Clinical Notes: Patient with Red Leg Rash

Patient complained of onset of red rash on his left leg below the knee in January 2014. Patient described an “unbearable” itch during a 20-minute onset of the condition, and described himself as being kneeled down on carpet at the time. The patient responded with vigorous fingernail itching, leaving red skin contusions. The contusions persisted as petechiae but without any itch.

In July 2014, the patient sought diagnostic testing which revealed he was low in vitamin D and high in cholesterol. The patient had feared autoimmune disease because of rash persistence by this point but testing showed normal leukocyte levels and no autoimmune disease markers.

Physical examination of the leg in July 2014 revealed tortuous varicosities down the center on the backside of the left calf. The patient had only noticed the petechiae prior to this examination, never the varicosities. The patient did not exhibit irregular heartbeat or high blood pressure during the exam. He did not report having had heart pain, but did report a case of viral pericarditis in November 2013, described as sharp, overnight heart pain with inability to take full breaths.

Diagnosis in July 2014 was subcutaneous nerve damage and irritation from deep fingernail itching during the condition’s onset in January 2014. The large varicosities were not explained by this, but the patient only consulted about the red rash.

Examination in December 2014 showed the tortuous varicosities to be in a similar condition down the middle of the left calf, as well as petechiae on the front and back sides of the left leg below the knee.The patient reported having stood up for additional hours each day over the last 6 months as an attempted remedy; the petechiae appeared to be 30-40% reduced, but still prevalent.

The patient also reported heart discomfort during cold mornings, as well as a feeling of fatigue at the end of workdays, characterized by a strong decline in desire/energy to lift weights, as he previously had often done. The patient also described feeling muscle twitches in his left calf muscle during portions of the day and night.

Further questioning about the patient’s diet revealed a borderline low salt diet, limited to a half a teaspoon a day, and sometimes less.

The plan of action has been to start the patient on a higher salt diet starting January 1, 2015.

Specifically the patient is to consume a minimum of 1 teaspoon a day of sea salt. The patient will include a mixture of Spanish sea salt and Himalayan mountain salt in a liquid cocoa mixture each morning. At night the patient will consume a mixture of the salts in warm water with a half teaspoon of honey. The patient is also to eat one salty snack each afternoon, and should lightly salt entrees.

A check up on January 16, 2015 shows 80% remission of the torturous varicosities on the rear left calf. New petechiae spots are limited, with the previous discoloration having faded in color.

The patient reports having increased late day energy and being able to resume lifting weights since beginning the higher salt diet. The patient reported cessation of heart discomfort on cold mornings, as well as cessation of left calf muscle twitching. Incidentally, the patient also reported a remission of preexisting central serous retinopathy in his left eye. The patient also reported cessation of occasional blood leakage from right nostril, a symptom he said had been common after waking in the morning.

The patient describes an amphetamine-like effect for 10 minutes after each night time consumption of the honey and salt water. This is described by the patient as a speeding of the heart, a tingling in the arms and legs, and a strong sense of well-being.

The patient is to continue on the higher salt diet until further notice.

I speculate the patient unintentionally triggered low blood pressure through a low-salt diet. This would explain the clinical low blood pressure symptoms. The torturous varicosities appear to be rapidly diminishing after two weeks of elevated blood pressure. The patient’s previous lack of energy to lift weights can be explained by low blood pressure. The patient’s reported remission of left eye central serous retinopathy in conjunction with the higher salt diet could be explained by remission of steroidal renin and aldosterone levels.

End analysis 01/17/2015: patient’s benelles needed more organic salt to produce correct blood circulation.

Update: 03/21/2015

Examination of the patient’s leg shows continued remission of petechiae rash. The largest varicosity running down the left calf behind the knee still shows bulge but less than in January. The leg is following traditional healing pattern of healing from the calf downward.

Some swelling around the left ankle is present. The patient reported calf pain one night in the past two weeks, but this was in the period that he reported his family suffered from a two week virus causing leg and deep lower back pain.

Patient reported straying from night time salt regiment for most of February. He reported staying on a high level of salt with meals and supplementing with salty potato chips. For the last two weeks, patient reported drinking 2 – 3 cups of raw cocoa. Before bed, patient consumed one cup black tea, one cup honey/salt water, and one glass of red wine. Patient reported “euphoric feelings” after this combination of drinks, including a “softening of the heart” which he defined as a total absence of any heart stiffness or pain, which he describes feeling on occasion at certain times during the day when in certain positions.

The patient reported near complete cessation of nose bleeds, which were a daily occurence for him, since beginning the higher salt diet in January. One of three nose bleeds since that time, he reported having on a day when he had not consumed any salt during lunch. Patient also reported firmer stool since January, with loose stool being normal before that time.

The patient reported, simultaneous to the light swelling in left ankle during the last 7 – 10 days, his left big toe was less likely to turn blue when standing on cold flooring. There is no evidence the better color in the toe is from repaired blood vessels versus a rise in ambient temperatures.

Patient reported exercising for 22 – 25 minutes a day, except for days when affected by the virus.

Patient was instructed to continue current the current regiment.

Analysis: the patient is stiff affected by a stiffening of the heart, brought on by too many years of a low-salt diet. The patient must likely continue on current course for up to a year, or January 2016, before the leg rash remits. The swelling in the ankle could either be a sign of long-term damage, or improvement in blood flow. The treatment is the same either way, so no further diagnostics are needed.

