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What Causes Difficulty Swallowing, Mouth Ulcer Along With Swollen Limbs And Face?
Question: Respected Doctor,
I was suffering from face & limbs swelling, whole body pain and itching, skin rash, mouth ulcer, swallowing difficulty, restricted body movement( middle of July last). After no improvement by anti-allergic medicines, vitamins & anti-inflammatory/pain relief tablets rather conditions had gradually deteriorated. Several doctors(Medicine/Dermatology/ENT) have primarily suspected Scleroderma or MCTD/SLE. All pathological/biochemical/serological tests and whole abdomen USG were normal, RA was negative. All auto-immune tests turned out negative done three times in interval of 15 days. Only some mild low Hb%, huge Vitamin D deficiency, Eosonophil/ESR/Absolute Eosonophilic Count were very high and Serum Calcium deficiency. After suffering a lot for about 2 months in serious condition I was admitted in a Specialized Hospital(26.09.2014) and remained for 24 days. A group of doctors(Medicine/Neurology/Endocrinology/Dermatology/General Surgeon) have treated me by Pulse Methyle Pednisolone Inj I.V. 1g each for 5 days(30.09.2014 to 04.10.2014) then oral tablets of Prednisolne 40mg Tablet and number of medicines for Vitamin D, Calcium, Thyroid(Thyroxine 50mcg), Anti-biotic, Rehydrating Skin Lotion, anti-allergic tablets etc. Before treatment they had done Skin Biopsy & Muscle Biopsy. They have diagnosed it as Eosonophilic Facitis. Within 5 days I was almost recovered from all symptoms. Now I am taking medicines Tablet Prednisolone 30 mg OD, CCM 1000 OD, Esomeprazole 40mg twice daily, Calcirol Granules once in a week and after one month of treatment another Tablet Azoran 50mg OD(Azathioprine) added. At the time in Hospital, I had strong constipation/hard stool, had to put pressure for evacuation and was given laxative.
(a) After that a ball type semi hard lump in the end of rectum inside has developed( on about 15.10.2014). I am feelng problem during evacuation but stool is soft and normal. There is no pain but sitting is inconvenient. General Surgeon has checked clinically and then Flexible Sigmoidscopy was done. Nothing has been found in the rectum. But still I feel a ball type lump just above the anus inside of sprinter/rectum which is creating inconvenience at the time of evacuation and sitting on a chair/bed. The lump is very clearly felt from outside by putting fingers touch pressure at the anus of slightly left side.
(b) I have also strong bilateral shoulder pain and difficulty in shoulder flexibility/movement.
I earnestly solicit your advice for above two problems, also your comments for diagnosis/treatment done and advice for doses of the above medicines which I am taking presently.
XXXXXX, E-mail ID: YYYY@YYYY XXXXXXX XXXXXXX
I was suffering from face & limbs swelling, whole body pain and itching, skin rash, mouth ulcer, swallowing difficulty, restricted body movement( middle of July last). After no improvement by anti-allergic medicines, vitamins & anti-inflammatory/pain relief tablets rather conditions had gradually deteriorated. Several doctors(Medicine/Dermatology/ENT) have primarily suspected Scleroderma or MCTD/SLE. All pathological/biochemical/serological tests and whole abdomen USG were normal, RA was negative. All auto-immune tests turned out negative done three times in interval of 15 days. Only some mild low Hb%, huge Vitamin D deficiency, Eosonophil/ESR/Absolute Eosonophilic Count were very high and Serum Calcium deficiency. After suffering a lot for about 2 months in serious condition I was admitted in a Specialized Hospital(26.09.2014) and remained for 24 days. A group of doctors(Medicine/Neurology/Endocrinology/Dermatology/General Surgeon) have treated me by Pulse Methyle Pednisolone Inj I.V. 1g each for 5 days(30.09.2014 to 04.10.2014) then oral tablets of Prednisolne 40mg Tablet and number of medicines for Vitamin D, Calcium, Thyroid(Thyroxine 50mcg), Anti-biotic, Rehydrating Skin Lotion, anti-allergic tablets etc. Before treatment they had done Skin Biopsy & Muscle Biopsy. They have diagnosed it as Eosonophilic Facitis. Within 5 days I was almost recovered from all symptoms. Now I am taking medicines Tablet Prednisolone 30 mg OD, CCM 1000 OD, Esomeprazole 40mg twice daily, Calcirol Granules once in a week and after one month of treatment another Tablet Azoran 50mg OD(Azathioprine) added. At the time in Hospital, I had strong constipation/hard stool, had to put pressure for evacuation and was given laxative.
(a) After that a ball type semi hard lump in the end of rectum inside has developed( on about 15.10.2014). I am feelng problem during evacuation but stool is soft and normal. There is no pain but sitting is inconvenient. General Surgeon has checked clinically and then Flexible Sigmoidscopy was done. Nothing has been found in the rectum. But still I feel a ball type lump just above the anus inside of sprinter/rectum which is creating inconvenience at the time of evacuation and sitting on a chair/bed. The lump is very clearly felt from outside by putting fingers touch pressure at the anus of slightly left side.
