Adult with HSP needs a rheumatologist
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.