Unexplained Symptoms in an 81-Year-Old: Seeking Diagnosis and Solutions

Uncertain etiology?

My grandmother is 81 years old and has a history of gastric ulcers.
She has been using sleeping pills for a long time and occasionally experiences palpitations, for which she takes medication for heart disease.
She also has bone spurs, osteoporosis, and hypertension.
She has been on medication for nearly a year.
Recently, the skin on the soles of her feet appears red and she experiences a painful, prickling sensation.
Her toes also show symptoms that prevent her from walking, and she has a tingling sensation throughout her body.
She has seen many different specialists but has not been able to determine the cause of her symptoms.
Please help diagnose her condition or provide other recommendations.

Fanrao de ziniang, 80~89 year old female. Ask Date: 2010/07/03

Dr. Yang Hongzhi reply Internal Medicine

Many symptoms cannot be definitively diagnosed; however, it may be worth considering the possibility of peripheral neuropathy.
If you have not seen a neurologist, it is advisable to seek medical attention.

Reply Date: 2010/07/03

More Info

Your grandmother's situation is indeed complex, given her age and the multiple health issues she is facing. At 81 years old, she has a history of gastric ulcers, long-term use of sleeping pills, occasional palpitations requiring heart medication, bone spurs, osteoporosis, and hypertension. The symptoms you describe, including redness and a prickling sensation in her feet, as well as a general feeling of tingling or pain throughout her body, are concerning and warrant a thorough evaluation.

Firstly, it is essential to consider the possibility of peripheral neuropathy, which is a common condition in older adults and can be exacerbated by diabetes, vitamin deficiencies (especially B vitamins), or side effects from medications. Given that your grandmother is on multiple medications, it is crucial to review these with her healthcare provider to determine if any of them could be contributing to her symptoms. For instance, certain medications can cause side effects that include tingling or numbness in the extremities.

Additionally, the redness and pain in her feet could indicate several conditions, such as:
1. Circulatory Issues: Conditions like peripheral artery disease (PAD) can lead to poor circulation, resulting in pain and discoloration in the feet. This is particularly relevant given her history of heart issues.

2. Skin Conditions: Dermatitis or other skin conditions could cause redness and discomfort. A dermatologist might be able to provide insights into whether her skin symptoms are related to an underlying condition or a reaction to her medications.

3. Osteoporosis and Bone Spurs: The presence of bone spurs can lead to discomfort and pain, particularly if they are pressing on nerves or affecting her gait. This could also contribute to her inability to walk comfortably.

4. Medication Side Effects: Long-term use of sleeping pills can lead to dependency and withdrawal symptoms, which might manifest as physical discomfort or changes in sensation.

Given the complexity of her symptoms, I recommend the following steps:
- Comprehensive Review: Schedule a comprehensive review with her primary care physician or a geriatric specialist who can evaluate all her medications and health conditions holistically. This review should include a discussion about her current symptoms and any recent changes in her health.

- Neurological Evaluation: A referral to a neurologist may be beneficial to assess for conditions like peripheral neuropathy or other neurological disorders that could explain her symptoms.

- Pain Management: Consult with a pain management specialist who can help address her discomfort and improve her quality of life. They may suggest physical therapy, alternative therapies, or adjustments to her current medication regimen.

- Nutritional Assessment: A dietitian can evaluate her nutritional status, especially considering her age and the potential for deficiencies that could contribute to her symptoms.

- Regular Monitoring: Ensure that her blood pressure, heart rate, and overall health are monitored regularly, especially given her history of heart disease and hypertension.

In conclusion, your grandmother's symptoms are multifactorial and require a coordinated approach to diagnosis and management. It is essential to work closely with her healthcare team to identify the underlying causes of her symptoms and develop a comprehensive treatment plan that addresses her needs holistically. Regular follow-ups and open communication with her doctors will be key in managing her health effectively.

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