Q: My former doctor retired and I went to see a new young doctor to get
my arthritis pills refilled. He did this, but also gave me a water
pill, furosemide, and potassium chloride. Two weeks later, I developed
two red-blue round sores on the back of each leg below the knee in the
muscle area. It was bigger in the weaker, arthritic leg. What is this
and what caused it? Could the heavy dose of furosemide (Lasix) cause a
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blood clot or blockage in the artery?
A: First, I will reassure you that it is unlikely that these red-blue
patches are anything to do with blockages in the arteries or blood
clots. These would be painful and bright red if they were in the
superficial veins or you would not see any red spots at all if there
were clots in the deep veins or arteries.
There are two other possibilities. Lasix can sometimes cause a type of
anemia, which can lower the number of platelets in the blood. The
platelets are responsible for the normal clotting of blood, and if they
are depleted you can bruise easily and bleed under the skin. These
could be the reddish-blue patches. Get your doctor to do a blood count
and see if it is normal. If the platelets or red or white blood cells
are low in numbers, the Lasix should be stopped immediately.
Just to confuse the issue further, the arthritis pills can also cause
this situation to occur. You may have to stop all the medications at
once, and then reintroduce them one at a time to see which is causing
the problem. The potassium chloride is just a dietary supplement and is
unlikely to be a culprit if taken in small doses.
The patches you describe might also be a skin condition known as
erythema nodosum. I do not know what type of arthritis you have since
there
are many different varieties, but patients with rheumatoid arthritis,
lupus or other auto-immune disorders, can develop these spots on the
back of the legs.
Erythema nodosum can also be a sign that there is some infection
present in the body that you may not be aware of. The cure is to find
and treat the underlying condition and the patches will gradually fade.
As they go, they will turn a bluish purple, like a bruise.
Treatment for psychiatric disorder
Q: What treatment is available for young people suffering from
psychiatric disorders? Are there any group homes in Saskatchewan that
can teach them to live with the condition and control their medication?
A: Unfortunately, community resources for children and adolescents
suffering from psychiatric disorders are sparse in most provinces. I
was on a committee looking into this problem in Alberta and there is
definitely a lack of government funding in this area. It may be because
the numbers are low compared to the adult population. There is also a
shortage of child psychiatrists and an even greater shortage of those
specializing in the care and treatment of teens.
There are a small number of group homes, but these are mainly for
children who are educationally handicapped, and whose behaviour is so
disturbed that they cannot be managed in their own homes. Community
mental health services usually offer treatment for children as well as
adults.
There are support services for certain types of psychiatric illnesses,
such as, the Friends of Schizophrenic Association, which gives a lot of
help and advice to patients’ families.
The Canadian Mental Health Association has branches in Saskatchewan.
You can e-mail the
organization at cmhask@accesscomm.ca, write
1011-102 St., North Battleford, Sask., SGA 1K3,
or phone 306-446-7177.
Clare Rowson is a medical doctor with a practice near Belleville, Ont.
Her columns are intended for general information only. Individuals are
encouraged to also seek the advice of their own doctor regarding
medical questions and treatments.
