Brief Answer:
Lipoma pains only due to nerve entrapment and increased vascularity

Detailed Answer:
Hi XXXXXX,
Thanks for writing in to us.

I have read through your query in detail.
Please find my observations below.

1. CT scan is an excellent investigation to study lipomas.

2. Lipomas are well defined fat containing benign tumors which grow slowly and can be present any where under the skin. It is present as a soft swelling that slips under the skin.

3. 99 percent of lipomas will not cause any pain. However, a lipoma that is entrapping a nerve or that contains many blood vessels within can cause burning pain in the region of the swelling.

4. Sometime taking psychiatric treatment with anti depressants can cause increased pain perception. If you are having pain all over your body then it can be a side effect of medicines and you should talk to your psychiatrist. However, if the pain is confined to the lipoma area then it is to be seen if there are nerves getting trapped of increased vascularity in the lipoma.

5. If the lipoma is just under the skin and medium sized, you can consult a surgeon and get it electively excised. It is a small surgery and has positive outcomes.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Request more details

Detailed Answer:
Hi XXXXXX,
Thanks for writing back with an update.

I would like to know some more details
1. Do you work for long hours without taking meals at proper time and also skipping meals. This can cause severe gastritis and gastroesophageal reflux disease.

2. I have worked in a psychiatry institute as a Radiologist for 3 years and am familiar with de addiction and psychiatry medicines. Can you please give me complete details of your psychiatry medicine and how you stopped smoking.

3. If possible, you can send me scan images of angiography CT scan available on CD. A CT scan angiography contains about 200 to 500 images in DICOM format which are medical standard images to be seen at the workstation. I have the software and workstation setup at my end. You can upload your raw images (all the files in the CT CD provided by your hospital) to a file sharing facility like Dropbox and send me the download link. That way I can have a detailed look at all images and tell you if the lipoma is visible on angiography CT.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Please find details below

Detailed Answer:
Hi XXXXXX,
Thanks for writing back with an update.

1. Having seen your angiography images, there is no problem concerning the heart. However the lipoma is not visible on the CT scan.

2. Your psychiatry medicines are unlikely to cause the chest burning. D Veniz might increase blood pressure in some patients taking it. It is important to know if your blood pressure was 160/ 120 mm Hg before or after taking D Veniz. Please discuss this point with your doctor as it is important.

It is suggested that you get your blood pressure medicines reviewed after every 3 months. Blood pressure should be measured after 30 minutes of rest and when the mind is at peace. Please do not rush to your doctor and get blood pressure measured. This can give false high reading.

You can also purchase a blood pressure measuring electronic machine and record your blood pressure every day in morning after 30 minutes of rest. This will give you accurate measurement. Avoid taking extra salt in your foods.

3. Coming back to the chest pain and burning, gastritis can still be one of the reasons why you are experiencing it. The lipoma can be the cause only if the pain is around the lipoma swelling. You have earlier written than the lipoma is in the back and your also have chest burning in the front in the front and therefore it will be wrong to say that the lipoma is causing chest burning in the front.

4. To prevent gastritis please do the following
(i) Take small meals regularly and avoid fasting for more than 4 hours.
(ii) Drink adequate amounts of water and fluids.
(iii) Reduce amount of spices and oils and eat home cooked food.
(iv) If you have spicy food occasionally then please have curds

5. If your chest burning increases more then please consult a gastroenterologist and get upper gastrointestinal endoscopy done.

6. Please consult a surgeon for the lipoma and take a clinical opinion.

7. Remain stress free and do not worry that you have any serious disease. Consult your doctors regularly and take precautions. Please do not forget to discuss about whether you should continue D Veniz because of hypertension.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Please keep your mind free and you do not have any serious medical problem

Detailed Answer:
Hi XXXXX,
Thanks for writing back with an update.

1. I have had many patients who have physical symptoms due to anxiety. Since your CT angiography is completely normal therefore there is no reason to worry about any heart related disease. Psychiatric disease does not mean a mental problem. Even thinking too much and unable to concentrate is a situation that can be improved with psychiatric medicine. You can also include 30 minutes of yoga every day in the morning to keep your mind free.

2. Psychiatry medicines need to be taken for at least few months to know response. Please follow up with your psychiatrist and tell them about your symptoms even if they seen small. The chest tightness will slowly improve with treatment. Please do not stop taking medicines without first discussing with your psychiatrist.

3. It is good to know that you have an electronic blood pressure monitor with you. You should record your blood pressure at the same time of the day and write it down in a diary. This will help to know any significant fluctuations in blood pressure from time to time.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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