Discussions By Condition: I cannot get a diagnosis.

Bells Palsy / Tingling numb hands feet / joint pain

Posted In: I cannot get a diagnosis. 28 Replies
  • Posted By: acre44
  • January 2, 2009
  • 05:38 PM

Can anyone help me out with my symptoms and possible solutions? I had been exceptionally healthy 38 year old white male until this and now I am suffering from panic attacks and anxiety over my health that is affecting my whole life and family.

11/23/08 I came down with what I thought was a severe sinus infection. Pain was worse than I had ever had before above my eyes. My forehead was even swelled up and puffy. The ER doc perscribed a Z-pac which I began taking immediately. I began feeling better the next day, pain subsided. On 11/25 my lips became numb. I called the Dr and he said that I was having a reaction to the Z-pac to stop it immediately. That night I had to go to the ER because the whole left side of my face was not working. Diagnosed that night with Bell's Palsy. Put me on prednesone for the inflammation and sent me home. I had appts with optamology, ent and PC dr on 12/11. They all said that it was classic bells and i should see an improvement quickly. The PC prescribed acyclovir just in case. Took that for 5 days. My face returned to normal in a few weeks. The night of 12/14 I began tingling in my feets and hands. I went to the ER. They did sugar check and some blood tests, all normal, sent me home. I went to see my PC Dr on 12/16. I had did my research and others had told me I may have lyme. I live in Pennsylvania and I am outdoors the whole summer. My dog even had ticks removed from our yard. The doctor ordered up the tests but said he would begin treating it as lyme even though I do not remember having a tick or any rash. I began IV ceftriaxone for 20 days. The next day I went in for my IV but my vision was getting blurry, lots of floaters. My spine was tingling and I had a burning sensation in my mid spine. He sent me to the ER for a full work up. They did an MRI, CAT scan, lumbar puncture (spinal tap), full blood work up, CBC, sed rate, etc. The neurologist did a complete physical. ALL were normal. All 3 lyme blood tests came back negative and my spinal fluid was negative for lyme and the protein level was normal. They stopped the IV anti-biotic. The neuros scheduled me for an EMG in mid-January. Since that ER visit I have had pain/stiffness mid spine, tingling lower spine, tingling/numb from knees to foot, tingling/numb from elbow to fingers, knee pain, foot pain, ankle pain, finger pain, elbow pain, sleeping trouble. The pain travels from joint to joint, comes and goes. I can sleep for a few hours then wake up suddenly wide awake, hard to go back to sleep. Two days ago I could feel pressure and tingling of my sciatic nerve down both legs and a sharp pain in my calf and ball of my foot. That lasted one day. The PC Doc thinks it is related to a virus (herpes, shingles, etc.) that caused the bells palsy and that it will get better with time. I never did have a rash or any skin disorder with any of this. I have read about lyme and the negative tests. I have also heard about different viruses causing joint inflammation. I do have joint pain but no swelling and my sed rate is excellent.

Any help would be greatly appreciated.

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28 Replies:

