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Dr. Andrew Rynne

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Suggest treatment for painful swelling in the arms, hands and feet

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Dr. Tushar Kanti Biswas

Internal Medicine Specialist

Practicing since :1975

Answered : 1487 Questions

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Posted on Fri, 3 Mar 2017 in Infections
Question: For the past three weeks my veins in my arms, hands, and feet have been swelling and feel painful. I noticed this one day because my arm was sore and I looked down to rub it and my veins were bulging on my hand, all the way up my forearm. my veins do not show at all. My arms hurt all the way up to my shoulders, so I'm pretty sure it's inflammation of the deeper veins. When I have bloodwork, they always say how little my veins are and how hard it is to find them.
I've also noticed I'll have a headache in my temples and when I went to rub it, my vein was swelled there also. My carotid arteries frequently hurt and the one is more visible on my right side. I have a lot of chest pain, so I'm thinking the veins or arteries near my heart are affected by this. I think it might be through the my whole body because I saw my specialist yesterday with an upper left pain, and she said my spleen is there. Then she said she felt like a "string" when she was examining the area.
I was diagnosed with chronic Lyme Disease January 19th after being really sick for months. I have sinus tachycardia and low bp because of it.
What should I be asking my primary doctor or Lyme specialist to check for with this inflammation? It's definitely not a normal thing for me.
doctor
Answered by Dr. Tushar Kanti Biswas 6 hours later
Brief Answer:
Prominence of superficial veins & symptoms of Chronic Lyme disease

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
Superficial veins on dorsum of your hands (better light & shade effect) are quite prominent.However prominence of these veins can be there in many normal individuals especially in people engaged with manual hand jobs, even typing on keyboard.
Pain in limbs (arms hurt all the way up to shoulders) can be due to peripheral neuropathy as neurologic involvement with chronic Lyme disease.Electromyography and Nerve conduction studies can be undertaken to rule out abnormalities (if any)
of proximal and distal nerve segments.
You may also undergo ECG recording and 2-D Echocardiography to exclude Chronic cardiomyopathy consequent to Lyme disease as you have some cardiovascular symptoms like prominent carotid pulsation,chest pain,sinus tachycardia ,low BP etc.

ESR/Erythrocyte sedimentation rate (fasting), CRP /C-reactive protein and Rheumatoid factors and ANA(Antinuclear antibodies ) can also be undertaken in your case (if not already undergone)to rule out any vasculitis factor as pertinent in a female of your age group with possible musculo-skeletal pains .

Regards

Dr. T.K. Biswas M.D. XXXXXXX
Above answer was peer-reviewed by : Dr. Kampana
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Follow up: Dr. Tushar Kanti Biswas 3 hours later
Thank you for responding.

I have pain only when the veins are swelling. When my veins in my forearms and hands and swelled, my upper arms hurt also. If I lift my hand to flow the blood back towards my heart, this causes pain in my arm. I'm wondering if this could be from thicker blood? I haven't been doing anything much with my hands to cause this, as I've been in bed mostly since becoming sick in December.
I have the same issue happen in my left temple. I'll get a pain there and the vein on my temple will be swollen. I saw a rheumatologist and he ordered an ANA which he said was normal. I also had a D dimer done about the weeks ago and it was a little high.

Thank you for responding.

I have pain only when the veins are swelling. When my veins in my forearms and hands and swelled, my upper arms hurt also. If I lift my hand to flow the blood back towards my heart, this causes pain in my arm. I'm wondering if this could be from thicker blood? I haven't been doing anything much with my hands to cause this, as I've been in bed mostly since becoming sick in December.
I have the same issue happen in my left temple. I'll get a pain there and the vein on my temple will be swollen. I saw a rheumatologist and he ordered an ANA which he said was normal. I also had a D dimer done about the weeks ago and it was a little high.
doctor
Answered by Dr. Tushar Kanti Biswas 3 hours later
Brief Answer:
Prominence of superficial veins & symptoms of Chronic Lyme disease

Detailed Answer:
Prominence of superficial veins in the upper limbs could be due to some obstruction proximally-in this case SVC (superior vena cava ) as the prominence is bilateral.Obstruction of SVC is usually due to some mass or lymph nodes pressing from outside.X-ray chest or HRCT chest (if indicated ) will clear the doubt.

Hyperviscosity ( thicker blood ) can occur in Polycythemia Vera (PV) due to erythrocytosis. Erythema, burning, and pain in the extremities, a symptom complex known as erythromelalgia, are other complications of the thrombocytosis of PV due to increased platelet stickiness. A complete blood count will help in excluding PV (might have been done already)
D-dimer is again non-specific because levels are frequently elevated due to systemic illness.
I feel you can undergo Doppler study of venous system of both upper limbs to see the state of venous valves and any obstruction in flow pattern.


Regards

Dr. T.K. Biswas M.D. XXXXXXX



Above answer was peer-reviewed by : Dr. Vaishalee Punj
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