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Victoria
Victoria, Chiropractor
Category: Health
Satisfied Customers: 590
Experience:  25 years overall experience in health care from hospital-based intensive care to private practice
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I have been feeling a burning sensation in my left calf ...

Customer Question

I have been feeling a burning sensation in my left calf today. Do you know what that could be related to?
Submitted: 6 years ago.
Category: Health
Expert:  Victoria replied 6 years ago.
Hi,

I would like to ask a few more questions.

Where is the burning, i.e., does it feel spread diffusely throughout the calf or does it seem to follow a specific "line"?

Do you have big, bulging veins in your legs, a past problem with circulation in your legs, a family history of varicose veins?

How intense is the burning and is there pain or aggravation of the burning or other symptoms with walking? Any associated numbness or tingling?

Do you have any ankle swelling, a low grade fever or any difficulty breathing?

Have you recently taken a long airplane trip?

Thanks for your patience in answering all my questions, but I want to be able to rule out anything serious.
Customer: replied 6 years ago.
There is no swelling. It is somewhat diffuse. I have not taken any long airplane trips.
I had had pain in both my calves over recent weeks and had dopplers done in both and there were o blood clots.
I have no ankle swelling or trouble breathing.
It is just a strange sensation of feeling of burning. It doesn't feel worse when I walk.
Expert:  Victoria replied 6 years ago.
Hi Regina,

You have already had my biggest concern ruled out, a blood clot, so that is good. The fact that your ankles are not swollen indicates that you probably are not suffering from venous valve incompetence. In order for the blood to be moved "uphill" back to the heart from your foot and leg, the veins have one-way valves in them to prevent the blood from falling back "downhill". Also your feedback pretty much rules out the spine as a source of referred burning pain and a peripheral neuropathy. Although this symptom or sensation is not that uncommonly reported, the cause can be enigmatic and difficult to appreciate in cases such as yours, where testing and clinical picture does not support an outright pathology or condition. I suspect you are have spontaneous bursting of tiny blood vessels due to relative fragility that may be related to some minor defect in connective tissue "quality". At this point, I think we have to assume the problem is benign. In my own patient population and among my circle of friends, this problem has been brought up many times and absent anything showing up on testing for vascular problems, it did not appear to lead to any particular problems. For now, I do not think there is anything in particular to be done. Exercising the legs and eating lots of fruits (Vit C, biotin, bioflavonoids) is helpful in maintaining circulation and vascular endothelial integrity.

Hopefully this information is helpful. I am sorry there is no "cut and dried" answer to give. Follow up questions are welcome. Please do not forget to click the accept button if you are satisfied with my work. Of course, positive feedback and/or bonuses are also greatly appreciated. Thank you.
Customer: replied 6 years ago.
How did my feedback rule out the spine as a source of referred burning pain and a peripheral neuropathy? Also, I had the dopplers done several weeks ago but I am assuming blood clots didn't form since then.
You wrote that you think I have spontaneous bursting of tiny blood vessels due to relative fragility that may be related to some minor defect in connective tissue "quality". That sounds serious. Would that cause a burning sensation?
Expert:  Victoria replied 6 years ago.
Hi,
1st question:

Burning related to an entrapped spinal nerve or an entrapped peripheral nerve will mimic a pattern that is consistent with the dermatomal pattern of the spinal nerve or the pathway of an effected peripheral nerve. More diffuse leg pain secondary to spinal stenosis and intermittent neurogenic claudication come on consistently after walking at certain distance and goes away with rest. For instance, one may be able to walk 2 blocks with no problem, then develops leg pain that forces the person to sit down and 10 minutes later the person will be able to walk another two blocks, then have to sit or lie down again for relief before proceeding another two blocks. That created by intermittent vascular claudication is also aggravated by walking because there is inadequate circulation to meet the working muscles metabolic demands.