(b) I have also strong bilateral shoulder pain and difficulty in shoulder flexibility/movement.
I earnestly solicit your advice for above two problems, also your comments for diagnosis/treatment done and advice for doses of the above medicines which I am taking presently.
XXXXXX, E-mail ID: YYYY@YYYY XXXXXXX XXXXXXX
Brief Answer:
MRI for anal swelling- Physiotherapy, Rx for stress, anxiety
Detailed Answer:
Hi Madam XXXXXXX
I can understand the plight you are going through.
Read and re-read the history and the treatment schedule you have received and already on it, noted all the problems you have mentioned and Particularly the ones you have asked an opinion for.
It is good that the multidisciplinary panel of Doctors have been working on you, so definitely they must have been doing the best for you.
The diagnosis, the treatment and the dosage of medicines look to be absolutely as per the requirements you have.
I can add a few more points which you have to discuss with your Doctors so that they can add-on if they feel necessary as they know your case in utmost details.
-Oral calcium - you must be already on it.
-Multivitamins with Ginseng.
-Banocide Forte (Diethylcarbamazine) for 21 days as on ''Empirical Basis) of 21 days course.
-Medicine like Albendazole +Ivermectin for intestinal worms again on empirical basis.
-You can take Vitamin A in therapeutic dose of 3 lac units. (if the tablet is of 30,000 units you need 10 tables) Continue Calcirol as you are already taking it.
-Since such a severe problem causes lots of mental tensions, stress and anxiety- a medicine for this may help
-As also an alternative therapy like acupressure or acupuncture. sometimes makes wonders.
Now as for your specific questions:
(a) Since a General Surgeon has examined you and Sigmoidoscopy has already been done, the ball like lump can be evaluated by MRI of the area. This may be due to excessive straining that a lump might have developed.
(b)Shoulder problem: you are already taking one of the strongest anti-inflammatory medicine- Prednisolone. Please discuss about whether you can be started on some anti-inflammatory medicine like Serratiopetidase or so. Actually it is better to have least possible as drug interactions have to be kept at the most minimum possible level, which your Physician thinks about.
-Physiotherapy should help you.
I hope this answer helps you to get a proper further treatment in addition to the one you are already taking. All the medicines you are on have been prescribed to you after careful evaluation of all the aspect of your disease-complex, so you have to take then as has been prescribed... Please feel free to ask for more or if you need further clarifications if you feel there is a gap of communication.
I will be really happy to assist you further.
MRI for anal swelling- Physiotherapy, Rx for stress, anxiety
Detailed Answer:
Hi Madam XXXXXXX
I can understand the plight you are going through.
Read and re-read the history and the treatment schedule you have received and already on it, noted all the problems you have mentioned and Particularly the ones you have asked an opinion for.
It is good that the multidisciplinary panel of Doctors have been working on you, so definitely they must have been doing the best for you.
The diagnosis, the treatment and the dosage of medicines look to be absolutely as per the requirements you have.
I can add a few more points which you have to discuss with your Doctors so that they can add-on if they feel necessary as they know your case in utmost details.
-Oral calcium - you must be already on it.
-Multivitamins with Ginseng.
-Banocide Forte (Diethylcarbamazine) for 21 days as on ''Empirical Basis) of 21 days course.
-Medicine like Albendazole +Ivermectin for intestinal worms again on empirical basis.
-You can take Vitamin A in therapeutic dose of 3 lac units. (if the tablet is of 30,000 units you need 10 tables) Continue Calcirol as you are already taking it.
-Since such a severe problem causes lots of mental tensions, stress and anxiety- a medicine for this may help
-As also an alternative therapy like acupressure or acupuncture. sometimes makes wonders.
Now as for your specific questions:
(a) Since a General Surgeon has examined you and Sigmoidoscopy has already been done, the ball like lump can be evaluated by MRI of the area. This may be due to excessive straining that a lump might have developed.
(b)Shoulder problem: you are already taking one of the strongest anti-inflammatory medicine- Prednisolone. Please discuss about whether you can be started on some anti-inflammatory medicine like Serratiopetidase or so. Actually it is better to have least possible as drug interactions have to be kept at the most minimum possible level, which your Physician thinks about.
-Physiotherapy should help you.
I hope this answer helps you to get a proper further treatment in addition to the one you are already taking. All the medicines you are on have been prescribed to you after careful evaluation of all the aspect of your disease-complex, so you have to take then as has been prescribed... Please feel free to ask for more or if you need further clarifications if you feel there is a gap of communication.
I will be really happy to assist you further.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Respected Doctor,
Thanks for your valuable advice. I have some more queries. (a) I already took Diethylcarbamazine 180mg for 21 days earlier after discharge from Hospital as per prescription. Should it be repeated ?
(b) Regarding Accupressure or Accupuncture, for what purpose it should be done and how it is done ?
(c) What is the brand name of the medicine for Vitamin A and dose.?
