Doctors' Answers to "Frequently Asked Questions" - Unknown Illness

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Numbness & Tingling Feelings [posted 11/25/98]
Question: For years, I have experienced cold tingling and numb feelings in my hands and arms when elevated. Lately, I have it often, even when not elevated. It occurs when typing, holding my chin, even resting my hands on my lap. What could be causing it? I also have hypoglycemia, low iron, and TMJ, but I cannot see how this could cause this problem. I would greatly appreciate any suggestions. I am only 27, but can remember the tingles from as early as the age of 10.

Answer:  Sounds like thoracic outlet syndrome-pressure on the nerves to the arm in the upper torso. Often by an extra cervical rib;but, other causes. Check with your doctor.

Activated Protein C Resistance [posted 11/24/98]
Question: I was recently diagnosed with activated protein C resistance. I am not on any medication and have been told not to worry. I have been doing a great deal of personal research to find out what I can about the disorder and recently saw a drug advertised on TV called Venastat. It's apparently for women and promotes health leg veins and good circulation. I can't find the drug listed on the web anywhere and interested in getting somemore info about it. Would it be an appropriate preventative measure that I could take? What would be some of it's side effects etc. Thanks for anything you could provide.   

Answer: Protein C Resistance is an inherited disorder of coagulation. It usually causes increased clotting, causing phlebitis etc. There is a lot of medical debate about whom to treat , when to treat and for how long. It would also depend on the frequency of your clotting and the level of Protein C levels. Your family all needs to be checked for this disorder so that when we understand what to do, they can receive treatment. As to the Venastat, of no use. If I had the problem, I would see a national level specialist in this area, have your doctor find them close to where you reside

Unknown Illness Presents with a Variety of Symptoms [posted 11/6/98]
Question:  I have tingling that comes and goes in my lips, fingers, arms, and legs. I am 41. What could cause this? I don't have it all the time.

Answer: Well, hard to tell with a short history. You'll need a neurologic exam to find the potential causes. It is very diffuse- possible causes: anxiety/hyperventilation, peripheral neuropathy, MS etc.

Unknown Illness Presents with a Variety of Symptoms [posted 11/6/98]
Question: My mother is 87 and suffered a massive heart attack over two years ago. Prior to this and still persisting, she has a syndrome of unusual symptoms. Since she is so weak, she has seen doctors in her immediate area. None have been able to figure out the problem. Her symptoms are: (a) dizziness (b) a tingling or prickling sensation starting in her lower legs crawling upward....like a limb that has fallen asleep and is awakening (c) when this sensation travels to her head, she feels very far away from everything including when spoken to, and the dizziness is more acute (d) she is very weak and fatigued. My mother was never ill until 80. Then she started having these symptoms which were infrequent and not strong. They kept increasing in strength and duration until her heart attack. Now, they are chronic and of great intensity. These symptoms are stongest when awakening but lessen after walking. Although the symptoms exist all day, it is the intensity that changes. Since it is chronic, quality of life is greatly diminished. She has a stent in one artery. The other is 65%+ blocked. The doctors have ruled out anxiety as the underlying cause for the symptoms. Thyroid = N. CAT SCAN = N. BP = N (sitting, standing, and with a 25 foot walk - drops significantly after 2nd walk of same distance). My mother is quite a fighter, and I have taken the fight to the internet highway hoping to find doctors who have knowledge about or have seen similar symptomatology in their patients. If you have any diagnostic guesses, suggestions, thoughts, or know of reserach relating to these symptoms, I would appreciate it. Thank you for providing this site. Sites like yours allow me an opportunity to pool information from various medical sources thereby affording a chance that a solution or direction may be derived at more easily by her physician. Thanks.

Answer: Has an EEG been done. Unusual seizures could present like this. Also, what is her blood pressure and pulse during the spells?

Pain & Light Headedness [posted 10/8/98]
Question: I have been experiencing pain in my upper back and it sometimes goes into my arm and chest. I am currently having testing done for my colon (constipation & pain in the lower abdomen). They have yet to find out the cause. When I have the pain in the back (between the shoulder blades) I become weak and light headed and have hot flashes. Could this be my heart or just gas?

Answer: Could be your heart, gall bladder, stomach or esophagus. Unlikely to be your colon.

