Mystery bruise appears, vanishes as if by magic

DEAR DR. ROACH: I have just returned from seeing my doctor, and was told that the cause of what I experienced is a mystery!

In the late afternoon, my husband and I were sitting at the kitchen table. He noticed that a bruise was forming on my right temple — a dime-size purple mark, with a bump near the hairline. Over the next few hours the bruise grew larger, with red discoloration down the right side of my face, to the jaw. I had not been injured in any way, and it did not hurt! I called a 24-hour advice nurse, and was told I probably had broken a blood vessel.

The next day, I called my doctor for an appointment, just to be on the safe side, but my doctor didn't have anything to look at. When I got up, all the bruising and discoloration was gone! She told me that there would still be some discoloration if it had been a broken blood vessel, so therefore it was a mystery. – C.C.

ANSWER: I agree with the nurse that it likely was a broken blood vessel, which can happen spontaneously to anyone. Once the blood is under the skin, it gets cleaned away by cells with enzymes that break down the blood. The color typically goes from dark red to green to yellow. This way, we can tell approximately how old a bruise is.

Very superficial bleeding also can move, as the blood literally gets pulled by gravity (which is why you had a darkening down to the jaw). I suspect that while asleep, the remainder got pulled into the hairline or lower down, where it could no longer be seen.

Many people have come down with another mysterious illness, chronic fatigue syndrome. The booklet on it explains the illness and its treatment. To obtain a copy, write: Dr. Roach – No. 304W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: Are men less likely to wash their hands after using the bathroom (for any reason) than women? Are there any studies providing statistics? I "preach" hand-washing as the single greatest preventive for most illness. – L.P.

ANSWER: If you can think of it, it's probably been studied. In 2003, a study at a university found that after using the washroom, women washed their hands with soap and water 61 percent of the time, and men 37 percent of the time. Placing a reminder sign increased the rate to 97 percent of women, but only 35 percent of men washed their hands with the reminder, although 53 percent rinsed their hands without soap.

Keeping hands clean reduces infection transmission to yourself and to others. Unfortunately, too often even doctors forget to wash our hands (only 65 percent of the time, in several studies). Our nursing colleagues are better at washing their hands. Many hospitals, including mine, have policies in place to improve hand-washing compliance.

DEAR DR. ROACH: Don't forget that although there are many medical causes of restless leg syndrome, varicose veins also can be a source of symptoms, and we have cured many people of symptoms with minimally invasive varicose vein treatments.

We always recommend that if you have visible varicosities or strong family history of varicose veins, you should get an ultrasound to determine if you have venous insufficiency. The treatments have essentially no down time and can mean one less medication for many people. In addition, just because you can't see visible varicosities does not mean you do not have venous insufficiency. We have patients with beautiful legs whose ultrasound reveals large veins under the surface. – Melissa A. Sandman, M.D.

ANSWER: Thank you for writing. Many people also have written about other causes and treatments for restless leg syndrome, so I wanted to talk a bit more about this important subject.

In addition to the iron deficiency I mentioned and the varicose veins Dr. Sandman writes about, there are several other important causes, including kidney disease, usually when dialysis has started. Diabetics have a higher risk for RLS, which sometimes can be mistaken for diabetic neuropathy. Multiple sclerosis and Parkinson's disease both are associated with RLS, and Parkinson's is important because when medicines such as levodopa/carbidopa (Sinemet) wear off, it can mimic RLS symptoms. When dopa drugs are used long-term for RLS, symptoms can get worse, a condition called augmentation.

Pregnant women are more likely to have RLS. Many drugs, especially antidepressants, can cause RLS. I had a reader tell me that hers was due to Benadryl she was taking for sleep. Magnesium deficiency is common in RLS, and several readers told me magnesium supplements stopped their symptoms.

The booklet on restless leg syndrome provides much more information on this common sleep disorder, and also offers advice on nighttime cramps. Readers can obtain a copy by writing: Dr. Roach -- No. 306W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: I am 92 and have spinal stenosis in my lower back and neck. The neck stenosis is causing a balance problem. Who would treat and/or operate on this — orthopedist or neurologist? – J.W.

ANSWER: I would be very slow to recommend surgery on the neck at age 92. I would try other treatments, including medication, physical therapy and possibly injection, before considering surgery.

Balance problems may benefit from problem-specific exercises. A neurologist may be very helpful in evaluating whether the symptoms are indeed coming from the spinal stenosis, because balance problems can have many different causes.

If symptoms were intolerable despite everything that could be done short of surgery, I would find the most experienced surgeon around, which could be either a neurosurgeon or an orthopedic surgeon.

DR. ROACH WRITES: Quite a few people have written in to recommend nasal saline gel for people with dry nose and recurrent nosebleeds. It is worth a try, especially for those who don't like petrolatum or for whom it isn't working.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]. To view and order health pamphlets, visit www.rbmamall.com, or write to P.O. Box 536475, Orlando, FL 32853-6475. (c) 2015 North America Synd., Inc. All Rights Reserved