### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I HAVE A LUMP AT THE LUMBAR REGION OF SPINE FOR 6 YEARS, NOW I HAVE PAIN AT THE AREA, AND ALL MY JOINTS HURT, MY ARMS AND LEGS FEEL HEAVY AND PAINFUL IN MUSCLES AND JOINTS, THE ACTUAL BONES FEEL COLD INSIDE WHEN HURTING THE MOST AND FIND IT HARD TO WARM THEM UP. SEEMS TO EASE A LITTLE WITH PAINKILLERS AND WARMTH BUT FEEL PRESSURE/PAIN AT ALL TIMES. CAN ONLY WALK FOR A SHORT AMOUNT OF TIME BEFORE TOO PAINFUL AND EXHAUSTED. NO REAL APPETITE, MAINLY LAYING DOWN. BEEN DIAGNOSED WITH PALLINDROMIC RHUEMATISM 10 YEARS AGO, ALSO RECENTLY HAD BLOOD TEST AND MY RED BLOOD CELLS ARE VERY HIGH AND MY DOCTOR SUSPECTS POLYCYTHEMIA. SINCE CHRISTMAS I HAVE HAD BOWEL PROBLEMS, DIARRHEA, VERY PASTY STOOLS, CONSTIPATION, MUCUS IN STOOLS AND A SMALL AMOUNT OF RED BLOOD ON THE OUTSIDE OF A MUCUS STOOL (ONCE). CURRENTLY TAKING SERTRALINE, CERAZETTE AND HAVE B12 INJECTIONS EVERY 10 WEEKS DUE TO A DEFICIENCY.

### output:

Hello, thank you for your question. I was thinking about your condition for a while. I want to talk about the lump first. It is important to know what is the structure of the lump, is it soft or solid, does it feel photogenic, or it is more heterogeneity and can it be moved around, or it is anchored at place. I suggest physical examination preferably by a general surgeon and probably excision and histopathology. If the skin around it is reddish and swollen it is probably infected. It is suggestive that the joint problems are due to the rheumatism you are diagnosed with. If you were my patient, I would suggest you to consult a vascular surgeon due to the pain after short amount of time. It is called claudication intermittent and is suggestive of arterial disease. I want to alert you about the mucus in the stools. I strongly suggest you to undergo colonoscopy. Mucus is secreted by a certain type of large Bowell polyp. Wish you a good health. Best regards.