Chest Pain
Question: If Joe has strong pressure in the right chest area and pain with movement, what is wrong with Joe?

Answer: Something mechanical in the chest wall or lining of the chest wall. This is not angina or internal in source; but, probably muscle, tendon or pleura in origin. Heat and Non-steroidal anti-inflammatories will usually suffice-see your doctor if it worsens or not better in 8 days or so of this treatment.

Unknown
Question: I had a fever on the first day that I felt sick. Since then it has gone down. I have a sore throat and rashes on my arms and back. I have not defecated in three days. I am taking penicillin and steroids(methylprednisolene 4mg).

Answer: First, why are you on steroids? Was this your idea or your physicians? Patients on long term steroids usually need to increase the dosage while sick. Secondly, you need to be evaluated to see if you need antibiotics.

Throat Problems
Question: I have had a sore throat for three days. The back of my throat has small oval shaped red bumps. I have no idea what could cause these. Could it be a sign of strain, I spent the other night out singing and smoking more that usual, or might it be more serious?

Answer: This comes from the infectious process not "strain". If the spots don't go away in 2-3 weeks have them looked at.

Facial Swelling
Question: My 75 year old mother has been plagued for several years with unexplained swellings of the soft tissues around her face. About once a week for several weeks at a time, when the spells strike, one part or another of her face will become distended, often swelling to grotesque proportions if she doesn't take a pill. She's been prescribed Atarax (hydroxyzine HCl) for the swellings, but she doesn't like to take it because it makes her very sleepy, and feeling hung over the next day. No doctor has been able to tell her what's actually happening or what the cause may be. Can you help?

Answer: Either an allergic reaction or familial angioneurotic edema. This is a inherited disorder that causes facial swelling. She will need complement levels checked to determine this. Treatment with attenuated androgens like Danazole can be very helpful.

21 Day Cycle
Question: My brother gets sick every 21 days with headaches, throat aches, pharyngitis, aphthous, joint pain, and stomatitis. We think he may have the syndrome of periodic fever. How long is this going to last? My Brother is 15 years old and has been sick like this for 9 months. Is there a place where I can get more information on this subject? My mother has been told that his illness resembles cyclic neutropenia.

Answer: Before you go looking for a zebra(unusual diagnosis) look for common ones. Has his doctor done an evaluation? Different infections, cancers, lupus etc. would produce these and are significantly more common. Cyclic neutropenia is almost a reportable disease it is so uncommon. Focus on common things first.

Weight/Diarrhea/Hot Flashes
Question: I am taking 20mg Paxil, daily. 75mcgm Synthroid, daily and twice weekly 0.3mg Premarin. I suffer from unexpected sudden bouts of diarrhea about once or twice a week, still have frequent hot flashes and my goiter swells for unexplained reasons. I had uterine cancer 5 1/2 years ago, as well as malignant sclerosing basil cell cancer one year ago. I am 62 and slightly(about 20 lbs)overweight for my 5'7"frame. Otherwise I'm fine. Can the weight gain, diarrhea and hot flashes have something to do with the medications I am taking? Oh, yes, I also have frequent heartburn for which I take prilosec occasionally. Thank you for your answer in advance.

Answer: The diarrhea is probably due to the prilosec if I had to guess. The hot flashes usually indicate inadequate doses of premarin-check your LH and FSH or just double your dosage for a week or so. This is a small dose for most people. Likewise the synthroid, most patients are on 0.1-check your TSH if it is in the normal range OK but, if high you need more thyroid replacement.

Salty Taste
Question: What causes a constant salty taste in the mouth and what can I do?

Answer: Got me on this one. Is your mouth dry? Occasionally, liver dysfunction will give different tastes; but, salt is not a usual one. Check with your physician or an ENT. Sorry.

Multiple Problems
Question: My daughter has been sick for a long time. In the course of her search for a diagnosis, she has been tested for diabtes, operated on for sinus problems, scanned, MRIed, treated with antidepressants of various kinds and finally tested by a chiropractor for Candida. The tests were done at the Great Smokies Laboratory and came out positive. Since then she has been treated with Diflucan, a very strict diet and started to feel a little better when she came down with a kidney infection and ended up in the hospital on IV antibiotics. Since then she can't get to feeling better no matter what she does. Her doctor also said her hormones are low so is treating her with hormone replacement. She is only 32 years old and we are at the end of the line. Have no idea where to go next or what to do as she feels worse all the time. So many doctors do not even believe in Candida. We do not know what to think. Desperate for help.