2nd:

One cannot assume a blood clot did not form since the Doppler exam, but a blood clot would be expected to present a blockage that would impair circulation and below that blockage you would have swelling, warmth, bluish hue and pain if the blockage occurred in the venous system. If it were an arterial blockage the tissues below it would be pale and very painful. In these cases, one would be dealing with a localized thrombus. When a thrombus is dislodged in a vessel and travels to a distal site and re-lodges, it is called an embolus. If originating in the venous system, it can result in a pulmonary embolism as it get stuck in the smaller pulmonary arteries after the venous blood containing the dislodged thrombus reaches the right side of the heart and sent to the lungs for reoxygenation where it now runs into much smaller caliper vessels. When an arterial thrombus is dislodged it tends to travel to the brain, resulting in a stroke. You do want to be aware of this possibility so that you will know to go to the doctor at the earliest signs of a problem. You might ask your doctor if it would be wise for you to take a daily baby aspirin for its anti-clotting properties since the risk is unclear.

3rd

The burning could be due to the release of prostaglandins, RBCs and other caustic or inflammatory chemicals into the tissues when the vessel ruptures or could be due to irritation of the free nerve endings in the tissue. You would normally see bruising if a vessel broke in the skin, but would not be observed if it occurred in the deeper tissues. The vessels I suspect to be involved are tiny ones that in the scheme of things do not cause a clinically apparent impairment in circulation. More likely, the tissues are irritated, confined to just that very localized area of rupture. This is merely a theoretical model that might explain this phenomenon.

Hopefully, this clarifies things for you. If not, feel free to ask more questions. Thank you.
Victoria, Chiropractor
Category: Health
Satisfied Customers: 590
Experience: 25 years overall experience in health care from hospital-based intensive care to private practice
Victoria and 3 other Health Specialists are ready to help you
Customer: replied 6 years ago.
My husband looked at my legs. He saw no swelling, no additional warmth, etc.
I have had the pain in my calves before and as I said, I ended up having 3 separate dopplers total on the 2 legs (2 on one leg, several weeks apart and 1 on the other leg) because of the pain in the calf.
Today the feeling is more of a burning sensation. I am just wondering if you think it is something serious.
Expert:  Victoria replied 6 years ago.
Hi,

Sorry it as taken me awhile to get back to you. I had plans this evening and have been off line.

Tell me about the calf pain. I was not aware that you were having pain. Does it feel like a cramp in the muscle? Do you have any other symptoms, in general (not just in your calf). How long does the pain last with each bout? Maybe you could just start over and tell me about your chronological experience of the problem in both of your calves. Walk me through how it all unfolded to date so that I can assess the whole picture and not little bits and pieces at a time. That would really be helpful as it is particularly difficult to sort through things without face to face interactions. I can sense that you are very worried and I would like to be sure I have an accurate understanding.
Customer: replied 6 years ago.

Over the last several months, I have been experiencing pain in my calves. It will alternate legs. I have see my doctor a number of times about it. Each time by physical exam he did not believe there was a DVT but he has sent me for 3 dopplers (2 on 1 leg and 1 on the other) just to reassure me. The pain seems to come and go every few weeks. Yesterday it was somewhat like a burning but last night, it woke me up a few times with a cramping/pain type discomfort. I don't want to go back to the doctor with the same complaint as he seems to think it is muscular. I just worry each time that it is a blood clot.

I have beem getting more headaches lately and I asked my doctor about that. I am peri-menopausal and after doing an exam, he did not think the headaches were significant. The headaches are not terrible and are short lived, I am just noticing them more.

It is important to mention that I suffer from health anxiety. I am always worried about my health and if you see from other questions I have asked, I have been to the doctor a lot and had a lot of work ups. (I had a brain CT scan in 1/07 after a bout of vertigo which came back fine. I also had an auditory brainstem response test at the same time to rule out an acoustic neuroma and that also came back fine).

I have a hard time knowing what is just a normal ache or pain that everyone experiences from time to time and what is actually something serious.

Expert:  Victoria replied 6 years ago.
Hello again,

Thank you for explaining the whole picture to me. Please do not take what I am about to say as flippant, but not necessarily objective either. But based on personal experience and that related to me by my patients through the years, the perimenopausal and even the first several post menopausal years are fraught with new aches and pains and emotional challenges in that you never feel quite well or quite like yourself, yet nothing in particular seems to be really wrong either. I share this with you in the hope that it can help give you some perspective to hold onto in times that can be even more difficult for one who realizes a tendency to overly worry about health issues. I say these things, not in any way to be trivialize what you are going through or even to blame hormonal changes for your calf pain, in particular. Rather I just wanted to share with you my observations of what might be par for the course during the transitional years ahead.