  • Dr.Cottle.I was a Board-Certified Family Physician.
    richard wayne2b 1232 Replies
    • February 4, 2009
    • 03:18 AM
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  • Dr.Cottle,What do you think of my wife's forearm and distal arm pain,only on the dorsal aspects of her arms?
    richard wayne2b 1232 Replies
    • February 4, 2009
    • 02:51 PM
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  • Dr.Cottle,Why does my wife need a tricompartmental arthrogram? She's very hesitant to have it.
    richard wayne2b 1232 Replies
    • February 4, 2009
    • 03:23 PM
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  • As I understand the case, we have non-diagnostic plain films and MRI, there is no suspected arthritis or recurrence of carpal tunnel, no history of trauma from a repetitive strain injury or occult fractures, the pain is bilateral and has recently progessed from the wrist to the dorsum of the forearms. If a determination needs to be made whether the extensor ligaments may represent the causal factor, then bilateral tricompartmental arthrography would be the logical next step. I suppose if we were to consider that Kienbock's is a possibility, then repeat imaging might be an intermediate step but with changes to the characteristics of pain mentioned, there is not much more to evaluate. Intersection syndrome would now be back on the table as well, since we have pain in that general proximity of the forearm based upon your description. Whether this would represent conversion as mentioned would, in my opinion, be implausible in the absence of thorough diagnostic imaging to determine a practical cause otherwise. It's not that it couldn't exist, just that I've never observed such a case. The other issue to bear in mind is that if you have her evaluated by a specialist, the arthrogram might not even be necessary if the cause can be elucidated prior to such a consideration. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • February 4, 2009
    • 04:51 PM
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  • I hate to tell you this ,but your symptoms are in what we call a stocking and glove distribution,which means that in all likelihood it's in your head.I,too,would probably get panic attacks if I developed Bell's palsy,but I know of nothing to be worried about.Your pain is real,but it's likelt to be psychophysiological. Stocking and glove distribution is a fairly common feature of b12 deficiencies. It's often responsive to b12 to some degree if that is the cause. http://www.merck.com/mmpe/sec01/ch004/ch004i.html"Subacute combined degeneration refers to degenerative changes in the nervous system due to vitamin B12 deficiency; they affect mostly brain and spinal cord white matter. Demyelinating or axonal peripheral neuropathies can occur. Symptoms and Signs Anemia usually develops insidiously. It is often more severe than its symptoms indicate because its slow evolution allows physiologic adaptation. Occasionally, splenomegaly and hepatomegaly occur. Various GI symptoms, including weight loss and poorly localized abdominal pain, may occur. Glossitis, usually described as burning of the tongue, is uncommon. Neurologic symptoms develop independently from and often without hematologic abnormalities. In early stages, decreased position and vibratory sensation in the extremities is accompanied by mild to moderate weakness and hyporeflexia. In later stages, spasticity, extensor plantar responses, greater loss of position and vibratory sensation in the lower extremities, and ataxia emerge. These deficits may develop in a stocking-glove distribution. Tactile, pain, and temperature sensations are usually spared but may be difficult to assess in the elderly." http://emedicine.medscape.com/article/1171558-overviewCyanocobalamin (vitamin B 12 ) deficiency About 80% of all cases are due to pernicious anemia, and another 10% are due to achlorhydria. Exposure to nitrous oxide can suddenly precipitate the deficiency, which should be considered in any patient who develops postoperative paresthesias.The disease predominantly affects the spinal cord; therefore, separating the painful sensory and sensorimotor paresthesias of the peripheral neuropathy from the symptoms of spinal cord involvement is difficult.Presentations vary greatly among patients.The symmetric glove-and-stocking paresthesias, or tingling in the distal aspect of the toes, numbness, coldness, a pins-and-needles feeling, and occasional feelings of swelling or constriction, are slowly progressive and insidious. Symptoms progressing up the legs, occasionally affect the fingers, and culminate in weakness and spasticity.In late stages, signs include moderate muscular wasting, optic atrophy, sphincter dysfunction, and mental disturbances. Examples of these disturbances are mild dementia (which is often the first symptom and clinically indistinguishable from other dementias), disorientation, depression, psychosis, and persecutory delusions.The hematologic manifestation of anemia, if present, can cause weakness, light-headedness, vertigo, tinnitus, palpitations, angina, heart failure, cardiomegaly, pallor, tachycardia, and hepatosplenomegaly.GI symptoms include a sore, beefy red tongue and anorexia.If left untreated, the gait becomes ataxic, followed by paraplegia with spasticity and contractures.The subacute combined degeneration that develops results in a severe myelopathy, involving posterior columns and lateral corticospinal tracts, with other manifestations including optic (retrobulbar) neuropathy, sensorimotor polyneuropathy, and dementia.
    Freddd 3576 Replies
    • February 4, 2009
    • 06:49 PM
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  • Dr.Cottle,How do you account for the synchronicity between my wife's wrists(Sx are bilaterally symmetrical and identical in both location and severity.)
    richard wayne2b 1232 Replies
    • February 14, 2009
    • 04:29 PM
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  • If you have tried everything else, might want to try a Chiropractor, sometimes just getting an alignment may help some of these issues. I have had a lot of the things you indicate and they can not find anything "wrong". I am headed for a massage this morning and next week the chiropractor to see if that helps me.
    Anonymous 42789 Replies
    • October 30, 2009
    • 00:44 PM
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  • I have almost the same symptoms and now getting bone marrow biopsy.also live in PaLyme was neg as well as west Nile what Sid u find out?
    Anonymous 42789 Replies
    • September 23, 2010
    • 01:34 AM
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