Science & Medicine

Arch’s Corner – May

Congratulations MPNforum on your First Anniversary.

“Forum…a public meeting place for open discussion, a medium of public discussion” ..Webster.  Our public meeting place is right here at MPNforum and I am humbled and honored, not to mention pleased and proud to have been accepted and welcomed in my small corner of it.

We have met regularly for a year now and at each gathering an ever larger group has discussed myeloproliferative neoplasm issues in a public medium available to anyone and everyone interested in these merging pathological entities. Our discussions have ranged over a large part of the MPN spectrum from in depth reports of leading edge research to a variety of personal experiences with the disease.

Led by our founder, mentor and fellow MPN patient, Zhenya Senyak aided by an experienced array of patients and caregivers who have something to say and know how to say it, MPNforum has carved out a significant position for supporting and helping to bring to public attention the many and varied aspects and phases of a life with MPN.  With its innovative in-depth magazine format MPNforum has clearly filled a need not met by other internet support groups. It has been or hopes to become a complementary adjunct to every group and any individual concerned with MPN from basic research to individual patients –always inclusive, never exclusive. In the words from a popular older Britcom, “You’ve all done very well”.

I’ve made my point and before I get a frozen shoulder from patting our backs, I better sit down in my corner and resume being the company curmudgeon. Hopefully more often the loyal opposition. Am I egocentric?  Of course. Aren’t we all?  Some show it with reversed humility, others with poorly disguised self-promotion, most of you with simplicity and honest restraint.

In whatever ways we show our egocentricities we are all interested in our own medical problems

…and I plan to use my bully corner to bore you with two problems that many of us have that seem to get short shrift.  At least they are seldom, if ever, mentioned by name on MPN Lists, but must be a common cause of painful symptoms and signs in the lower legs, ankles and feet.  I refer to ‘stasis dermatitis’ and ‘tarsal tunnel syndrome’. Naturally I have both maladies or I would mercifully end my column here. Woe is me!

Neuropathy, erythromelalgia, Reynaud’s and peripheral artery disease are all given their rightful places when the differential diagnoses of painful affectations of the lower extremities are discussed on MPN support lists.  Stasis dermatitis and tarsal tunnel syndrome seem to me to be missing from the list of usual suspects.

Stasis Dermatitis is the skin’s response to chronic venous insufficiency in which the venous return doesn’t work right causing dermal signs and symptoms.   The skin over the feet and ankles may be red and warm, itchy, painfully numb (paresthesia) with sharp shooting or dull aching pains and/or exquisitely tender to touch. There may be scattered brownish-red patches owing to engorged arterioles and capillaries and iron stains from ruptured red cells.These patches often coalesce and the skin over the entire lower leg, ankles and feet, sparing the soles, exhibits a mottled dirty-brown pigmentation.  Early on the skin is often thin and translucent then conversely may become roughened and scaly.

Scratching often produces a cloud of tiny whitish grey flakes. Later the skin may become thick and indurated. Surfacefissures, Infection and necrosis lead to weeping blackened areas and indolent ulcers. Textbooks and websites love to picture these late stage complications that doctors see, but the early stages are usually what we see  …and feel.
One interesting sign with — a sporty name, “Coke Bottle legs” — is seen with the commonly coexistent  ‘Stasis Pannniculitis’ –a thickening and induration of the layer of fat just beneath the skin (panniculus)  –‘beer belly’ in the abdomen, but in the legs a constricting band around mid-leg causes an abrupt tapering of the leg toward the ankle making the leg resemble an inverted Coca Cola bottle. It’s interesting to me because my alma mater is hugely endowed by Coca Cola zillionaires. I wonder if Pepsi is still banned from the campus and if Dr. Pepper is still considered a quack. But I digress.  :)
In an attempt to salvage my dignity I’ll note that the underlying etiologies and pathologic physiology of the venous insufficiency that causes stasis dermatitis are so many, complicated and varied that for me to discuss with pompous importance (ie. repeat info that I just read on the net that you can read for yourself) would
render my corner puffed up with literary edema even too much for yours truly.
    For our purposes look on it as venous hypertension or peripheral venous disease (PVD),
with characteristics being somewhat opposite to those of peripheral arterial disease (PAD). Okay I’ve made my point about Stasis Dermatitis, ad nauseam. But since I have it myself I want everybody else to know about it. I got mine at an operating table when they swiped all my saphenous veins to make detours around my clogged coronary arteries.
    Tarsal Tunnel Syndrome is well known to runners and cyclists, but for most of us it takes a back seat to its famous cousin, Carpal Tunnel Syndrome. The tarsal tunnel syndrome is a cluster of signs and symptoms seen or felt on the medial (inner) side of the foot resulting from compression of the nerves, arteries, veins and ligaments within the narrow tarsal tunnel. This structure lies just below the medial mallelolus (bump on inside of ankle) surrounded by bone and unyielding aponeurosis (fascial sheath).
    This brings on the dull aches and shooting pains and if ignored the wasting and weakness of the foot.That’s a lot more than I started out to say or that you wanted to read, but I bet y’all won’t forget to include Stasis Dermatitis in your list of possibilities next time you meet up with an ugly brownish or reddish painful affectation of the feet and legs.
     Also you’ll remember the tarsal tunnel syndrome next time you are awakened with a bad hurting in your foot after running the marathon. I leave you now with a bonus suggestion for two tests that your doctor may have done that you can do for yourself, and a lot cheaper. If anybody is still reading and wants to bother, look up Trendelenburg’s test re stasis dermatitis and Tinel’s test re tarsal tunnel syndrome. Or better yet just enjoy a frosty coke.
      Best,   Arch
Take me back to the Contents© Dr. Arch M. and, 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Arch M. and with appropriate and specific direction to the original content.

Comments on: "Arch’s Corner – May" (5)

  1. Coletta Sharits said:

    Dermatitis can be caused by a lot o things. Most of the time it is caused by allergice reaction to some chemicals and biological organisms like bacteria and viruses. Topical corticosteroids helps a lot in alleviating the itchiness.“`”*

    Take care

  2. Kathy Van Meter said:

    Thanks, Arch. My husband gave up wearing shorts in his 40’s ’cause not everyone enjoyed the rusty brown/black shades of his legs. AtracTain cream keeps them moist with only one skin tear in the past year. He ran 3 to 5 miles a day for over 25 years. Ah, the irony. Peace………….

  3. “Apology is only egotism wrong side out.” …O.W. Holmes If so this is an explanation, not an apology. My comments about repeating what I had just read on the net were in reference to MY column and NOT veiled innuendo. That sort of misunderstanding and ideas of reference got me banished from reading about the doings of old friends that have remained on a MPD List. If my columns have hurt the feelings of anyone of my friends here, I truly regret it. A.

    • I love smart people, especially witty ones! My infrared light bulb and my aloe vera is certainly helping me and my tiny trampoline.

  4. Good information! Thanks.

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