Update:  5/25/2015

Examination of the patient’s leg shows mixed results. The largest varicosity running down the left calf looks generally healthy. The two major blood vessel leaks, one above the left-inside ankle and the other about two inches higher on the calf, both appear to be undergoing a long-term healing process. The leak above the left-inside ankle is shedding skin as a snake sheds, indicating slow repair of deep tissue. There is some swelling inthe left ankle area, generally only on the inside ankle bone.

There are a number of new minor leaks, in particular as a small “blood vessel delta” just above the left-inside ankle, and to the rear of the lower left calf. Additionally, there is a small collection of about nine petechia dots on the patient’s right-inside ankle.

The patient reported near total cessation of honey and salt water since the last visit. He reports eating a significant amount of salt compared to times previous to January 2015, in the form of salted potato chips, salted almonds, and salting entrees. Patient reports having rubbed coconut oil on the affected left calf each night for five weeks prior to the calf shedding skin like a snake. Patient now only takes the coconut orally, using it topically only hen the area with rash is dry or irritated.

The patient reports nose tissue is now highly resistant to bleeding as compared to the few years  He s able to touch and itch his nose in a rigorous manner without bleeding. Previously, light touch would prompt bleeding, and even changes in blood pressure, like squatting.

Patient reports some weight gain; about 5 pounds. Patient reports greatly increased vitality for lighting weights. Patient also reports cessation of a wet cough that had been progressive for about five months prior to January. Patient reports left toe is still apt to turn blue whenever he is cold, or stands directly on a cold surface.

The rash markings are consistent with right ventricle heart failure. There has been vascular damage that appears to be healing, however it is difficult to say how long, and how fully, the repair will take. The cessation of cough and nosebleeds indicate important elements of heart health that have revived. Long-term apotosis and vascular rebuild may be necessary in the lower extremities.

Patient reports about 5 extra minutes of exercise per day in last 6 weeks, along with increased cocoa/chocolate and red wine consumption. I have instructed patient to continue on this course, which is consistent with vascular repair. I have also instructed to continue the high-salt diet, which appears to be the most significant component of recovery, The higher salt diet is slowing and balancing his renin-aldosterone system.

Update:  01 June 2015

Patient reports noticeable recession of central serous retinopathy of the left eye, after a reported period of five years. Patient describes some restoration of color perception in the eye, as well as a modicum of clarity in close-range (8 to 12 inches) central vision, with “pixels dropping out out along the circumference.” Despite this, the patient is still near legally blind in the eye.

Patient also reports sudden significant recession of leg rash, but I have not had a visit from him to make any detailed observation or notes.

 Update 06/20/2015

Examination of the patient’s leg shows positive results. The large varicosity on the left calf looks generally unnoticeable; only one spot about 0.75 inches in length appears to be abnormal, with a stronger bluish color and zig zag pattern.

There has been a significant improvement in the concentrated petechiae. The area above the left inside ankle on the last visit was looking like it could slough off and become ulcerous. Instead, new skin of healthy pallor has replaced the purple circle that was approximately 1 inch in diameter.

There are new petechia spots below the area just described, but they are spaced out and non-ulcerous.

The other large 1-inch circle just below the left calf has morphed into a brownish bruise compared to distinctive petechia, or an ulcer. There are some new petechia spots below this area.

The front of the calf seems to consistently have about 18 to 20 small petechia marks that are not highly visible.

There is a tiny amount of swelling in the left inside ankle upon close examination. The patient reports having had no heart pain. Patient’s weight has increased to 155 pounds, a 5 pound increase since January.

Patient reports a sharp increased ability to lift weights on a daily basis. The patient also reports that the central serous retinopathy in his left eye has reduced sufficiently to allow him to read text, though it is still “wavy”.

Patient reports a near complete lapse in sticking to the original plan for salt consumption. He has been generously salting entrées and vegetables, eating heavily-salted, homemade tomato soup, and incorporating what he calls “tapas” with his chocolate and red wine at night’s end; some combination of salty olives, capers, pistachios, potato chips, and artichoke hearts.

Seeing the better results the patient has achieved, I encouraged him to continue on his path. The key element is keeping the patient’s salt level high, and it matters little which organic manner is employed.

I asked the patient if he had ever become faint after giving blood previously. He responded that he had, nearly every time, including even if only three or four tubes were drawn.

I asked the patient if any other positive or negative changes have been noticed by him. He indicated his nosebleeds are extremely infrequent now, compared to the last five years. Also, his left big toe nail had grown a large amount in the last 30 days. Lastly, his appetite was generally the same, but his stool more firm, as it had been when he was young man; not liquid-like, as during most of the 12 year stretch of low-salt diet.

I speculate the patient has experienced low blood volume and blood pressure for the 12 years of his low-salt diet. This would explain his reduced tolerance for weightlifting and hypersensitivity to blood draw during that timeframe.

I further speculate salt helps down regulate this patient’s naturally-aggressive metabolism. The lack of salt was leading to improper absorption of nutrients—in a sense causing him to starve, despite eating correctly. Here, the return to firm stool is the indicator.

Central serous retinopathy was likely triggered by increased renin levels due to low salt intake.

End analysis 06/20/2015: six months of a high salt diet seem to be curing the leg rash, and also: a heart problem, eyesight issues, a metabolic problem, and general blood pressure problems.

Update 10/26/2015.  Patient reported that his lower molars on both sides are no longer hurting if he eats ice cream or dried cranberries. he had ceased to eat them for the last 3 years because of tooth pain. In conjunction with this, the patient reports a lessening of his leg rash but claims to be too busy for me to make a clinical evaluation at this time. Patient also reported discontinuing salt on days of an event where high stress/high blood pressure were assured; then resuming salt after the event.

 

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