ultrasounded plantar facitis and previous celulitis (due to one garden item I knocked across my shins). The symptoms such that I have put on stockings. I hope you can trust that I am somewhat objective and not merely stressed. I am tired of a beggarly posture for medial help, but will go to local GP tomorrow, but may not get 'my' regular GP. It is getting very discouraging (please do not think depression is driving these remarks) because I cannot keep telling my wife that there is something wrong. I do not want my children to remember me for health issues. What i find is that I feel guilty for taking a doctor's time. I get the issue as I am a very competent, though unemployed, pastoral counselor who 'gets' people, health, and mental health so quick that people open closed doors to me when I present myself to care for them. i think I cloud the complexity of my symptoms. All of my doctors accept that I have Dercum's Disease. I am HLAB27 positive. I have an 18 months wait for an appointment with a Rhematologist, who is unlikely to have heard of DD but would find it hard to avoid - not that the GP would have suggested it to him in letter; I do not have gross deformed lipomas and only a few bigger ones stretching 20 cm with larger masses - 23 excised today from marble to thumb size, etc. Back to veins, I am partially dumbed to them because of the narcotics, but the sharp, pinching pain and the cramping seem there to stay. See i have got myself lost so will just ask that you please help me break this down so I can talk to my doctor and get investigation to avoid DVT (have has a couple - shown up as old DVTscar or something on ultrasound - there another example of why did I have that ultrasound and for what - I cannot track these things, let alone have my GP stay on top of one of hundreds of patients and his ??? Oh my other GPs: one for pain management; one for surgery of lipomas; one, a uni lecturer specializing in muscular-skeletal, who I saw for 2nd opinion on complexity of pain - he said from my files I got from pain doctor that I could not get a better pain Dr. All have said that I did not have key hole surgery for my stenosis as I was told since I have an 8 inch zipper... I think that is all I can regurgitate and both apologize - you really do not need to comment on the more personal aspect of this email. Thank you and please in the same breath.
Posted Mon, 6 Jan 2014 in Medicines and Side Effects
Answered by Dr. Shafi Ullah Khan 15 hours later
Brief Answer: Multidimensional confused history, needs a plan Detailed Answer: hello There Sir! My name is Dr. S Khan and i would try to answer your multifactorial troubles and try to guide you what is best for you. I read your concern about your decrum/Adipose dolorosa , your DVT issues, Your spinal stenosis issues, and all other essay of symptoms you presented yourself with are allied to these three major troubles which are followed by an extreme bout of depression and denial of that.Superseded by your geriatric age limits and a history of interventions you had with surgeries and medicines. Sir i want you to know that your troubles need to be addressed one by one. 1) DVT/ Varicosities. As you said your Varicose veins recurrences with DVTs presence and all the bruising and colour discolouration needs a very good Endovascular surgeon, Interventional radiologist and haematologist to keep your Blood profile at a pace friendly to DVT and alot of manuevers like Heparin,Factor Xa Inhibitors,Management of Complications of Anticoagulant Therapy ,trying Emerging Anticoagulant Agents, Pharmacologic Thrombolysis, Endovascular Intervention ,Surgical Thrombectomy, Placement of Inferior Vena Cava Filters, Replacement of Venous Valves, Use of Elastic Compression Stockings,Ambulation etc or you might end up with an embolus. so my advice, seek help for that before its too late. 2) Now the Adipose dolorosa/ Decrum: As it is a genetic disease not much can be done about it except controlling its symptoms with agents like 20 mg prednisone daily, Traditional NSIAIDs, Intravenous Lidocaine injections 400 mg over 15 minutes every alternate day, oral mexiletine, interferon alpha 2b, infliximabs, methotrexates etc. With focus on weight loss and fatty diet avoidance and Liposuctions and excisions when necessary. You will need a constant touch with a chronic pain management specialist for that to stay out of pain.And for that you need a triad of psychiatrist, rheumatologist and endocrinologist. 3)Severe psychiatric Issues: Despite your denial , your way of communication is an utter explanation of your Stress and anxiety and trust me you need a lot of psychotherapy sessions with a good psychiatrist, sign up to some group discussions and let it out man, There is nothing to shy about and no good comes from hiding it like you are hiding from your wife or what people will say. what matters the most is you and you should know that. 4)Now the spinal stenosis: you need a lot of work for that including medicines like NSAIDS, muscle relaxants, membrane stabilisers like gabapentin, Antidepressants, analgesics and steroids and a lot of physical therapies and Epidural steroid injections and Surgical de compressive surgeries if necessary. SO what have you been waiting for ? seek neurologist help and lets see what option comes best for you. But the age of 57 may be an issue here and i am afraid conservative approach be the better one for you. Hope you see the barrage of complications and multi dimensions of your illness here, Trust me this was the best i could or any one from XXXXXXX i believe could come up with. You should know that you need not a single GP but a team which should consist of all those specialties i mentioned above and then we can expect some thing fruitful. Starting with number one to reaching number 4 one by one will get you through eventually. It needs a lot of endurance and perseverance. so Hold your horses and hang on there buddy. Help is on the way waiting for you. Go get it before its too late. Good luck and take some very good care of yourself. If you have any more queries please feel free to ask other wise i request you to kindly close the discussion and rate the answer as per your experience. May the odds be ever in your favour. Regards Dr. S Khan
Follow-up: Is it normal to have cutting like pain in and around veins while suffering from Dercum's disease 2 hours later
Dear Dr XXXXXXX your reply was quite confrontingly honest and refreshing. I did get to my GP and he did look at my veins and said that they were very convincingly Phlebitis. It took me to email you and tell my wife (again) to clarify that I go into the Dr surgery in short pants and thongs. I am very grateful for the clear information you have provided and have printed it off. I am particularly grateful that you outline 4 steps to take one at a time. That is so simple and obvious, and really helps me with the perspective I have been looking for. Thank you for weighing through my barrage of communications to help me gain and keep perspective on the 'barrage of complications and multidimensions' of my illnesses. Your kind frankness is really very refreshing and has me smiling with that sense perspective. Sincerely, XXXXXXX XXXX
Answered by Dr. Shafi Ullah Khan 9 minutes later
Brief Answer: Appreciated by my patient, Dream of my life! Detailed Answer: Mr. XXXXXXX XXXX! Want to thank me? Take some very goo care of yourself and keep me updated about your followups. You are my patient too now and My patient is My family. Have a very good rest of your day with all coming days ahead of you.I will be here for you. Kindly don't forget to close the discussion and rate the answer as per your experience. Pleasure to be of help. Yours sincerely Dr. S Khan
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