Weird changes in my nails

[Dr. Diana]

Ewww… My nails are developing longitudinal ridging (I think that is poor nutrient absorption), redish ends, and they are flattening. Jeez, Louise. Kidney trouble? Does anyone else show this? Thanks!

[MGC.]

Yep, sure do. If I do not keep my fingernails cut short, they are almost flat on the ends. I have vertical ridges on a couple. And the nail on one of my great toes is starting to curl under. I guess I will have to try to see a Dermatologist soon!

[Dr. Diana]

Gosh, do you think a dermatologist would know? It seems more like general medicine… I know my little white dots are poor zinc absorption, the longitudinal ridging is likely poor nutrient absorption overall, but the red ends I read may be kidney issues? yeeks.

[mother1991]

I have ridging on all my nails as well. They are soft, and will be break easy. More than likely due to all my deficiencies as well. I have multiple ones. I am now currently getting multi vit IV infusions was for monthly but being changed to weekly. Hope in a couple of moths I am not as tired and crappy feeling as i am now.

[Dr. Diana]

Hi Mother1991, I had a thought. Do you know if you have mast cell disease? I’m on treatment for that, and if the mast cells are in your GI tract, you will show IBS-type issues. This week, I was also a bad girl and pigged out on cupcakes 3 days in a row (I know. Bad, but they were a gift – How could I not eat them?). Well, I ALSO developed a systemic YEAST infection in my GI tract. I had the white tongue, feeling of bloating, etc.
I had that one other time, so I knew what to do, but talk about bad nutrient absorption! Do you think you may have either of these conditions?
🙂

[mother1991]

The mast cell disease I will definately bring up when I see the dermatologist on the 27th at UCLA because of the erythema rash and swelling of my right arm that is still undiagnosed. The swelling is worse around wrist. I have had in Sept last an endoscopy and colonoscopy with many biopsies to determine if possible vasculitis, lymphedema, protein losing enteropathy ect. All biopsies were normal except for focal intestinal metaplasia cause unknown but possible to bile. This is in my stomach. ANA, PANCA, other autoimmune disorder tests all negative. In May I had an enteroscopy performed because on a CT with contrast Abdomen pelvis done in March 2011 showed an intusseption at the Juejunojuno stomy. This was also on Ct from Oct 2010 as well. At the time no sign but there was a couple of ulceration patches in the efferant limb and biospies were taken. Also clips had to be placed due to bleeding. Result was thought to be from old injury and healing. Concluded it is an intermittant intusseption. I am not candidate for surgery as thought may have been there before surgery or develope afterward. Because of way reacted after gastric bypass surgery, malabsorbtion, current chronic nausea, EDS, and multiple vitamin deficiencies I am not a condidate for surgery. The doctors feel it will more likely develope again. Right now the intermitant intusseption does not compromise the small intestine. If it does then surgery will have to be performed.

My vitamin deficiencies are Vitamin C which is half what the norm should be so clinically scurvy, Vitamin D 25 hydroxy 18, Vitamin K sometimes, sometimes B12, and Niacin (B3) has come back non-existant. Serum Ionized calcium is low.

My PTH levels last tested May 2011 was 109 despite Calcitriol 1 mcg TID since November 2010. This has risen from 92 to 109 from January 2011-May 2011. I was diagnosed with Secondary Hyperparathyroidism in Sept 2010.

Also conclusion from the Endo is that i also short gut syndrome so absorbtion does not happen with me. The wierd thing can absorb macronutrients but not micro nutrients. No one still knows the reason for this.

My multivitamin infusions will be moved from Q month, just had first one on July 13 to Q week. Calcium, Vitamin D3, and Vitamin C will be added extra to vitamins.

I speak more on this matter to the Endo on monday when i see him. He called me yesterday as he got back from a conference recently. Turns out I was a bit curiosity there as he shared my info with other physicians and concluded the same. We are supposed to talk more indepth on this matter then and some suggestions that were given.

I also just had labs drawn and will know more whe they come in as many are specialized send outs:
Magnesium, Zinc, Serum Copper, Comprehensive Metabolic panel, PTH Intact, Serum Ionized Calcium, Lipid Panel, C-Reactive protein, West Sed Rate, CBC with auto and manual diff, Vitamin A, Vitamin B1, Vitamin B2, Vitamin B3, Vitamin B5, Vitamin B6, Vitamin B7, Vitamin B12, Vitamin C, Vitamin D 25 hydroxy, Vitamin D 1,25 di-hydroxy, Vitamin E, and Vitamin K, and Folic Acid.

It has been consistant for alost 3 years that the CRP and Sed rate are high, almost double than highest norm. Still to this day no one explain this as it ususally indicative of inflamatory process.

The results i do have from new tests is my CRP is 1.08 mg/dL with reference range of 0.0-0.50.
and Alk Phos is slightly high at 107 int_units/L reference range is 32-104. Rest Routine Chemistry normal except BUN 6 mg/dL. I was fasting for this test.
Lipid Normal-have never had cholesterol issues and HDL has always been high.
Folate and B12 normal.
CBC all normal except MCV, and MCHC, are low and RDW, and MPV, are high. Monocyte Relativity low. This seems to be consistant with other labs in past.

