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Dr. Andrew Rynne

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Suggest alternate over the counter medication for Lansoprazole

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Dr. Geeta Sundar

Internal Medicine Specialist

Practicing since :1975

Answered : 1329 Questions

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Posted on Mon, 3 Apr 2017 in Veins and Arteries
Question: Hi guys, good night to everyone one on-line tonight. I know must of you are there to be paid but the thing is that I have a challenge from you all, all specialties and specialists out-there because so far in about 6 years nobody has an answer for what I have and I continue with that going worst. So I will introduce everybody to what's going on I will let my email and if any of you have 5 minutes to think in it, please let me know my choices. Feel free to recommend me any colleague to whom I might consider my next step. Ok here we go:
About 6 years ago suddenly I started a burning itching in my both heels, slowly went up to the legs, then to the thighs then to the hips and even a little more where the belt of the pants goes.
My wife has a career in General Medicine and a Family Specialist in Cuba, before coming to the USA. She also served as an Emergency Doctor for 4 years in our town there: "She said: I've never seen that in my whole career"!. At that time she was working with a Cuban Physician in XXXXXXX and I was needing a comb to relief my self of the itch; starting to hurt my self. We visited the referenced Family Physician and he made to me a complete physical with the same phrase:" itching and burning, no rashes; last workblood ok? Never seen that before!!. He decided to order a droplet US because the symptoms and the family antecedents of huge circulatory health problems. My mother use to have for years like a Rynaud syndrome but not clinically diagnosed. Ok, back to the droplet results and the technician said there was a little something in the right leg. The doctor put me in the examination room again and tested me with needles for the sensibility to the the puncture. He also brought to my wife attention the hair loss in most of my both legs! And he said the sensitivity was diminished a little in my right leg. He said I ever seen that before but the only thing I could try is to prescribe PLAVIX, to see what happens and " we are going to change your PPI to LANZOPRASOLE instead of OMEPRAZOLE because the interactions.
I left the Dr office and started to take PLAVIX 75 mg once a day, for about four years. My burning itching disappears at the second pill.
Unfortunately, I had complicated UTI with bleeding -probably because the PLAVIX?? and the doctors retired the anticoagulant immediately. Went out of the hospital, now with another Primary Care Doctor. With the time the itch started to happens again and she said"I ever seen that before in 40 years of practice" , I would like to use first CILOSTAZOL to avoid PLAVIX as much as we can. Cilostazol functioned more or less but not with the same effectiveness as PLAVIX. The next programmed visit she said : I will send you with one of the best US Techs here in town for a 3D arterial and venous droplet, I want to see the results.
Droplet done both, and the old Tech told me during the examination: I barely see and arterial 3D like this"! and she continued with the venous: Results: My Dr call me and said : " I know what you have and how the itch would mean to you, but based on the 3D droplet results I should discontinue the Cilostazol therapy because there is no clinical evidences to order any blood thinner and/or anticoagulant!!! She also tried one of the lab test on Rynaud Disease and was Negative.
I discontinued Cilostazol and shortly after I saw my self again and worse with the same clinical situation. Back to PLAVIX and started to feeling better but far to start feeling like years ago. Now some rashes appear on the arms
Do you guys have any idea what is this?

Thanks for your time XXXXXXX
doctor
Answered by Dr. Geeta Sundar 6 hours later
Brief Answer:
burning and itching localized to lower limbs has to have a local cause.

Detailed Answer:
Hi welcome to Health care magic,
Hi you have an interesting case history and I am thinking as I am writing.
To my mind--burning and itching localized to lower limbs has to have a local cause.
This can be--
Venous--
when leg veins do not properly circulate blood back towards the heart, excess blood in the failed veins then makes the veins swell, and the swollen veins can leak blood and fluid into the surrounding tissue of the leg. This leaking blood can cause itching, burning and rash.
Tiny clots in a vein close to the skin's surface can cause a burning or itching sensation yet typically doesn't lead to serious problems.
This is likely in your case as you responded to Plavix (Clopidogrel), and to Cilastazol.
Neuropathy
Burning and itching can be due to Neuropathy especially Diabetic neuropathy.
Please get a GTT (glucose tolerance test) done. Sometimes neuropathy presents before Diabetes is detected. It could also be non-specific non Diabetic neuropathy.
Since symptoms are bothering you, I would as a Physician put you on Cilastozol/ Diosmin--they dilate the veins.
They are safer than Clopidogrel for long term use.
I also see no harm in trying a course of--- Pregabalin 75 and B-12 (1500 micrograms) with any preparation of ALA (alpha lipoic acid) before starting Cilostazol or Diosmin. This will rule out neuropathy aspect.
You can discuss this with your doctor if you found it useful.
Please revert back.
Regards


Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Geeta Sundar 10 hours later
Thank you so much for your time Dr XXXXXXX really appreciated.
Now I remembered when I stopped the medication I was on Cilostazol maximum dose (200 mg) per day (100 morning + 100 at the bedtime).
The recurrent crisis I have right now is definitively related to stop the medication.
I don't know if Diosmin is available in the USA market, we have to make some research. At least it looks like it's FDA approved registered form Spain.
Let me tell you I'm a Clinical Lab Specialist and as you know from time to time and for less than nothing we test ourselves in many panels; so I will take keep your suggestion on the GTT but I dont think its the issue here. Considering the venous antecedents in my maternal side I will be focused to see if I can rid out of my itching; PLAVIX is working but even when this is is a severe recurrence; is not been as fast as before.
QUESTIONS:
-Can I start with CILOSTAZOL replacing PLAVIX TOMORROW? with maximum dose as before?
- If I find Diosmin which gonna be the dose?
Thanks again

R.A.M., BSc., AMTC-MT, FBC-CLS.
doctor
Answered by Dr. Geeta Sundar 3 hours later
Brief Answer:
you can re-start Cilostozol in maximum dose and try to taper

Detailed Answer:
Hi, yes I think you can re-start Cilostozol in maximum dose and try to taper it down after you see a response.
The dose of Diosmin I am comfortable with is 300 mg three times a day.
Plavix should not be suddenly stopped. Reduce it gradually--150 to 75mg---for a week---then Alternate day---then bi weekly---then weekly---and then stop.
But I would be comfortable if you take all the medication under monitoring by a doctor.
Wish you the best.
Regards
Above answer was peer-reviewed by : Dr. Yogesh D
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