Answer: Sorry, but, I'm one who really hasn't seen any evidence of this syndrome. Other than fringe doctors who make exorbitant fees for their "treatments" I doubt if any physician considers it worth treating. It may represent a change in the immune system; but, that is the most I'll concede. If it really existed, why doesn't anyone get better or cured? Chronically ill, desperate people will go to many lengths to get treatment. I emotionally understand this; but, candida is not her answer. I have several patients that I can't diagnose who are really ill; but, I refuse to offer hope for treatment that really is not there.

Eye Problem
Question: About eight months ago, I started having trouble opening my right eye after being asleep. After blinking a few times it would open. I went to an Ophthalmologist. He thought it was Myasthenia Gravis but was puzzled that it happens only after my eye has been closed and rested. My eye at times "aches" and most the time feels very dry. He sent me to see a Neurologist. He was not very helpful, and wants to take the "wait and see" approach. I have no follow-up with either doctor and that was four months ago. I have noticed lately that my vision is very blurred or foggy in that eye, again after several blinks it clears up. My sister mentioned Horner's syndrome. I’m trying to search for information on this. Also three years ago I had 3/4 of my thyroid removed due to a non-cancerous tumor. Any information on this would be helpful.

Answer: I'm not sure what you have; but, any first year medical student would easily diagnose Horner's Syndrome. I doubt if a Neurologist would miss it. Blurry vision is not a part of that syndrome unless it is part of the dryness of the eye. Also, it would not vary with sleep/waking. There are neuropathalmologists-probably your best option.

Oxaprozin & A Rash
Question: My husband is taking a medication oxaprozin he has a rash on his legs and private parts. It is so bad he can't wear underwear. He stopped taking the drug yesterday and he still has the rash. How long would it take for the rash to go away? He started taking the medication on Wednesday of last week and Friday the rash came.

Answer: If it is the oxaprozin(Daypro), I would suspect about a week after stopping. However, this is a peculiar site for a rash. Generally, drug rashes start on the central trunk-occasionally on the arms or legs. The Inguinal areas are uncommon. This might be a fungal infection instead of a drug reaction.

Throat Virus
Question: I went to see a doctor about 11 days ago. A number of days before that I discovered bumps on the back of my tongue. Also my tongue is whitish from the back to about the middle. I had a bad cold 4 weeks ago. The doctor told me it was a virus and that the bumps were my glands swollen. How long can I expect to have these bumps? Should I have further tests done? Do you know anything about this virus. I went to out patients so I can't go back to the same doctor as I am not a patient.

Answer: Most oral viruses would clear within 10 days or so.

Abdominal & Lower Back Pain
Question: What could be causing pain much like appendix pain. It seems to radiate from the lower right side of the abdomen through to the lower back. The appendix was removed 27 years ago.

Answer: Either adhesions where the surgery was performed, ovarian cysts or other problems, problems with the colon(like diverticuli or inflammation like Crohn's Disease or Ulcerative Colitis). Occasionally, renal problems will present in this area and radiate to the back.

Nocturnal Focal Seizures
Question: What long-term strategy would you recommend for a 40-year-old white male with a history of nocturnal focal seizures (over a 12-month period) that led to a nocturnal grand mal seizure. Should I be concerned about the prospect of taking Dilantin indefinitely? I had a history of several nocturnal focal seizures: I'd wake up with one arm in spasm, lifted straight over my head and banging against the headboard of my bed. This would happen to both arms, but only to one at a time. Sometimes I would not wake up, but my wife would see the seizure or I would find cuts on my hand in the morning. I attributed this to muscle spasms until a grand mal seizure, which started with first one, then the other arm going into spasm. Since then, I have taken 300 mg of Dilantin daily, which has stopped all seizure activity. This question is motivated by a difference of opinion between my neurologist, who seems content to keep me on Dilantin indefinitely, and my next-door neighbor, who happens to be neurosurgeon. My neighbor is concerned about the possible effects of long-term use of Dilantin (even though I have demonstrated no adverse side effects thus far, at least, since the initial acclimation period).

Answer: I'd stay on Dilantin. Take some extra Vitamin D and watch your gums. However, other side effects are usually pretty minimal. A sleep study might also be warranted to rule out sleep disorders that could be fixed by other methods than Dilantin. However, for practical purposes take the Dilantin and forget it.

Autoimmune Disease
Question: My palms & fingertips from the first joint to the tips swell & turn bright red. I have been told that I have some sort of autoimmune D/O, but have tested negative for lupus. Was a 6-month preemie in 1951 & have a lot of food allergies. I don't drink & I smoke 1 pack of super ultra light cigarettes/day. Take Hydroxyzine & Claritin-D for allergies. The Hydroxyzine seems to help the puffiness & redness of my palms & fingertips. Sometimes do experience hives & itching, especially on face & upper chest. Are all of these Sx related to allergies or are they related to an autoimmune D/O? Will stress exacerbate Sx? All seem worse since the accidental death of my son in 1991 & the deaths of my father & grandmother 2 mons. apart 18 mons. ago. Also, I am in a high-stress job - I am a case manager for severely mentally ill. Would appreciate any helpful comments - can't seem to receive any answers from my PCP here.

Answer: I suspect he/she is describing Raynaud's Phenomenon. This is a condition caused by spasm of the distal arteries of the feet and hands. It can be induced by vibration, cold or extreme temperature changes. About 10% of women have this problem at some level and most do not develop systemic problems. Sores on the fingers are usually about the only problem. It can be blocked by calcium channel blockers-particularly nifedipine. You will need to have a sedimentation rate and a Rheumatoid Factor done as well as an ANA(if not already done). If these are normal you probably will experience nothing more than an occasional nuisance. A Rheumatologist would be the referral source to seek.

Ethex
Question: Please help me. One of my friends has taken ethex, and her mom found it on her and she doesn’t know what it is. So could you please help me and tell me what this drug is? It is making her sleep! Please help me as soon as you can.

Answer: Sorry, I'm not aware of what this drug is-street drug?

Head Pain & Arm Bruises
Question: My brother-in-law has been experiencing pain in the side of his head, not headache pain, but rather, a sharp, severe pain. This has been happening for about three weeks. He also seems to be "breaking out" in bruises on his arms and back. I've tried to encourage him to see a doctor, but he's stubborn. Maybe your opinion would help change his mind.

Answer: I agree with you not the least reason being that off-hand I can't figure any condition that would cause the problem.

Finger "Blisters"
Question: For the last five years I have had a problem with these dots that appear on the ends of my fingers that are filled with a clear liquid. They almost look like blisters under the skin but they always work their way to the surface and then the skin dies. What is really strange is that they often appear in groups. It used to be on one finger but now shows up on several fingers on both hands.

Answer: Hard to tell without seeing it; but, probably dyshydrotic eczema. This can be treated with over the counter steroid creams pretty well -if it still occurs get a higher strength prescription steroid for local application.

Rash
Question: A friend of mind has a rash that appears from the neck up and no where else. It is red raised and itches. What could this possilbly be cause from and what treatment recomendation would you advise.

Answer: As you might guess, without actually seeing the rash which you describe, it is difficult to make a specific diagnosis. However, your description is quite helpful, and you do mention some key points to note when evaluating a rash of any kind. Firstly, location is of the utmost importance. On occasion, diagnoses can be made just on the basis of location and appearance on physical examination. The duration, exacerbating factors (temperature, activity, foods, etc.), as well as time course, and other associated symptoms also aid in making a diagnosis. Some rashes require the expert opinion of a dermatologist, or even skin biopsy to determine its cause. Your friend’s raised, red, and itchy (“pruritic”) rash that is limited to the neck and face raises several possibilities. There are few rare (especially in the United States) malnutrition conditions and vitamin deficiencies that can result in such a rash. Given that it is pruritic, however, an allergic rash, or atopic rash, is more likely. Perhaps there is an allergy to are scarf, new shirt, toweling at home, pillow or pillow case, detergent or soap being used, or some other change that has resulted in an allergic type of rash. Your friend should review whether any changes in these areas have been made recently, and whether they match up with the time the rash started. New medications can cause are rash as you describe, if your friend is allergic to them. Other less common possible causes would include skin infection, or an underlying whole body, or systemic, disorder that can produce a rash. Your friend should see his or her health care provider. The best way to determine the cause of the rash is to have are full history and physical examination. Once the cause is determined, appropriate therapy can be started.