Awaiting results of rest.

Can a person have mast cell disease but biopsoies both from esophagus to stomach, small intestine and colon nad some large intestine be normal showing no inflaamatory process, and all tests for autoimmune all normal? There have been no skin biopsies performed.

Can Mast cell disease show up in genetic testing? I had a Micro- Array CGH done and the only thing that came up was Chromosome 2p16.3 microdeletion. DNA fingerprinting agreed to finding but was also partially inconclusive. I will have copies of these results monday when I meet with the geneticist again. All I know from what genetic counselor stated was that this chromosome abnormality is very rare. I can not really find anything on it online but will have more info when I see doctor.

I have lymphedema and lipodema bilateral legs, EDS type 3, seconday hyperparathyroidism, REM disorder, malabsorbtion syndrome, intermittant intusseption, focal intestinal metaplasia-stomach, mix headache tension/migrain, chronic and complete tears of the ACL left knee and menicus left knee, photophobia, amblyopia, presbyopia, strabismus, myopia, some dry eyes, pupils larger than norm 4mm even with glasses off, chronic insomnia, chronic nausea/vomiting, and osteopenia. I do have bone spurs both feet as well. Wierd rash swelling right arm unexplained. I also have hard time adjust body temp, have preiods of extreme dizzyness, low blood pressure or pulse, and I always tired.

[mother1991]

In relation to GI symtoms I do have IBS like symptoms, have been told when intusseption act up can have gas swelling bloating with pain and nausea in early part and can get worse from there. Was told when this happen go NPO except for light fluids, water, gatorade half water mixture, tea like chamomile or mint, and broth for a day or two and rest stomach gastro tract. If pain symptoms worse then goto ER.

I was started on Creon 24,000 2 tabs each major meal total 6 per day. This helps some but not all of symptoms.

Still seems like some gastro areas a mystery.

Stools run from watery to harder, times slow to rapid evacuation with severe stomach pain and increased nausea sometimes vomiting and I no have stomach virus or bacterium, from normal size to skinny, from baby bright yellow to darker sometimes green. Can have movement from 2-4 daily to 5-6 days between. There is no pattern.

Have taken med flagyll for poss overgrowth bacterium in Jan 2011 but made me so sick for 3 weeks. Even reg antibiotics I can take make me very sick. Talk is if need may do IV antibiotics to bypass gastro tract or watch closely and use antibiotics sparingly.

I do take probiotics daily but have found really no difference than without.

[Dr. Diana]

Hi Mother 1991, Wow, have you been through the testing! Your bloodwork should certainly reveal even more pieces of your puzzle. From what I can tell from my reading and talking to other mast cell patients, it is VERY difficult to diagnose mast cell, so with symptoms (like your rashes and GI issues), they just treat it. You will know in a couple of days if you are headed down the right track, and in a couple of weeks, you should notice a BIG difference. I like this website, and be sure to print out the “Patient Experience” letter: http://mastocytosis.ca/ . In that letter, they explain how it’s all related. You may want to ask your doctors if a trial of Diamox could be considered. As you probably know from this site, I’ve learned that most of us have a bit too much pressure on our brains from birth, and that may start some of the cascade of symptoms that we endure. Please keep us posted, OK? 🙂

[mother1991]

the only problem is I am severely allergic to sulfa drugs and with this med (diamox) from what i read would not be really able to take. I am not sure if i am mistaken on this. Also is not diamox also like HCTZ, if so need to be very careful because of lymphedema as it can exasperate it. But hey I am willing to try different things if it helps even if there is no explanation as to why it may help.

Here is full list allergies, meds, supplements, and conditions. This i think may also be helpful. The supplements may be stopped because of the IV infusions I take will know next week.

Allergies

Latex
Penicillin
Novocain
Sulfa
Zithromax
Zovirax
Erythromycin
Tetanus
CT Contrast
Compazine
Reglan

Special Note:
**CT Contrast even with high doses of premedication still had reaction of instantaneous hives and itching around face even for a couple of days afterwards negating taking Benedryl
50 mg TID for 4 days. Advised no more Contrast do MRI instead.

**Compazine and Reglan cause Tardive Dyskinesia.

Medications

Ambien CR 12.5 mg QHS
Marinol 2.5mg BID
Midrin PRN
Calcitriol 1mcg TID
Creon 24000 IU 2 tabs with each major meal or 6 per day with food.
Multi Vit IV Infusions Q month
Oxygen 2 Liters at Night
Farrow Wraps for Lymphedema
B12 injection Q Month
Gas x PRN
Tylenol PRN
Tens Unit-Knee pain

**Promethazine and Zofran ineffective in control nausea and have failed.
**Kytril, Anzemet, and Benedryl tried and failed to control nausea.
nausea

