[57F] Experiencing multiple chronic symptoms including pain and swelling

Question

What's the expected diagnosis

Patient Description

A 57-year-old female reports a complex medical history including sharp lower back and buttock pain extending down the legs for 15 years, worsened by movement without relief. She has been experiencing shortness of breath for 1 year, particularly when walking, rated at a severity of 3 out of 10. The patient has managed gastroesophageal reflux disease (GERD) for 20 years, with a severity of 5 out of 10, noting spicy foods as a trigger. She also mentions food allergies. Pain in the feet, described as severe and burning, has been present for 5 years, predating an ankle fracture. Psoriasis, which she had in childhood and returned 3 years ago, presents as two itchy spots. She has been dealing with irritable bowel syndrome (IBS) for 25 years, which worsened significantly after an appendectomy. Swollen ankles have been a problem for 12 years, becoming more noticeable recently. Shin pain described as chronic fiery pain has been present for 7 months. Numbness and tingling in the legs and feet were also reported. The patient was diagnosed with degenerative disc disease 17 years ago. She is allergic to sulfa and currently takes venlafaxine, trazodone, tizanidine, and Pepcid. No recent unexplained weight loss, fever, or changes in the color or temperature of the legs were reported.

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Arora's Assessment

What might be happening

Based on the information you provided, here are some possible explanations for your symptoms:

  • Chronic Back Pain: Given your history of degenerative disc disease and the nature of your back pain, it's likely that this condition is contributing to your symptoms. Degenerative disc disease can cause sharp, chronic pain that can radiate down the legs.

    • Treatment typically involves pain management strategies, physical therapy, and in some cases, surgery.
  • Peripheral Neuropathy: This condition, which involves damage to the nerves outside of the brain and spinal cord, could explain your numbness and tingling in your legs and feet. It can be caused by a variety of conditions, including some types of cancer.

    • Treatment usually involves managing the underlying condition and relieving symptoms.
  • Chronic Venous Insufficiency: This condition, which involves poor blood flow in the veins of the legs, could explain your swollen ankles and shin pain. It can be caused by deep vein thrombosis or varicose veins.

    • Treatment usually involves compression stockings, leg elevation, and in some cases, surgery.
  • Gastroesophageal Reflux Disease (GERD) and Irritable Bowel Syndrome (IBS): These conditions could explain your digestive symptoms. Both conditions can be exacerbated by certain foods and stress.

    • Treatment typically involves dietary changes, stress management, and medication.
  • Psoriasis: This is a chronic skin condition that can cause itching and discomfort. It can come and go over time.

    • Treatment usually involves topical creams, light therapy, and in some cases, oral or injected medications.

What you can do

It's important to consult with a healthcare provider about your symptoms. They can provide a formal assessment and order relevant tests if necessary. In the meantime, here are some general suggestions:

  1. For your back pain, consider gentle stretching exercises and over-the-counter pain relievers (as long as they're safe for you to take). Heat or cold therapy may also provide some relief.
  2. For your swollen ankles, try elevating your legs and wearing compression stockings. Avoid standing or sitting for long periods of time.
  3. For your GERD and IBS, try to identify any food triggers and avoid them. Eating smaller, more frequent meals can also help. Over-the-counter medications may provide some relief, but it's best to consult with a healthcare provider.
  4. For your psoriasis, over-the-counter creams and lotions may provide some relief. Avoid scratching the affected areas.

What you should look out for

Please seek immediate medical attention if you experience any of the following:

  • Severe pain
  • Sudden or severe swelling in your legs
  • Difficulty breathing or chest pain
  • Any new or worsening symptoms

Please remember that this advice is intended to be general in nature, and specific causes may not apply to your personal circumstances. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

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9 mo ago

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People Also Ask


What are the common symptoms of degenerative disc disease?

Common symptoms of degenerative disc disease include chronic back pain, pain that radiates down the legs, and sometimes numbness or tingling in the extremities. The pain often worsens with movement.


How can peripheral neuropathy be managed effectively?

Peripheral neuropathy can be managed by addressing the underlying cause, if known, and relieving symptoms through medications, physical therapy, and lifestyle changes such as maintaining a healthy diet and regular exercise.


What lifestyle changes can help manage GERD and IBS symptoms?

To manage GERD and IBS, it is helpful to identify and avoid food triggers, eat smaller and more frequent meals, reduce stress, and consider medications as advised by a healthcare provider.


What are the treatment options for chronic venous insufficiency?

Treatment options for chronic venous insufficiency include wearing compression stockings, elevating the legs, avoiding prolonged standing or sitting, and in some cases, surgical interventions to improve blood flow.


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1 Comments


Jasmine#4037

9 mo ago

The sharp pain in your back and buttock is probably due to nerve root irritation, most often due to age-related spinal wear and tear. My mother had this and unfortunately her doctors say there's not a whole lot that can be done except physical therapy and occasional pain-killer patches. They say surgery is only reserved for very severe cases

As for the shortness of breath and swollen ankles, that sounds like heart failure which my grandma had. Have you gotten your heart checked (with an ultrasound for instance) in recent years? Or seen a cardiologist

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