Painless Lump
Question: I have a very small (less than a B.B. size) hard, somewhat moveable,painless bump(?) about in the center of my armpit. It is below the skin and does not show to the eyesight, but con be felt with my fingers. Noticed for about 2 weeks, but could have been there longer since it’s so small?

Answer: Any lump in the armpit (also known as the “axilla”) should be evaluated by your health care provider, who can take a careful history of any other symptoms you may be having, as well as perform a physical examination. From your description, it is difficult to determine the cause of the lump, but there are several possibilities to consider. Infection of the hair follicles or sweat glands can lead to formation of a scar that could appear and feel like the lump you are describing. Enlargement of the lymph nodes that are located in the armpit can also explain the presence of a lump, and can be due to infection and/or trauma of the arm on the same side as the lump, a systemic infection (especially if other nodes are also enlarged), or may represent a more serious condition.. As axillary lumps can be due to many causes, a visit to your health care provider to review what medical conditions you may have, as well as the medications you are taking, would prove beneficial. Women in particular, who present with axillary lumps warrant careful evaluation and perhaps biopsy, out of the concern for disease related to the breast. However, in this part of the body, any newly discovered lump should be evaluated by a health care professional. See your doctor, or health care provider; they can examine the area, and decide what the best course of action should be.

"Over Heating"
Question: I sent in a medical question approximately two weeks ago (possibly longer), however my question related to symptoms which I’ve been having for some time. If I have no idea what condition these symtoms might be connected with, and that was, in fact, my question. How do I know which FAQ page to look for my answer on? I have been searching ALL pages, but do not see mine in any of them. My question related to severe “over-heating” problems that I have been experiencing for several years, and the severity seems to be escalating recently. I am a 40 year old woman, post-hysterectomy, but these do not appear to be ordinary hot flashes. I over-heat severely (to the point of almost passing out) by ordinary activity; walking down the street, taking a tepid shower, washing dishes and cooking in my kitchen, or even VERY mild physical exertion. (Such as dressing or very light housework.) I also appear to be more adversely affected by the weather than anyone else I know. If the outdoor temp reaches 80 degrees, I feel as though I am having a heat stroke. I also cannot cool down easily once I have over-heated. Takes me sometimes 20 minutes in a highly air conditioned environment to return to normal body temps. This condition is so severe that I am practically disabled by it!! What could these be symtoms of? I have had no medical history of anything like this before, but I don’t think this INTENSE and regular over-heating is normal for anyone. I would also appreciate it if someone could send me an e-mail to tell me what page to look for my asnwer on? Not knowing WHAT could be causing this condition, of course I cannot find the correct page to read the answer!

Answer: This is the first time I have come across your question, and I hope the suggestions I have prove to be helpful. As you already mentioned in your question, a common cause of hot flashes in women are menopausal, or post-menopausal hot flashes. The menopause need not be on the basis of age alone; since the hot flashes are caused by hormone changes, any cause for decreased ovarian/uterine function (even if they are surgically removed, for example) can cause menopause-like flashes. You describe these spells of “over heating” as being above and beyond these flashes, however. There are several other possibilities to consider. By far the most important part of determining the cause for your symptoms would be a detailed and thorough history and physical. Are there any other symptoms? Do these spells relate to meals, time of day, season? Do you have any medical conditions which may predispose you to this problem? What medications are you taking? These are just a few of the questions your health care provider may ask when evaluating you for your symptoms. Allowing for the information you have provided, the possibility of hyperthyroidism, or, an over active thyroid gland may be a consideration. Other conditions affecting the hormone-producing organs of the body, such as the pituitary gland or adrenal glands, may need to be considered. The best course of action would be to see your health care provider. He or she can take a history, perform a physical examination, and determine what testing, if any, needs to be done to determine the cause of your symptoms.

