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Suggest Treatment For Severe Pain Caused By An Injured Blood Vessel

Posted on Fri, 23 Oct 2015

Question: My 89-year-old father has type II diabetes (under control with an insulin pen taken before each meal), froze his feet in WWII and suffers from arthritus. He recently took treatment from a chiropractor for a slipped disk in his lower spine which was pinching a nerve causing pain going down both legs. The slipped disk was corrected and that pain has subsided. However, during the treatment, he was asked to roll over on his left side. When he did, excruciating pain shot down his left leg and the chiropractor had to help him roll over to his back. Within three days, he had a purplish mottled rash (looks like broken blood vessels) develop from his left hip to his knee throughout the outside of his left thigh. Within another couple days, the rash spread to the inside of his thigh. An x-ray was taken revealing extensive arthritis in the hip, but no broken bones. The leg is stiff, hard to move and he is in constant pain. He is scheduled for an MRI this Friday. What could be the cause?

Answered by Dr. Praveen Jeyapathy (1 hour later)

Brief Answer:
Injured blood vessel likely

Detailed Answer:
Hello. Thanks for writing to hcm. Noted the contents. Its likely that your father has suffered an injury to the blood vessel. The fact that it spread over the next few days involving the outer and then the inner thigh suggests that the extravasation of blood would have travelled between the partitions of the muscle groups of the thigh over that time. However in view of age it would be good to get his complete blood count including coagulation profile and liver function test as this seen not commonly. The pain in the back radiating downward however suggests a sciatica kind of pain which involves the spinal nerves originating the low back area called the lumbar area for which an MRI is invaluable. You can try some ice packs for now to help facilitate the resolution of the bleeding as for now. It might take about three weeks though. I would like to know what other medications he is on if that is possible. Warm regards.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Praveen Jeyapathy (11 hours later)

Dad had a triple bypass heart operation when he was age 80 and has been doing well since then. No stints were used - only blood vessels to bypass the blockages. However, he has been on an aspirin regiment since the operation.

I also forwarded a PDF of his prescriptions and over-the-counter medications.

Answered by Dr. Praveen Jeyapathy (2 hours later)

Brief Answer:
Noted

Detailed Answer:
Hello again, Noted the reports and the pictures. I would suggest you reconsider the dose of aspirin. 325 mg is not essential in his case. That in itself can cause superficial blood vessels to rupture due to trivial trauma. A dose of 100 mg-150 mg is enough/day. Elderly patients have very friable vessels and are prone for bleeding. The large echymoses on the thigh should settle in 2-3 wks provided you come down on the dose of aspirin according to my opinion. Regards.

Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar