Have a lovely weekend!
|About to get my IV line inserted at the hospital.|
|IV line ready for contrast when I get the CT Angio.|
|Bruising from the IV line.|
|I have no idea what is being shown in this image beside my kidney.|
Nutcracker has reportedly produced POTS symptoms in some individuals. Nutcracker phenomenon (NC) is the congestion of the left renal vein due to its compression by the aorta and the superior mesenteric artery (Takahashi, Ohta, Sano, Kuroda, Kaji, Matusuki & Matsuo, 2000). The main and common findings of one study on pediatric NC patients were chronic fatigue associated with orthostatic hypotension and/or postural tachycardia (Takahashi, Ohta, Sano, Kuroda, Kaji, Matusuki & Matsuo, 2000). The authors of this study point out that "the originally reported symptom of NC is renal bleeding. However, reported 'renal bleeding' patients, including ours, have no complaints of chronic fatigue and our 'chronic fatigue' (NC) patients have no renal bleeding". Some of these patients did report fibromyalgia type pain. Some patients had proteinuria,others had no urinary abnormalities.
The authors of this study explain the various ways in which NC might affect autonomic function: First, severe congestion in the kidney may cause the expansion of the renal venous bed, which would affect the renin-angiotensin system. Secondly, severe congestion in the adrenal medulla, which is innervated by sympathetic nerves, may disturb a complex set of central neural connections controlling the sympathoadrenal system. On the other hand, overproduction or night retention of catecholamines might be responsible for the various symptoms of pediatric chronic fatigue syndrome (Takahashi, Ohta, Sano, Kuroda, Kaji, Matusuki & Matsuo, 2000). The nutcracker phenomenon occurs in adults as well as children. Transluminal balloon angioplasty has successfully been used to treat compression of the left renal vein between the aorta and superior mesenteric artery (Takahashi, Sano & Matsuo, 2000).
The methods used to diagnose nutcracker phenomenon include Doppler US, MRI and three-dimensional helical computed tomography. Dr. Takahashi (personal communication, September 8, 2002) explains the procedures for testing as follows: Conventional ultrasound requires patients to be examined for left renal vein obstruction in 4 positions: supine, semisitting, upright and prone. Nonvisualization of the left renal vein lumen or absence of the left renal vein wall between the aorta and superior mesenteric artery is regarded as signifying left renal vein obstruction. Doppler color flow imaging can be used to locate a blue-colored blood stream flowing to the dorsal direction. This is a collateral vein flowing from the left renal vein into the paravertebral vein. With MRI, oblique coronal images along the left renal vein, and also axial images, are recommended to visualize the collateral veins around the left renal vein. Read more
Does severe nutcracker phenomenon cause pediatric chronic fatigue?
Background: In the past five years we experienced 9 fatigued disabled children who were intermittently or persistently absent from school.
Patients: They had been suspected to be burdened with psychosomatic disorders, having orthostatic hypotension, postural tachycardia, or other autonomic dysfunction symptoms.
Results: Investigating the cause of moderate orthostatic proteinuria in some of them, we found by chance severe typical nutcracker phenomenon (NC), which was present in all 9 children complaining of chronic fatigue.
Conclusion: Their symptoms filled the criteria of childhood fatigue syndrome or idiopathic chronic fatigue (CFS/CF). An association between severe NC and autonomic dysfunction symptoms in children with CFS/CF has been presented.
From the nutcracker-phenomenon of the left renal vein to the midline congestion syndrome as a cause of migraine, headache, back and abdominal pain and functional disorders of pelvic organs.
"What is Prolotherapy?
Prolotherapy is a simple technique that stimulates the body to repair a painful area when the natural healing process needs some assistance. It involves the treatment of two specific kinds of tissue: tendons and ligaments. A tendon attaches a muscle to the bone and aids in movement of the joint. A ligament connects two bones and aids in the stability of the joint. A strain is defined as a stretched or injured tendon; a sprain, a stretched or injured ligament. Once these structures are injured, the immune system is stimulated to repair the injured area. Because ligaments & tendons generally have a poor blood supply, incomplete healing is common after injury. The incomplete healing results in these normally taut, strong bands of fibrous or connective tissue becoming relaxed and weak. The relaxed and inefficient ligament or tendon then becomes the source of chronic pain and weakness*.
Prolotherapy involves the injection of a solution generally consisting of dextrose, lidocaine (an anesthetic), and vitamin B12, which causes a local inflammatory response. This localized inflammation triggers the body's own healing cascade, resulting in the deposition of new collagen**, the material ligaments and tendons are made of. New collagen shrinks as it matures, tightening the structure that was injected and making it stronger. The resulting ligament & tendon tissue can be thicker and stronger than normal tissue, up to 40% stronger in some cases.
A typical prolotherapy treatment plan involves 4 to 6 sets of injections, done in series. Anywhere from 3-10 sets of injections may be necessary depending on the complexity or chronic nature of the problem. Each set is done 2-4 weeks apart and may involve the injection of several different sites around the joint being treated. Prolotherapy has a cumulative effect; each treatment builds on the previous one to increase tissue strength and improve joint stability. Over time this will lead to the desired effect of pain relief. You should not assume prolotherapy will not work if you do not see benefits after 1 or 2 treatments. In some cases, because of nutritional, metabolic, or hormonal abnormalities, your body may not be able to mount an adequate healing response. If you do not experience any improvement in your symptoms after 4 treatments, chances are you will not respond to prolotherapy and additional treatments are usually not recommended. Once a plateau in improvement is reached, treatment will stop."
*All of my tissues are relaxed and weak.
**The controversial part of the treatment for EDSers stems here: will creating more faulty collagen stabilize the joint or not?