Lower Body Heat: Which Specialist to Consult?

If you are experiencing heat in the lower body, which specialist should you see? Which doctor? (Forwarded from the Director's mailbox)

My mother has been experiencing heat in both of her legs, and she has to rinse them with cold water several times a day.
When she soaks her calves in cold water, the heat seems to transfer to her thighs, and the warm sensation remains in her lower body (legs).
Using air conditioning provides some relief.
She has been consulting various doctors (hematology, neurology, and surgery), and a neurosurgeon mentioned bone spurs.
If it were bone spurs, wouldn't there be numbness in the lower body? (Conditions such as degenerative joint disease, osteoporosis, osteophytes, and sciatica can cause symptoms like soreness, cramping, pain, numbness, and tingling.) How can it be heat-related? The heated areas cool down when exposed to cold water, but the heat in her thighs persists.
The sensation of heat has been present for 3-4 years, and it has worsened since May of this year.
Which specialist should she see? What is the appropriate medical specialty?

Ms. Zhang, 30~39 year old female. Ask Date: 2013/06/13

Dr. Gao Qingyun reply Family Medicine

Dear Ms.
Chang,
Hello.
The issue you have described requires an examination of the lesions for proper assessment.
I recommend that you consult with a physician in the Allergy, Immunology, and Rheumatology department to discuss your concerns.
Thank you.

Wishing you peace and good health,
Dr.
Gao Qingyun
Attending Physician, Family Medicine Department
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2013/06/13

More Info

When dealing with unusual body heat, particularly in the lower extremities, it is essential to approach the situation with a comprehensive understanding of potential underlying causes. Your mother's experience of persistent heat in her legs, which seems to improve with cold water immersion or air conditioning, raises several considerations that warrant further investigation.

Firstly, the sensation of heat localized in the legs can be attributed to various factors, including circulatory issues, nerve-related conditions, or musculoskeletal disorders. Given that she has already consulted specialists in hematology, neurology, and orthopedics, it may be beneficial to consider a multidisciplinary approach. Here are some potential avenues to explore:
1. Rheumatology: If there is an underlying inflammatory condition, a rheumatologist can evaluate for disorders such as rheumatoid arthritis or other autoimmune diseases that may cause localized heat and discomfort.

2. Neurology: Since you mentioned that she has seen a neurologist, it is crucial to ensure that any nerve-related issues, such as peripheral neuropathy or radiculopathy, are thoroughly assessed. These conditions can sometimes manifest as abnormal sensations, including heat, in the extremities.

3. Vascular Surgery or Cardiology: Given that the sensation of heat may be related to blood flow, consulting a vascular specialist could be beneficial. Conditions such as venous insufficiency or peripheral artery disease can lead to abnormal temperature sensations in the legs.

4. Pain Management or Physiatry: A specialist in pain management or physical medicine and rehabilitation can provide insights into musculoskeletal issues, including the effects of bone spurs (osteophytes) and degenerative changes in the spine or joints. They can also recommend therapies to alleviate discomfort.

5. Endocrinology: Hormonal imbalances, such as those related to thyroid function, can also cause temperature regulation issues. An endocrinologist can evaluate her hormone levels to rule out any endocrine disorders.

6. Dermatology: If the heat sensation is accompanied by skin changes, a dermatologist may be able to identify any skin-related conditions that could contribute to the sensation of heat.

In terms of the relationship between bone spurs and the sensation of heat, it is important to note that while bone spurs can cause pain and discomfort, they typically do not directly cause localized heat. However, if the spurs are irritating nearby nerves or causing inflammation in the surrounding tissues, this could potentially lead to abnormal sensations, including warmth.

Given that your mother's symptoms have persisted and worsened over the past few years, it is crucial to pursue a thorough evaluation. A comprehensive approach that includes imaging studies (such as MRI or ultrasound) and laboratory tests may be necessary to pinpoint the underlying cause of her symptoms.

In summary, the best course of action would be to consult with a rheumatologist, neurologist, or vascular specialist, depending on the specific symptoms and findings. A multidisciplinary approach may yield the best results in diagnosing and managing her condition. It is essential to communicate all symptoms clearly to the healthcare providers to facilitate an accurate diagnosis and appropriate treatment plan.

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