Multiple Problems
Question: I was diagnosed w/Thrombophlebitis in June. I have hair loss, and a butterfly mask identified as Roseacea. Also have “something” cellulitis or phlebitis going on in the other leg. I feel it is really odd to have bilateral problems. Despite my advancing age, could this be a lupus related issue, or what? I don’t feel that my legs are getting any better.

Answer: It would be easy to check. Ask your doctor to check an ANA and a sedimentation rate. If both are normal than these are just random problems. However, if the ANA or sed rate is elevated you have some systematic inflammatory problem-sure sounds like it could be.

Arm & Hand Circulation
Question: Whenever I lie down my right arm and hand feel like the circulation is interrupted. A dull throbbing and pulsating pain begins. After several hours of sleep the pain becomes so intense it awakens me and will not subside unless I get up and allow my arm to hang at my side. Numbness and tingling last about two hours after rising. Throughout the day if I turn my hand to a certain position I feel some pain similar to an electrical shock shoot up my arm. Could this be nerve damage or what?

Answer: Sounds like you have either a cervical rib entrapping the nerve or some local entrapment of either the nerve or blood vessel. If there is an extra cervical rib, this usually needs to be treated surgically. You can check by having someone take your pulse as you hold it erect over your head. Loss of a pulse is nearly diagnostic;but, see your doctor-you have something that needs treatment before it is permanent.

Ill in Ireland
Question: I was away in Ireland and for the first two days was sick with vomiting, diarrhea, lightheadedness, cramps, gas and general aches. I have been sick now for eight days... have had stool tests done with normal results, had an electrolyte test done on my blood. I am still light headed, have cramps and gassy. Any Ideas? Are there some tests that should be being performed? The doctor in Ireland thought it might be food poisoning, my doctor is taking days to get back to me. Help, I need to get back to work!

Answer: Food poisoning wouldn't last this long. If it is due to "travelers diarrhea" a dose of peptobismol, cipro or equivalent would fix the problem. If not "travelers diarrhea" further evaluation will be necessary.

Itchy Feet
Question: Many times when I lay down to sleep, my feet or a foot starts to itch unbearably. This can last up to 2 hours, then it ceases as quickly as it starts! At times both feet feel itchy simultaneously...which drives me crazy! I do not have Athlete's Foot or any obvious skin condition. Recently my arms and hands are starting to do the same. I have had this condition for about a year and nobody seems to know what it is. I do have high blood pressure, but have discounted the Atenolol since this started before I began treatment with it. The only thing that helps is getting my feet in water. Could this be that I swell up when laying down? I do suffer from water retention from the BP med. and the Ortho Est that I am on. I really have no itching during the day and this doesn't happen every night...so I am baffled! I know it sounds so bizarre to be kept awake from "itchy feet"....but I am at a lost as to what to do....Got any ideas? Perhaps changing the hormone pill! Or could this be nerve related...as I do have a lot of stress in my life! I could really use your opinion!

Answer: I'd really like to help, but, I don't have any ideas about this one.

"Lump on Inside of Leg"
Question: I have a lump under my skin at the inside of my leg close to where the leg socket connects to the pelvic bone. I began to notice it a year ago just after I jammed my leg while doing a front kick into a large individual in Karate class. Since the injury, my hip tends to twist ( and one leg appears shorter ). I also experience discomfort riding a bicycle or sitting on a hard surface for long periods. I have been seeing a chiropractor every 7-8 weeks for an adjustment and try to stretch out any tightness in the gluteus. I would like to find out exactly what this lump is but I don't know what kind of doctor to start with. It's soft and can be moved around under the skin. The size is about 50% of a golf ball. It is very noticeable on my build (I am female, 31 years old, 5'9", 130 pounds, 16.5% body fat) and disconcerting. I haven't been to the ob-gyn because I've been embarrassed about this. Can you provide insight into my problem or suggest a next step?

Answer: Parts of this sound like a ruptured muscle sheath-parts don't(like the shortened leg). I'd see an orthopedic surgeon-I doubt that a chiropractor would help with this particular problem.

Rectal Discharge
Question: What might be a list of reasons for a small but daily excretion of yellowish pus from the rectum accompanied by some abdominal discomfort and some slight nausea? Duration to date: about 14 days.

Answer: Usually a hemorrhoid;but, this wouldn't fit with the nausea. I'd see your physician for a more complete evaluation if it persists.



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