How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. Chip Your Own Question

Dr. Chip
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 21197
Experience:  Over 20 yrs of Family Practice
Type Your Health Question Here...
Dr. Chip is online now
A new question is answered every 9 seconds

My rt forearm spontaneously swelled w/ pitting edema on 1-17-13

Resolved Question:

My rt forearm spontaneously swelled w/ pitting edema on 1-17-13 & while it's subsided, it is still present & I now have nerve pain. No injury, bite, recent surgery, cancer, etc) I've had every test (blood, ultrasounds, venogram, MRI & acupuncture) & everything came back NEGATIVE. I even developed a rare brachial vein DVT 2/15/13 that resolved after about 2 wks w/ a course of lovenox + coumadin. Ten Drs have "never seen it" & "can't explain it" & have dismissed me w/o a recommendation. HELP!!!
Submitted: 11 months ago.
Category: Health
Expert:  Dr. Chip replied 11 months ago.
Hi--did you have nerve conduction studies of the arm and an MRI of the neck and chest?
Customer: replied 11 months ago.


Oh, yes. I forgot about the EMG (I think that's what it was called) "nerve test" & a chest x-ray...both negative.


I also had xrays of my spine taken recently but no MRI on neck or chest.


 

Expert:  Dr. Chip replied 11 months ago.
OK--just your forearm is involved and not the upper arm?
Customer: replied 11 months ago.

My forearm from just above my wrist (about 2") to just past my elbow. The elbow region seems to be where the most swelling is currently.


The MRI suggested that I have very slight 'tendinosis' and subcutaneous swelling (which is obvious). It comes and goes with use of my arm and the nerve pain is sometimes significant.

Expert:  Dr. Chip replied 11 months ago.
OK--you said the DVT had resolved--can you tell me exactly what you meant by its resolving?
Customer: replied 11 months ago.


On Feb. 15th I was dianosed with the DVT but the swelling had been present for one month prior to that diagnosis but without pain.


When I felt pain in my bicep, I figured a possible clot so I went to the ER and they confirmed that with a venous ultrasound.


My hemotologist then gave me those really fun Lovenox shots to take every 12 hours for a week along with a course of coumadin, which I finished about 2 weeks of, and upon revisiting the ER (bc I developed more of the same swelling along with nerve pain and I got scared) they repeated the venous ultrasound and found that the clot was gone.


My hemo kept me on coumadin for a few days but then took me off of it all together because she said that it was very rare to have a DVT in that vein so she said more of the coumadin (which I asked to be taken off of asap...I was thinking 3 months...) wasn't warranted.

Expert:  Dr. Chip replied 11 months ago.
OK--sorry for dwelling on this but you didn't have a second venogram to show that there was no clot left?
Customer: replied 11 months ago.


No worries, I've been dwelling for almost 4 months on this. And sorry for the delay, I was consulting my notes for clarity.


That is correct. I had one venogram only, following the DVT diagnosis & course of coumadin.


The DVT was diagnosed via venous ultrasound, not the venogram.


The venogram was clear (after the ultrasound showed no clot).


I have not had another venogram since.


My hemotologist said that there shouldn't any swelling left since the clot is gone but...the swelling came first.


The clot isn't what caused the swelling...


If it matters, I am 5'7", 130 lbs., fairly athletic & avid health conscious eater = otherwise (very) healthy.


 

Expert:  Dr. Chip replied 11 months ago.
OK--just one more question--was a lymphagiogram considered--like a venogram but looking at your lymphatic vessels and not your veins?
Customer: replied 11 months ago.


It was considered but unwarrented for some reason...


I have been 'dimissed' as I said by my primary (& other Drs) who suggested that I visit one of the University hospitals (I am near Chicago) where someone there may have seen this type of thing before because they see 'unusual' pt conditions but none of them could direct me to which field of practice I should begin at because none of my tests came back positive for anything. Is there such a thing as a 'lymphatics specialist'??


I've done that LDM and it doesn't seem to do anything... ??

Expert:  Dr. Chip replied 11 months ago.
OK--the type of specialist you'd be looking for would be a neurologist and perhaps a vascular surgeon if this were a problem with lymphatic blockage but first the cause would need to be found so I would get an MRI of your chest and upper arm to look at that. I don't think this is a tumor in your neck or in your axilla, but that could be the problem. That said, you may well still have a clot in a vein in the same area that just hasn't been detected as yet. Finally, with the nerve symptoms, you could have reflex sympathetic dystrophy which is a type of nerve inflammation that is usually seen after injuries but not always. I would suggest at this point that you first consult a neurologist and a vascular surgeon at one of the University teaching hospitals.
Customer: replied 11 months ago.


Thank you for your replies, I appreciate your help.


I have a question though. You said that there may still be a clot there but wouldn't that venogram have picked that up?


That venogram was done after the ultrasound confirmed the clot was gone.


And, wouldn't that EMG be positive in some way if there was some nerve inflammation present?


Frankly, all of these tests are seriously 'adding up'!!


Have you seen this before?

Expert:  Dr. Chip replied 11 months ago.
Depends on the kind of venogram and if we're talking about a clot outside the brachial vein that might not be seen on ultrasound or a standard venogram. The EMG alone wouldn't rule out RSD but I just added that possibility to give you the complete differential here. Yes, I have seen this before and it has been either a missed venous clot or a lymphatic obstruction in the patients I have had.
Customer: replied 11 months ago.


Thank you. Ok, well one last note then.


Is it possible to have a lymphatic obstruction without injury that developed "spontaneously"?


Regarding the RSD, I seem to only have the pain & swelling symptoms and none of the others that typically accompany that.


And...so I should look for a vascular specialist and they will look into the lymphatic issue possibility for me?


Thanks again.

Expert:  Dr. Chip replied 11 months ago.
No--usually there's either a tumor or sometimes a past infection can block the lymphatics. Pain and swelling alone can be seen with RSD. And yes--a vascular surgeon is the one to evaluate a lymphatic obstruction. You're very welcome but please let me know how it goes and please remember to rate my service to you
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 21197
Experience: Over 20 yrs of Family Practice
Dr. Chip and 3 other Health Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4013
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/NU/nursescare4u/2013-3-31_03429_JApic.64x64.jpg Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4013
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Doctor

    Satisfied Customers:

    102
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    5575
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/drphophalia/2007-08-23_095626_dr._arun_phophalia.jpg Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    16265
    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • http://ww2.justanswer.com/uploads/VA/VANP/2012-6-6_235535_Skye2.64x64.jpg A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    12090
    Board Certified NP, MS, RN. Private practice & hospitalist
  • http://ww2.justanswer.com/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Doctor (MD)

    Satisfied Customers:

    8726
    Over 20 yrs of Family Practice
  • http://ww2.justanswer.com/uploads/neurosurg/2009-10-06_120923_profile.jpg Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    6234
    U.S. Physician/Surgeon in Neurosurgery