Has this patient got angina/ischemia - please advise?

[winnythepooh]

I have a new patient (I am a structural therapist) and I am really concerned about her.  She has a very high colour - her lips and feet go blue.  For the last week her mouth and tongue have been feeling dead and her husband told her her lips and surrouding mouth area had gone blue - but she told him she felt fine.  About 8 years ago she had her bite realigned by a dentist but hadn't really noticed any problems before.  She doesn't eat much, although she's not anerexic - she has a normal looking body weight however for the past 25 years she has been drinking a bottle of wine a night.  She also has B12 injections for pernicious anemia.  However, I appreciate that drinking that much does deplete essential vitamins from a person but I think her problem is tied in more with angina/Ischemia.
Can anyone give me any pointers here?  Something needs to be done.  (I have after doing her consultation discovered the emotional distress that has driven her to blot things out and I will be tackling that next week when I see her again).   Am I barking up the wrong tree here?

Cheers

Viv

[winnythepooh]

Thanks everso much for your input.  You sure are right that it's reallly difficult.  I'm going to see about the pulmonary function test and maybe look into scleroderma or lupus.

Thanks

Viv

[ireneo]

Is she unwilling to see a doctor for a stress test or a pulmonary function test? If it's not heart or lung related there are other things that can cause extremities to change color. I have Raynauds. In some folks it can turn lips and even nose a bluish color. Typically it affects hands and feet. I take it she has no concern over her abnormal coloring. Raynauds is usually diagnosed by a rheumatologist  who can also see if it's primary (Raynauds alone) or secondary to something else like Lupus, Scleroderma or RA. It's just too difficult to guess at these things, isn't it? Good luck convincing her to go for some testing.