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HIV positive, suffering from burning foot pain, chronic migraine and diarrhoea - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: HIV and AIDS
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2582 Questions
User :   I suffer from burning foot pain in both my feet, chronic migraines, chronic diarrhea, Fatigue, insomnia. loss of balance, lack of concentration and short term memory loss
Doctor :   Hi
User :   hi
Doctor :   I am Dr. XXXX
Doctor :   Let me read you query first
User :   ok
Doctor :   Give me a minute
Doctor :   I have few questions for you in this regard
User :   ok
Doctor :   What is your age, gender?
User :   49 male
Doctor :   Do you have any specific medical conditions?
User :   I have hiv, but my counts have always been good,
Doctor :   Ok
Doctor :   Are you on ART? If so Since how long you have been on treatment and what is the treatment?
User :   yes , since 1997
Doctor :   What medicine are you taking because on chronic use some medicine can cause side effects
User :   truvada and keletra, gabapentin, hydromorph contin, oxy contin
Doctor :   Do you have Diabetes, High Blood pressure, any psychiatric disorder?
User :   no
Doctor :   Since how long are you on gabapentin, hydromorph
User :   my last nuerologist , she was the fouth diagnosed my as post concussion syndrome
User :   about 2 years now for the meds
User :   since this all started
Doctor :   Ok
Doctor :   Did you seek a doctor's opinion on this problems?
Doctor :   Long term use of the above medicines can lead to addiction and the above problems you mentioned
User :   yes but they cant give me answers, they just keep medicating the symptoms,
Doctor :   Ok
Doctor :   I need more time to be able to assess you
User :   ok
User :   at the start of all of this I had vertigo, fainted twice. I also suffered from conjuntivitis about six times over several month
User :   the pain in my feet and head is unbearable. the pain in my feet is alot worse at night although walking distances is a problem
User :   I was quite active before this, walking 20km around a park for exercise and also spent an hour a day at the gym
Doctor :   Do you think your prolonged exercise causes local injury or aggravated the problem
Doctor :   of burning sensation in the foot
Doctor :   or soles?
User :   I dont think so,
Doctor :   There is an entity called plantar fascitis which cause similar symptoms
Doctor :   The second thing is the long term use of HIV medicine can cause peripheral neuropathy
User :   but what about the migraines and vertigo they all started together. I had photophobia and phonophoba for over six months at the start of all of this, I spent 2 weeks in hospital while they ran tests
User :   I cant walk a straight line heel to toe and get jumpy legs
Doctor :   Was an MRI done?
User :   yes nothing was found
Doctor :   What is your hemoglobin?
User :   it is all good, except once my platelets took a dive to 0000
Doctor :   Ok, What is the HIV viral count
Doctor :   or the CD 4 count done in the recent date?
User :   undetectable always has been
User :   and cd4 is alway over 500
Doctor :   Ok good
Doctor :   I now think of only two reasons
Doctor :   1) Problem in the higher centres of the CNS that is brain
Doctor :   2) Long term medicaiton use
User :   what could the problem in the brain be, how do I explain this to my doctore
User :   the pain is really driving me to thoughts I dont want to think
Doctor :   Which pain?
User :   the foot and the migraines
User :   migraines are daily
Doctor :   Ok if these are problematic
Doctor :   The doctor usually adds prophylactics for migraines
User :   we have tried , topiramate and nadol
Doctor :   I also suggest you to consult a Neuropsychiatrist who can give few imputs
Doctor :   There are different medications some may not suit you
Doctor :   It takes some time to exactly know which is best for you
Doctor :   So a close follow ups shall do good
User :   we tried all the normal migraine ones as well, like maxalt,
User :   they also tried amytriptiline
Doctor :   Ok
User :   Ok well , I guess you too are at a loss for it
Doctor :   There are others like Kepra, DepaKot
Doctor :   Changing the medicines is the only way you can go about
User :   I am just tired of all the meds I have to take , just to take the edge off
Doctor :   Ok the natural measures
Doctor :   Yoga, Meditation
Doctor :   Migraine diary
Doctor :   Food restrictions
Doctor :   Are these done?
User :   yes
Doctor :   Observing the factors that aggravate the migraine
User :   even relaxation and accupunture
Doctor :   Yes
Doctor :   these should help
User :   if I get to sleep the migraine wakes me
Doctor :   Did you enquire if any one is doing migraine surgery
Doctor :   They split the muscles
User :   I have never heard of it
Doctor :   and break the tension developed in the muscles
Doctor :   There are specific neurosurgeons who are practisiong
Doctor :   very few
User :   one neurologist suggest botox, but it was never follow up on
User :   ok , I am in XXX, I take it you are in the states
Doctor :   Botox why is not tried
User :   only one neurologist suggested it , and I moved provinces
User :   and none of the new ones felt it was an option
Doctor :   Then before the surgery you can try botox
Doctor :   But it is not one injection
Doctor :   the effect may wane away in few motnhs
User :   yes I know
Doctor :   so you need one more again
Doctor :   The injection is given at the most frequent site
Doctor :   even the surgery is done likewise
User :   and for the burning foot pain?
Doctor :   Make sure you wear proper shoe or foot wear which does not aggravate the problem
Doctor :   There are Orthotic foot wear that help you
User :   ok
Doctor :   Gabapentin should help
User :   it doesnt
Doctor :   if it is not, change of dose or change of medicine
Doctor :   is the other alternative
User :   i am on the highest dose
Doctor :   Ok add another medicine is the alternative
User :   for example?
Doctor :   like other Neurontin with the help of your treating doctor
Doctor :   Carbamazepine is the other alternative
Doctor :   you can discuss with your doctor
User :   ok thank you.
Doctor :   My advice is to consult a Neuropsychiatrist also
Doctor :   if he has some inputs
Doctor :   after examining
Doctor :   Not Neurologist but a Neuropsychiatrist
User :   yes I understand
Doctor :   Some psychiatric component can also have similar symptoms
User :   really
User :   and they would just come on
Doctor :   yes
User :   ok I will show this to my doctor and see what he says
Doctor :   Ok I know you have lost patience
Doctor :   but there are few options left
User :   I hope so
Doctor :   I also suggest you to continue on Meditation / Yoga
Doctor :   for life time
User :   because I cant live like this
Doctor :   Breathing techniques have far more beneficial effects
Doctor :   than adverse
User :   I am practically a shut in,
Doctor :   So the lifestyle modifications, medications, alternative therapies all should set in
User :   other than dr's appts I dont leave the house
Doctor :   and it is a holistic approach
Doctor :   In fact I suggest you not to confine home
Doctor :   Do some gardening work with proper protective wear
Doctor :   Take joy in enjoying the nature
Doctor :   If you cannot go out, make your mind serene and calm
Doctor :   Relax in your chair
Doctor :   think as if you are on a beach and sipping a drink
Doctor :   These are imaginery
Doctor :   You can think about smelling a rose
Doctor :   These are absolutely practical
Doctor :   Only it needs patience and time
User :   ok, I have been in one position too long I need to move around, thanks sincerely for all your help
Doctor :   Pleasure here
Doctor :   Think of me if you need some help and want to speak to a professional
User :   ok thank you
Doctor :   Bye for now
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