Adult with HSP needs a rheuma­tol­o­gist

Cape Breton Post - - ADVICE / GAMES - Keith Roach Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health newslette

DEAR DR. ROACH: I am a 58-year-old fe­male who was di­ag­nosed with Henoch-Schön­lein pur­pura in July 2016.

With HSP, I had the tell­tale bro­ken blood ves­sels and swelling in my legs, an­kles and feet. Ever since the swelling sub­sided, I have ex­pe­ri­enced a con­stant burn­ing sen­sa­tion, worse be­low my breast­bone and my ab­domen.

Other burn­ing comes and goes in my back, my left side, the in­side of my arms and wrists, and the bot­tom of my feet. The pain in my torso wors­ens af­ter I eat.

A scope of my esoph­a­gus and stom­ach re­vealed un­de­ter­mined ir­ri­ta­tion. I also have se­vere cramps in my legs if I stretch dur­ing the night.

Lit­tle seems to be known about how this con­di­tion re­solves it­self in adults. What do I need to do? I’m not re­ally be­ing treated for it now. My physi­cian as­sis­tant re­ferred me to a spe­cial­ist in gas­troin­testi­nal is­sues. Ev­i­dently he didn’t re­al­ize that I was di­ag­nosed with HSP un­til I told him to­day. -- S.K.M. AN­SWER: Henoch-Schön­lein pur­pura is a type of vas­culi­tis, which is an in­flam­ma­tion of blood ves­sels. It also is called “im­munoglob­u­lin A vas­culi­tis.” Ninety per­cent of cases hap­pen in chil­dren. The dis­ease con­sists of a skin rash of raised pur­ple le­sions; joint pain, some­times with swelling; ab­dom­i­nal pain; and kid­ney dis­ease. In most peo­ple, the dis­ease goes away by it­self as mys­te­ri­ously as it came.

The ma­jor con­cern in adults is the kid­ney dis­ease, which can be de­struc­tive and pro­gres­sive. Your provider needs to keep a very care­ful eye on your kid­ney func­tion and on any pro­tein in your urine.

I’m con­cerned that you con­tinue to have ab­dom­i­nal pain. There are some se­ri­ous com­pli­ca­tions pos­si­ble with HSP. In­tus­sus­cep­tion (the fold­ing of a part of the in­tes­tine into it­self) is uncommon in adults but is very dan­ger­ous. Bleed­ing is a com­mon prob­lem: It should have been seen on the scope, but the small bowel is not in­cluded in a typ­i­cal en­doscopy; any swelling, bleed­ing or spasm there may need ad­vanced imag­ing to di­ag­nose. Pan­cre­ati­tis is an­other uncommon man­i­fes­ta­tion of HSP.

I think it may be time to get a more thor­ough eval­u­a­tion. In ad­di­tion to see­ing the gas­troen­terol­o­gist (which I think is an ex­cel­lent idea), I would con­sider a visit with a rheuma­tol­o­gist or an im­mu­nol­o­gist with ex­pe­ri­ence in tak­ing care of adults with HSP.

DEAR DR. ROACH: I am a 69-year-old wo­man. In rou­tine lab tests, I was found to have a high cal­cium level. An en­docri­nol­o­gist and sur­geon agreed that this was a prob­lem with the parathy­roid gland, but an ul­tra­sound did not find any parathy­roid prob­lems, only two small nod­ules on the thy­roid.

I have had kid­ney stones, and each kid­ney now has a small stone in it. I dread the thought of surgery. Is surgery nec­es­sary? -- S.P.

AN­SWER: Surgery cer­tainly is rec­om­mended for peo­ple with pri­mary hy­per­parathy­roidism and ev­i­dence of dam­age from it, such as kid­ney stones. I ex­pect that you had a parathy­roid hor­mone level taken, and that it was el­e­vated, con­sid­er­ing the level of cal­cium in the blood. With high cal­cium, parathy­roid hor­mone should be low. If not, it strongly sug­gests that you have a parathy­roid-se­cret­ing ade­noma (a be­nign tu­mor).

When a parathy­roid ade­noma can’t be found be­fore surgery, the sur­geon will vis­ually in­spect the four parathy­roid glands and re­move the en­larged one (or, rarely, two). Some­times, parathy­roid blood lev­els are mea­sured dur­ing surgery to be sure the re­spon­si­ble gland has been re­moved.

Nat­u­rally, the de­ci­sion to pro­ceed with surgery is yours, but even a sin­gle kid­ney stone at­tack is likely to be worse than the surgery.

READ­ERS: The book­let on asthma and its con­trol ex­plains this ill­ness in de­tail. Read­ers can ob­tain a copy by writ­ing:

Dr. Roach, Book No. 602, 628 Vir­ginia Dr., Or­lando, FL 32803 En­close a check or money or­der (no cash) for $4.75 U.S./$6 Can. with the re­cip­i­ent’s printed name and ad­dress. Please al­low four weeks for de­liv­ery.

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