Headaches are extremely common in the peri-menopausal years, particularly for anyone with a history of migraines. I suspect you have chronic tension headaches that are just being made worse by an increased level of anxiety which I perceive to often become heightened for many women as their hormone levels become increasingly imbalanced and erratic. Vertigo is most unpleasant and frightening, but a single, short- lived bout may be the result of a temporary inner ear disturbance that can be brought on by something as simple as a bout of sneezing. More serious causes are usually associated with hearing losses or other, co-existing neurological mediated symptoms.

Some people, for reasons not apparent, do experience problems with cramping of their calf muscles in their midlife or older years. Usually calf cramping is easily recognized for what it is, but the reason for it may remain a mystery.

I really cannot tell you exactly what the burning in your calves mean, other than the fact that it effects both of them, means that it is not due to a uniquely localized cause. For me personally, I would not be alarmed by the symptoms you described once I was reassured I did not have DVT. But that is much easier for me to say than for you. Whatever it is, modern medicine currently does not have sensitive enough testing to appreciate the source or how to "fix it". The only thing you can do is be pro-active about doing things positive for healthy circulation, joint mobility and muscle flexibility and strength in your legs. Examples would include routine cardiovascular type exercise, near daily stretching and relaxation exercise routine, not wearing high heels, getting periodic massages, eating well, controlling weight, taking periodic breaks from sitting to walk around, possibly take a baby aspirin daily(should consult with doctor about this), maintain your resting blood pressure at less than 120/80 mm/Hg and make sure you get enough calcium in your diet + supplements if needed. Calcium (recommend citrate or carbonate form] intake should range from 1200-1500 mg/day + 800 mg Vit D. A single dose of calcium should not exceed 500 mg due to poor absorption. Magnesium is sometimes helpful for cramps ( take separate from calcium and recommended dose is 325 mg/day (I actually take it to offset the constipation secondary to taking calcium - not easy to absorb). Low dose propranolol can be helpful for anxiety control and migraines with minimal side-effects once you get through the 1st couple of weeks and no risk of addiction (it is a beta blocker that may need to be avoided if you have asthma or low blood pressure) - again that would be something you would need to discuss with your doctor. Psychotherapy is probably the most effective treatment for milder anxiety issues. Also women should be screened for hypothyroid in their late 40s-early 50s due to the high prevalence of this problem and symptoms that may be difficult to appreciate early on.

I hope by giving you so much information that I have not actually fed into your health fears. A serious problem will not go unrecognized even if the underlying condition remains an enigma. You have to trust that you are an intelligent, pro-active and highly communicative health care consumer that is capable of both questioning and understanding one's medical management and know when a doctor is not really listening vs being attentive. That, in my opinion, markedly reduces the "need" to feel overly anxious about one's health issues, if that is any small comfort to you.

Hopefully, in some small way, I have taken away some of your anxiety with regard to your ongoing calf symptoms. There is no medical reason, at this point in time, to suspect a serious problem. But if there is a change in this condition, you should not hesitate to seek a medical evaluation. Remember you can always ask questions to help put your concerns in perspective and work through your anxiety, rather than letting it build up. If you are satisfied with the service I have provided, please click accept so that I can get credit for my work. Of course, positive feedback and/or bonuses are much appreciated as well. Thank you.

Sincerely,

vj
Victoria, Chiropractor
Category: Health
Satisfied Customers: 590
Experience: 25 years overall experience in health care from hospital-based intensive care to private practice
Victoria and 3 other Health Specialists are ready to help you
Customer: replied 6 years ago.

Thank you. What you said was reassuring. My problem is since I worry so much about my health, I do not know when something is serious or when it is a common ache or pain that most people in the general public experience. Like today, I have some soreness in my arm and I worry it is something serious. Like it may be some kind of neurological symptom. I worry that about the calf pains too.

Also, I have been to doctors so many times and had so many tests done that I am afraid my doctors don't take me seriously anymore. I am concerned they think I am a hypochondriac and may miss something serious.

I am working with a therapist on CBT techniques but they are so hard to do when it comes to my health. I am afraid I may be ignoring a symptom that may turn out to be something serious. Yet, I can't run to the doctor every day for every ache and pain.