(d) What is the brand name of stress/anxiety relief medicine ? Is it Libotryp (Chlodiazepoxide + Amitriptyline Hydrochloride) once daily at bed time & Primosa 1000 Tablet(Evening Primerose Oil) once daily as doctor gave me at bed time but I am not taking for fear of interaction with medicines Steroid Tablet & NSAID Azoran Tablet ?
(e) How long I should continue Wysolone(Prednisolone) & Azoran(Azathioprine) Tablets ?
(f) Please Give me name of a very good multivitamin + Genseng Tablet/Capsule. Just 1 day back I have started to take Complete TD Tablet once daily(Antioxidants + Multiminerals + Multivitamins + Mecobalamine) as
OTC medicine without advice of my doctors.
I am eagerly waiting for your reply/advice once again please.
Regards & Thanks
XXXXXXX
Thanks for your valuable advice. I have some more queries. (a) I already took Diethylcarbamazine 180mg for 21 days earlier after discharge from Hospital as per prescription. Should it be repeated ?
(b) Regarding Accupressure or Accupuncture, for what purpose it should be done and how it is done ?
(c) What is the brand name of the medicine for Vitamin A and dose.?
(d) What is the brand name of stress/anxiety relief medicine ? Is it Libotryp (Chlodiazepoxide + Amitriptyline Hydrochloride) once daily at bed time & Primosa 1000 Tablet(Evening Primerose Oil) once daily as doctor gave me at bed time but I am not taking for fear of interaction with medicines Steroid Tablet & NSAID Azoran Tablet ?
(e) How long I should continue Wysolone(Prednisolone) & Azoran(Azathioprine) Tablets ?
(f) Please Give me name of a very good multivitamin + Genseng Tablet/Capsule. Just 1 day back I have started to take Complete TD Tablet once daily(Antioxidants + Multiminerals + Multivitamins + Mecobalamine) as
OTC medicine without advice of my doctors.
I am eagerly waiting for your reply/advice once again please.
Regards & Thanks
XXXXXXX
Brief Answer:
No need to repeat Diethylcabamazine...
Detailed Answer:
Thanks for your feedback and queries..
(a) Great to know you have already taken Diethylcarbamazine. Not, it should NOT be repeated.
(b) Acupressure / Acupuncture is done for equalizing Yin and XXXXXXX of your body to harmonize with each other. The person who is doing it should really be a master. (I do not know if someone is available at Siliguri) It does helps as a Naturotherapy. If the expert is not available you can try Yoga or Meditation too.
(c) Vitamin A is available as Aquasol A capsule. it may contain 30,000 or 50,000 units. Total dose is 3,00,000 units. Take accordingly you can take twice a day till stipulated dose is completed - like if it contains 30 thousand units take 1 capsule twice daily for 5 days.
(d) Please take Libotryp one at bedtime if you have been already prescribed by your Doctor/s. Evening primrose oil is the oil from the seed of the evening primrose plant. It seems to help decrease inflammation so please continue it. Do not worry as your Doctor has considered all the factors while prescribing such medicines.
(e) Continuation of Prednisolone and Azoran: please excuse me, the dosage, duration will be decided only by the treating Doctor considering all the factors of indication, requirement, effects etc. So please continue exactly as prescribed by your Doctor. Do no teven seach net for such medicines as you will unnecessarily get confused. Have full faith in your Treating Doctor/s. I hope you understand what I mean by this.
(f)Complete td is a fine combination-you may please continue with it at the moment. You can ask your Medical Store about the name of the multivitamin with Ginseng available with him, he surely will assist you.
Wishing you the best and permanent recovery.
Dr T Chandrakant.
No need to repeat Diethylcabamazine...
Detailed Answer:
Thanks for your feedback and queries..
(a) Great to know you have already taken Diethylcarbamazine. Not, it should NOT be repeated.
(b) Acupressure / Acupuncture is done for equalizing Yin and XXXXXXX of your body to harmonize with each other. The person who is doing it should really be a master. (I do not know if someone is available at Siliguri) It does helps as a Naturotherapy. If the expert is not available you can try Yoga or Meditation too.
(c) Vitamin A is available as Aquasol A capsule. it may contain 30,000 or 50,000 units. Total dose is 3,00,000 units. Take accordingly you can take twice a day till stipulated dose is completed - like if it contains 30 thousand units take 1 capsule twice daily for 5 days.
(d) Please take Libotryp one at bedtime if you have been already prescribed by your Doctor/s. Evening primrose oil is the oil from the seed of the evening primrose plant. It seems to help decrease inflammation so please continue it. Do not worry as your Doctor has considered all the factors while prescribing such medicines.
(e) Continuation of Prednisolone and Azoran: please excuse me, the dosage, duration will be decided only by the treating Doctor considering all the factors of indication, requirement, effects etc. So please continue exactly as prescribed by your Doctor. Do no teven seach net for such medicines as you will unnecessarily get confused. Have full faith in your Treating Doctor/s. I hope you understand what I mean by this.
(f)Complete td is a fine combination-you may please continue with it at the moment. You can ask your Medical Store about the name of the multivitamin with Ginseng available with him, he surely will assist you.
Wishing you the best and permanent recovery.
Dr T Chandrakant.
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Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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