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    What do swelling on the arms and difficulty in swallowing indicate?

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Posted on Thu, 29 Jun 2017 in Medicines and Side Effects
Question: Hello Dr. Rynne,
My husband and I are away for a few days and he just began having symptoms he's had, on and off, quite a few times since last August (2016). The following are the symptoms: His right palm, always the right hand, gets increasingly warm and begins to get swollen. The heat is easy to feel. In the center of the palm is a whitish circular spot, which I can most accurately describe as similar to the lack of color in one's finger or toe, when it's extremely cold. Then, he begins to feel tightening in his chest, and feels that he'll have trouble swallowing shortly. I guess to sum it up, I can say that he's had every test they can think of, with no answers. Cardiological (a stress test, an ecocardiogram etc.). Where he wore a monitor on his chest, under his shirt for 2 weeks and the results were fine. He went to a Gastroenterologist several times (colonoscopy etc. etc)...with mostly good results, except that he takes Omneprozale, as his stomach is sensitive. He sometimes takes Pepsid/Pepto Bismol as well. When he gets this strange thing with his palm, his stomach begins to feel gas bubbles and other stomach stuff. The only test that showed "some" sensitivity (as they called it), was a Vesal Vegal "TILT TABLE"test. His dad has this and so they checked it out too. Right now, he's laying down resting, took Benadryl first, and I just cancelled a dinner reservation, as he's afraid he's not going to feel comfortable eating etc. There's probably more to tell, but the above is the gist. He is such an upbeat and terrific guy, not ever a complainer, and is so fed up at this point. Is there any insight you might have into this terribly frustrating dilemma of his/ours? I'm hoping to hear back with some ideas. Thank you so much. Sincerely, XXXX
doctor
Answered by Dr. Prof. Kunal Saha 3 hours later
Brief Answer:
Orthostatic training should help. Lifestyle modification is needed.

Detailed Answer:
Thanks for asking on HealthcareMagic.

Your question has been posted on a common pool and Dr. Rynne may be currently unavailable. I have taken up your query since I believe that I would be able to address the issues. I have gone carefully through your query and understand your concerns. Let us approach the issues one by one.

Regarding the gastrointestinal symptoms, I would suggest him to:
* Avoid spicy food. Take small but frequent meals. Avoid long gaps between meals.
* Avoid alcohol intake (if it a part of his habit).
* Continue to take Prilosec (omeprazole) once daily before breakfast.
* Take plenty of green leafy vegetables as well as other sources of dietary fibers. Take fiber supplements like isabgol/psyllium husk or senna. I would insist him to increase your dietary fiber intake.
* Regular morning walk and exercise to keep the bowel movements proper.
* Take curd or yogurt on daily basis. It contains beneficial bacteria and should help.
* Stress reduction has a very important role to play. Yoga and meditation should help.

Regarding the outcomes of tilt table test, it possibly indicates sick sinus syndrome. Orthostatic training should relieve him of his problems. It consists of standing straight without moving the legs, thus letting the blood pool in the peripheries. He has to stand straight with a wall just behind him. The first day it should be just for 5 mins, the following days it would be 10 mins, 15 mins and so on, increasing by 5 mins per day till 40 mins is reached. Then the 40 mins orthostatic training (standing) has to be continued for a month. Ask him to discuss this with his treating cardiologist.

I have checked the attached images. I can see the swelling but do not have an explanation for it. It could be somehow related to body fluid being unable to drain back properly to the heart. Could you please provide details on his pulse rate and blood pressure? It will enable me to evaluate the situation further. As of now I would insist on trying the orthostatic training and see if it helps.

Let me know if I could help further. Pardon me if I have missed something.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Prof. Kunal Saha

General & Family Physician

Practicing since :1954

Answered : 4439 Questions

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