Supplements

Multi Vitamin and Mineral/no Copper QD
Calcium Citrate 250mg four time’s day
Vitamin D3 50,000 IU TID
Niacin 500 mg TID
Vitamin A 30,000 IU QD
Vitamin E 400 IU QD
Vitamin K 1000 mg QD
Vitamin B Complex QD
Zinc 50mg QD
Magnesium Citrate 140 mg QD
Vitamin C Ascorbic Acid 2000mg Four Times Daily
Probiotics QD
Copper D/C 10/1/10 due to high Copper Serum Level

Current Conditions

Ehlers Danlos Syndrome Hypermobility (Type 3)
Gastric Bypass RouxNY 2004
Malabsorbtive Syndrome
Secondary Hyperparathyroidism
Chronic Nausea/Vomiting
Osteopenia
Chronic Insomnia
REM Disorder
Mixed Headache (Migraine/Tension)
Focal Intestinal Metaplasia
Intusseption at Jujunjujunostomy
Anycytosis
High Iron Unbound
Low Iron Saturation Percentage
High CRP
High West Sed Rate
High PTH
High Vitamin D 1,25 Dihydroxy
Low Serum Ion Calcium
Niacin B3 deficiency
Vitamin B12 deficiency
Vitamin D deficiency
Vitamin C deficiency
Vitamin K deficiency
Low Serum Beta Carotene
High Serum Copper
Low Hemoglobin
Low MCV
Low MCHC
High RDW
High Neutrophil Rel
Low Lymphocyte Rel
Chromosome 2p16.3 microdeletion
(Not know more on this but told very rare.)
High B1
Lymphedema Bilat Legs
Lipodema Bilat Legs
Astigmatism
Myopia
Presbyopia
Amblyopia
Strabismus
Photophobia
Pupils Large 4 cm Bilat
Some dryness in eyes

Right Arm swelling rash 2 1/2 years
Marked decrease in strength right hand

**Erosion patchy area afferent jejunal loop. Two clips placed to control bleeding.
Bx report-Flatten Erthymatous Mucosa, Duodenum Biopsy
Small bowel mucosa with focal minimal gastric surface Metaplasia, consistent with healed injury. No features of acute duodenitis.

**Left Knee-Complicated and Chronic tears in ACL and Meniscus tears both lateral and vertical. Mild water on the Knee. Mild arthritis.

Surgeries

Widen Nostrils Age 3 months, 6 months, and 2 yrs
Eye-cut and stretch muscle-Age 3, 6, 9
Adenoidectomy-Age 3 and 5
Tonsillectomy- Age 5 and 26
Tubes in ears 8 times from age 8 months- 7 years
C-Section 1989 and 1991
Lap Choley 1996
Umbilical Hernia Repair 2001
Gastric Bypass Roux N Y 2004
Ventral hernia Repair 2006
Feed Tube Placement 2005
Port Placement 2011- Bard power port right side.

[Deb]

Back to the fingernail conversation… Look at this page about fingernails http://www.normanallan.com/Med/askdr/finger.html
I have ridges and have always heard it means malabsorption or could be dry nail beds lacking oil due to chemicals or hard detergents. It can also be hereditary. But this page says it could also be kidney or low iron.

“Lengthwise grooves or ridges may indicate a kidney disorder and is associated with aging. An iron deficiency may also cause ridges.”

[RandomJelly]

Yes to the longitudinal ridging and I hate it with a passion. I assume mine are from malabsorption.

[Dr. Diana]

Can a person have mast cell disease but biopsoies both from esophagus to stomach, small intestine and colon nad some large intestine be normal showing no inflaamatory process, and all tests for autoimmune all normal? There have been no skin biopsies performed.
Can Mast cell disease show up in genetic testing?

Hi again — yes, you can have mast cell with negative biopsies — mast cells can hide in various tissues and organs. And no, I don’t believe there is a genetic test for MCAD. The docs like to get a bone marrow biopsy, because that is where mast cells are “born”. But even those results are not a guarantee either way. There is a big push to just TREAT it, because they think the current criteria is missing over half of us. Yikes.

[Dr. Diana]

Oh, and mother 1991, Neptazane can sometimes be substituted for Diamox if you’re sensitive to sulfa drugs. It is still a sulpha derivative, but if you work closely with your doctor, you may be able to squeak by. Diamox (and Neptazane) are carbonic anhydrase inhibitors, not HCTZ drugs, so you may want to see if it could help you. Fingers crossed. 🙂

[mother1991]

I see the dermatologist today and will see what goes from there. I will post what I know tomorrow as I will be home late. The endocrinologist is also going to do some more research into mast cell disease and will call when he may know more. Next week the weekly multi vit infusions begin and labs will be done again in 4 months of weekly infusions to see what improvement there may be.

The vertical ridging on nails is actually quite common and as we get older they seem to be more prevalent. Been told they are like wrinkles in a way. If ridging with other nail changes happen then need to make appt with doctor to be evaluateed as it could be something a little more serious.

Have a good day all.

mother1991 aka Christina

[mother1991]

Well the driver was late to my home and had to reschedule appt with dermatologist. Nerxt time get to see is Sept 15. So will know more that day and the driver taking me already has on schedule so there will be no mixups this time.

[Author]

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