Hi @venki welcome back to the group. I wished I had some answers for you and hopefully someone can offer some suggestions. You are much younger than I and you have a lot going on. I'm guessing you've already discussed your thoughts and questions as to what's going on with your doctors. You might want to read through the following discussion on Connect which seems like it could be a possibility for some of your symptoms:

Groups > Just Want to Talk > Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) treatments
-- https://connect.mayoclinic.org/discussion/myalgic-encephalomyelitis-chronic-fatigue-syndrome-me-cfs-treatments/

I recently found out I had obstructive sleep apnea which does cause fatigue. A lot of people have this condition and are not aware of it. You might want to ask your doctor about it and get tested.

Obstructive Sleep Apnea - Symptoms & Causes
-- https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090

@venki have you decided against surgery for the varicose veins?

John

Hello, Venki. I think you should have a thorough assessment about your fatigue and the CSVD in case it is increasing your risk of stroke. Surgery always has risks and blood clots, pneumonia and strokes are among them. Did your doctor advise you to stop taking aspirin? There are other blood thinners, but you should discuss that with your doctor. Thyroid problems also contribute to fatigue, also asthma, allergies, heart issues, etc. When you have answers about your other health issues, your doctor can determine what your surgical risks could be, and no one on this forum can answer what your specific risk would be. If you come to Mayo, they will assess everything and refer you to other departments and your doctor will consult them as it is a team approach at Mayo, and that usually takes just a few days because they are very efficient.. The neurological problem you have might need clarification with testing because a compression anywhere along a nerve path can produce pain in the same place. You can have ulnar nerve entrapment in your elbow, but thoracic outlet syndrome causes the same pain with the entrapment of the same nerve pathway where it passes in-between the collar bone and rib cage. That is very often missed by doctors, but Mayo can assess that as well. I have TOS and have had it along with carpal tunnel and spinal cord compression all at the same time. I might have some ulnar entrapment in my elbow too. I do physical therapy for TOS with myofascial release that helps a lot, and I had spine surgery at Mayo for cervical stenosis that fixed all the pain I had everywhere in my body except for the TOS. Have you tried any physical therapy? You can use Arnica gel topically to help reduce pain and help with muscle spasms. You could also have inflammation contributing your issues. I have had that from allergies and food allergies and with diet modifications, I have eliminated that. For example, if I eat tomatoes, I have pain in my knuckles; if I avoid tomatoes, my hands don't hurt. I also have to avoid gluten, dairy , and other foods, but it makes a huge difference in how I feel. There are medical foods and supplements like turmeric that help with reducing inflammation. I recommend discussing that with your doctor in case it would conflict with any of your drug prescriptions. Before I figured out all my food allergies and thyroid function, I was pretty fatigued too, but doing all of that helped a lot. My thyroid was affected by the old silver amalgam fillings in my teeth because they release mercury and it affected my thyroid. I had them all removed, and my thyroid function has improved, but I still need thyroid medicine since I don't make enough thyroid hormone on my own. Here is some information of MFR therapy http://www.myofascialrelease.com. Hopefully, there is some useful information here from my experience.