Dr. Cranquis' Mumbled Gripes

HANDS AND FEET SWELL WHEN I TOUCH SOMETHING COLD

So I developed this issue about a year ago: If I hold a cold drink my hands swell up. It’s semi-painful and nothing seems to get rid of the swelling. It goes away after about 48 hours. My feet do the same thing if I walk outside barefoot and the concrete is cold.

I went to a doctor and had blood work and xrays done and they couldn’t find anything wrong with me.

Any ideas?

Thanks!

Yeesh. This is a toughie. If I was forced to guess (such as, with an ice cube being held to my temple or something), I’d be torn between (1) Raynaud’s Phenomenon (but without the usual color changes?) or (2) Cold-Induced Urticaria (which usually looks like hives, but I suppose if the stimulus was just on the hands/feet, the hives would cause diffuse swelling?).

But I don’t have enough data to say anything further — you mention swelling of hands and feet only, but you don’t mention color-change, or numbness, or whether a cold exposure to other parts of the body also causes swelling (i.e. the Ice Cube Test, where you place an ice-cube on your skin and look for welts/hives to develop in the area — a simple diagnostic test for cold-induced urticaria.) You also don’t mention whether the swelling goes away quicker if you run warm water over the swollen areas.

I’m bemused that they did “xrays” as part of the workup. What did they expect to see? I’d think a more useful (though not necessarily diagnostic) test would be a doppler ultrasound to measure blood flow before and after cold exposure.

Anyhoo, I’d recommend seeing a rheumatologist about this, for starters. Good luck, and stay warm!

***Pending Cranquis-Mails: 3; Inbox: Closed***

Recurrent UTI’s, Cold Sores, and Bumps Behind the Ears

Hi Dr cranquis! I tend to get recurrent uti’s a lot as well as cold sores. Any recommendations to prevent either? 
Also let me attempt to fit in another question.. .. my relative has bumps behind his ears which are probably swollen lymph nodes. What could it be indicative of? 
Thank you x1000000! 

Yeah, I think X1000000 Thanks is about right, since you included about 1000000% more questions than should be legal for One Cranquis-Mail!

Therefore, I dub thee: Poly-Extra Pants. However, all the topics of your question(s) have been discussed on the blog in the past, so my reply isn’t X1000000 difficult to produce.

1) Recurrent UTI’s: This old post discusses some ways of trying to prevent them — and also mentions an often-overlooked cause of “UTI symptoms” which might not be “infectious” at all (interstitial cystitis).

2) Recurrent Cold Sores: If they are true “herpes simplex cold sores”, some basic lifestyle interventions might help prevent flare-ups. This post discusses those, as well as OTC/prescription options for treatments.

3) Bumps behind the ears: You’re right, those are most likely swollen post-auricular lymph nodes. This post discusses some rough guidelines on “When to start worrying about lymph nodes”. However, your description of your relative’s “bumps” is quite vague (size? pain? color? firm? oozing? etc?), so it’s impossible for me to guess if they’re lymph nodes vs skin infection vs insect bites vs fat-cell deposits vs plugged sweat ducts vs… Yes, as you can see, the possibilities are many. :)

Have a poly-extra super day!

***Pending Cranquis-Mails: 4; Inbox: Closed***

Food Comas and Rashes

Hello Dr. Cranquis!

I have a two part question. 
After eating a meal, whether it be at breakfast, lunch, or dinner, (or a midnight snack), I tend to feel drowsy and sleepy after eating. I’m not sure as to why this happens most of the time, but it is starting to interfere with my school work at college. I do get about 6-8 hours of sleep every night and regardless of that, I still manage to feel sleepy/drowsy after eating. It has come to a point where I will skip my lunch break in between classes so that I do not fall asleep in class. Could you help me out and explain how to prevent this from happening?

Also, part two of my question is that I have gotten two rashes since the winter. They are located on my back left hip and do not seem to go away. I have tried searching what I have through the internet, but have only come across that it is a rash and believe that it is something else. At times, they will get very itchy regardless if I am wearing any clothing. I also noticed that when I do itch it, the ‘rash’ becomes itchier until it feels painful because I am breaking the skin to a point of very minor bleeding. If the rash is not itchy and I accidentally itch (or activate) the rash, then it becomes very itchy as well. I am unsure of what this is and how to go about treating it. 
Here is a picture of the ‘rash’: http://i41.tinypic.com/21brko6.png

I would like to hear what you have to say about these two topics and would appreciate the advice!