I sometimes think the head aches are stress/tension then I get afraid that they are indicative of something more serious. It is so hard for me to judge.

Thank you again.

Customer: replied 6 years ago.
I wondered if you had anything else to add.
Thank you.
Expert:  Victoria replied 6 years ago.
I can only say that I truly do not think you have anything wrong with you that is serious to the best of my ability to understand the problems you are having without directly examining you and taking an in depth history. I think your problem is being compounded by the fact that you fear your anxiety over health issues will create a pattern of over-seeking medical help that will cause doctors to automatically assume you are a hypochondriac which in turn makes you even more fearful that if something really were seriously wrong, the doctors may not be adequately attentive to your complaints, dismissing them because you "were always crying wolf, when there really was no wolf around". It is certainly easy enough to understand that fear. You realize that your fears are not entirely rationale, but somehow that does not make the fear any less real and no matter how many times I try to reassure you that you will be capable of not allowing your fears to come true, I will not be able to wipe out that fear. You really need to find an internal or family medicine doctor that communicates well with patients and takes the time to do so to manage your overall healthcare. Someone who can deal with the fact that you are overly anxious about health issues without letting it color his/her own judgment/assessment of the clinical picture. That may be easier said than done, but I find it much less draining to work with patients who understand that they have an issue, such that the doctor and patient can "hear" one another and create a situation where the patient can trust the doctor despite not being totally able to let go of their fears. Keep up your therapy and realize you can learn to manage the problem more effectively, more often with hard work, but it is unlikely to just go away. Fear reactions arise in the really old parts of the brain before your cortex(higher brain centers)have a chance to rationalize whether or not it is appropriate under the circumstances.

Sincerely,

vj

Customer: replied 6 years ago.
Thanks again.
I worry about each physical thing and sometimes I really let my fears spiral. Like I am worried that the calf pain and the soreness in my arm are related to the head aches and are neurological symptoms of something. Part of me thinks that is a nutty idea but another part of me is afraid.
I don't know if I should see a neurologist or accept that there is nothing serious going on.
Expert:  Victoria replied 6 years ago.
Tell me a little more about the soreness in your arm.
Customer: replied 6 years ago.
I woke up a few weeks ago and my right arm hurt as if I had been working out when I hadn't. It went away in about 2 or so days but it seems to be back again. It just kind of appeared again during the day at work today for no apparent reason.
Expert:  Victoria replied 6 years ago.
Where was the pain and what kind of pain was it? What is the nature of your work activities?

Does the arm pain and the calf pain feel similar?
Customer: replied 6 years ago.
The arm pain feels a little different this time. It feels almost muscular. I have had some muscle tension in my neck/shoulder on that side.
I have a sedentary job and use the computer a lot.
The pain in the calf and in my arm don't feel similar.
Expert:  Victoria replied 6 years ago.
Sitting at a computer all day can explain muscle tension in the neck and shoulders, headaches, arm pain, especially the forearm/wrist/fingers and calf muscle tightness and soreness as a function of maintaining prolonged relatively static postures with a paucity of movement in the joints and rhythmic muscle contraction-relaxation of contraction-elongation and sustained intramuscular pressures. Active muscles need more blood flow to support increased metabolic demands, but when a muscle is maintained in a state of near constant tension, even though relatively speaking the tension is low grade (e.g., holding your forearm poised over a computer all day) the result in very little change in the pressure within and between adjacent muscles. This lack of change in pressure gradient acts to slow blood circulation through a metabolically active tissue that requires more not less blood perfusion to function optimally. You need to get a stretching routine that you can do at your desk for your arms, neck and shoulders, as well, as getting up walking around a few minutes per hour. I would also suggest a massage and using moist heat on posturally-induced muscle soreness and stiffness.

Hopefully this was helpful. These are complaints I see everyday in my practice. Clicking accept, positive feedback and/or bonuses are always greatly appreciated. Thank you.
Customer: replied 6 years ago.
So you do not think it is something terribly serious?
Expert:  Victoria replied 6 years ago.
Good morning - well it is morning for me, but approaching lunch time for you.

No, I do not think it is something serious. If something changes keep me posted, but right now you have nothing to fear.

Sincerely,

vj

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Victoria
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25 years overall experience in health care from hospital-based intensive care to private practice