Thank you,
Fellow Tumblr 

Howdy! Now, let’s be clear: what you submitted was not a “two part question” — it’s two separate questions. I’ll let it slide… for now… :)

1) Your postprandial somnolence (feeling sleepy after eating) could be totally normal, or not. Hard to say, based on the few details you provided. If you were my real-life patient, I’d get some of these details out of you:

• Has this been going on all your life, or is it a recent development?
• Have you developed any symptoms consistent with a thyroid or adrenal condition?
• Does the amount of sleepiness vary, depending on whether the meal is high in protein vs carbohydrates?

And if nothing helpful came out of that search, along with some basic lab-work, I’d send you to either an endocrinologist or a sleep specialist for further evaluation. But for now, I gotta admit, I’m, uh, really not sure what to suggest?

2) The picture of your rash makes it a bit easier to understand what you’re describing. Your rash looks quite suspicious for either (a) some kind of contact dermatitis (Do you wear anything metallic or dyed that is in contact with those particular spots on your body? A wallet-chain, a belt, an iPod waist-strap, a fanny-pack? Something you wear during working out? You may be allergic to that), or (b) ringworm (Do you have any pets with hair problems? Do you participate in contact sports, such as football or wrestling?) My best advice, when it comes to rashes that don’t go away after trying basic over-the-counter creams for a couple weeks, is: let a doctor actually examine the rash. All the pictures and words in the world don’t outweigh the diagnostic value of being able to touch and see a rash in person.

Good luck! And no more two-for-one questions in the future, k?

***Pending Cranquis-Mails: 6; Inbox: Closed***

Bump on Arm

Hello, 
I have been a huge fan of your blog for a while. It’s always entertaining and informative. Ok, so now for my question. I have this bump on my arm that has been there for about 2 years. It showed up very suddenly, and it hasn’t grown/shrunk at all. It doesn’t hurt even if I press down on it. It feels as if there is a chunk of play do stuck in my arm. I haven’t seen a doctor about it, mostly out of some sort of irrational dislike of the doctor’s office, so I was wondering if there was anything you could tell me about it without actually seeing it, even though I realize there probably isn’t. I am 19, healthyish, in that I don’t get sick much, but I don’t eat so great and I don’t exercise much at all. 

Thank you so much for everything that you do. Your blog is awesome! 

Hello yourself! Thanks for reading.

As I always say when replying to skin-related questions without being able to see and touch the questioner’s skin: It’s hard to answer a skin-related question without being able to see and touch the questioner’s skin. But what you’re describing sounds most like a lipoma, which is a non-cancerous growth of extra fat cells.

(No, I did NOT just call you “fat” — though it would never hurt to eat and exercise better!)

If the lump starts to hurt, gets bigger than an inch in size, or drains pus or blood, then have someone check it out for sure! :)

*Pending Cranquis-Mails: 8; Inbox: Closed*

WORSENING DRY SKIN 

Hey Dr. Cranquis,

I’ve had the very vague diagnosis of “dry skin” since childhood and thought I was familiar enough with it, but this year (I just turned 20) the dryness seems to have gotten worse. My legs, which have always been driest, now seems to have a very light pink rash that doesn’t itch at all. Recently the knuckles on the back my hands became inflamed and itched like crazy, but slathering on moisturizer meant for eczema soothed the irritation. Up until now I’ve only been self-treating, but when should I throw in the towel and finally see a dermatologist?  

Ok, let’s clear up our terms from the beginning, Eczema Factor — “dry skin” and “eczema” go hand in hand (and leg in leg, in your case). Your skin is a complex organ that relies on a fine balance of water moisture, oils, and ambient humidity to stay healthy. If your skin is always dry (either from internal health conditions, your surrounding environment, genetics, or whatever), that will lead to a variety of (usually itchy) rashes which fall under the general heading of “eczema”. 

I’ve discussed some of the basics of treating eczema in prior posts, so check those out. Sounds like you’ve been moisturizing, which is good; be sure to do that as soon as you are done bathing, while your skin is still damp. Make sure you haven’t been using extreme temperatures of water in your bathing, and in general don’t spend too much time in water: the 1 Hour Shower of Power is a bad thing for people with dry skin. For flare-ups of itchy/inflamed/red skin, try some topical corticosteroids (hydrocortisone 1% is the most common over-the-counter option — it’s very mild, but may work if your outbreak is early and not wide-spread).

But if all those interventions stop working, then yes, a visit to a dermatologist (or a knowledgable primary care physician) would be next on the docket. Sounds like for right now, though, “moisturizer meant for eczema soothed the irritation” — you probably don’t need to rush in right away. May your skin stay moist and may your days be itch-free.

***Pending Cranquis-Mails: 1; Inbox: Closed until Cranquis gets back from vacation***