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Tachycardia, verapamil, heat sensation, shingles, peripheral neuropathy, celebrex, normal brain scan, basal ganglia, Parkinson's disease, nebivolol

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Hi, My father is 81 y.o. and 5 years ago he was put on verapamil to control tachycardia. After a few months on verapamil he got the sensation of heat in his legs and pain in feet and legs. Littel after that he got shingles, then he has been going down losing movement and has a constant feeling of hot feet and weak legs that make difficult for him to walk. He has also lost flexibility and is a little rigid, is mental clarity is fine but I notice some confusion sometimes. He has been to many doctors and all lab work comes fine, neurologists said he has Peripheral neuropathy, they have given them drugs for that and for pain such as celebrex and high doses of B12 or the sort, but nothing works, and they can't say why or what to do about it, just that he is old, which bothers me so much because I know more old people who aren't like that so that is not an answer.. In addition, his right hand has unwanted movement sometimes (tremors or shaking). Recently he saw a new doctor (geriatric) who asked for a brain scan and it came out normal except that it mentioned "some physiological calcification of the basal ganglia". Due to that, the doctor said he has parkinson's disease and test with some levodopa, but my father noticed no difference so he stopped using it since it hurt his stomach.

A year ago ago he was changed from verapamil to nebivolol because verapamil was causing him too much digestive problems including with going to bathroom and loss of energy. A few months ago I started noticing that his blood pressure was getting too low and he was getting dizzy and feeling even more fatigued. Only thing is that in the mornings his heart rate is always kind of high even with the medication, around 94 to 105, to go to normal for the rest of the day. I started also changing his diet and he is eating with very little salt so I weaned him off the medication little by little and his blood pressure is still a little low (105/66 aprox., but sometimes it goes to 124/75 or so). Heart rate is the same as when he was with the medication, kind of high in the mornings when he wakes up and start walking around and then goes to 79-89 for the rest of the day.

So, my question is about the condition he feels of being so tight with body ache, hot feet sensation and leg pain and weakness, coupled with the results of the brain scan (basal ganglia's calcification). Could this be the cause of his pain in legs and lack of movement flexibility, hands shaking, fatigue, rigidity? He think he has arthritis also but so far we can't tell what it is.

I have all results from recent lab work and many tests so ask for it if you need more information. I really want to see y father get rid of the pain and be able to move around with energy and flexibility. He gets depressed due to not being able to do so. Please help!

Posted Tue, 17 Apr 2012 in Brain and Spine
Answered by Dr. Shiva Kumar R 3 hours later

Thanks for the query.

It looks like he has burning or painful Peripheral Neuropathy.

Most common cause for painful neuropathy is Diabetes and Vit B12 deficiency. He is already on treatment with B12 supplements.

To control the pain you can use Pregabalin or Gabanpentin. Check his serum ferritin level. If it is low give him Iron supplements.

Also his Brain CT scan says, he has physiological calcification of the Basal Ganglia. Basal ganglia is important in regulating the blood pressure. This may be the reason for the fluctuation in his BP and also in his heart rate.

It is quite normal to have this finding in your father due to his age. These changes do happen.
continue giving him the vitamin B12 supplements.

Coming to his shaking and stiffness of the body, he may be suffering from Parkinsonism. He is also confused at times (? hallucinations). No response to Levodopa. This means he is suffering from Parkinson's plus syndrome which does not have any treatment so far.

Only thing is to re-try Levodopa and see if he gets any benefit from it.

The allergies and the calcification in the Basal Ganglia are definitely not related to each other.

In addition he is depressed because of the above problems. He needs a good clinical evaluation from a neurologist.

I hope I have answered your queries.

I will be available for your follow up queries if any.

Above answer was peer-reviewed by
Follow-up: Tachycardia, verapamil, heat sensation, shingles, peripheral neuropathy, celebrex, normal brain scan, basal ganglia, Parkinson's disease, nebivolol 7 hours later
Thanks Dr. XXXXXXX

Yes, he has had some high doses of b12 before and has been to the neurologist.... How much should he continue to have regularly? Recently he got a shot of 500 mcgr and told me he felt his legs cold and then hot.

Confusion, he has always had very good memory and mental clarity, thanks God, but I have noticed sometimes he has gotten confused, I don't think he is having any hallucination, just sometimes he has become very slow to understand when you are talking to him. But he likes playing dominoes and he is still doing it and does fine with it. The biggest problem is the pain on his leg, heat and stiffness of the body, he said his body does not respond and his legs feel very weak.

He has already been prescribed both pregabalin and gabanpentin, they did not work. His sugar levels are confusing as well, sometimes normal and I have been recently monitoring and sometimes they are in the border but he does not show sugar levels of a person with diabetes and he has been to endocrinologist. I have recently changed his diet as if he does have it though, but he is not taking anything to control sugar spikes, the endocrinologist did not think he had to.

As to the iron, last year he did come low and we gave him some supplements. But his symptoms did not improve.

So, do you think he has arthritis as well? He has been told by friend it is that and he was to now be seen by a special doctor for this but he had already been to one before and now wants to go to another in hope of good results.

Regarding his blood pressure, the heart palpitations in the morning only are due to this calcification in the basal ganglia? Yes, his blood pressure does fluctuate from very low to normal and so far he is not needing the medication for blood pressure.

So there is no way to treat the calcification? I was reading about treatment with disodium etidronate, what do you think?

Since what you told me about the pain on his leg has already been tried, what do you think we should do in order for him to have some better quality of life? It really bothers me to see him like that, no doctors has helped him so far. He was always a very strong man and used to be so fast walking around.
Another thing is that a lab test he had done before (C-Reactive Protein) came now positive up to 6mg/L, the doctor did not seem to care about that. Is that normal?
Answered by Dr. Shiva Kumar R 2 hours later

Thanks for getting back to me.

If he has received Vit B12 injections (about 4-6 injections) he can now continue on oral supplements (1000 mcg methylcobalamine) once a day. There is no need for injections of B12 for next 2-3 years.

It is good if he does not have any hallucinations. He may be slowly understanding as you have suggested. He should undergo detailed neuropsyhcological testing to pick up the reasons for this.

Stiffness of legs and feeling of weakness is due to parkinsonism. You have to try Levodopa for at least 3 months adequately (800 mg/day) to say that he is not responding to it. If possible try it again to see for the response, speaking with your treating Neurologist / Neuropsychiatrist, as levodopa is the only drug available for parkinsonism.

If sugars are not very high you can continue on diet control with regular monitoring of sugars. If they shoot up he may require medications to control his sugars. If he has associated arthritis get him treated which can help him to relieve his pain and stiffness in the legs.

Physiological calcification of the brain does not require any treatment.

For his pain in the legs you can speak to the doctor and ask him to try other medicines like Amitryptilline, carbamazepine or trial of Botox injection or nerve blocks in the legs.

C reactive protein indicates inflammation in the body and it is very nonspecific. So no need to worry
about this.

Hope this helps you in taking better decisions.

Above answer was peer-reviewed by
Follow-up: Tachycardia, verapamil, heat sensation, shingles, peripheral neuropathy, celebrex, normal brain scan, basal ganglia, Parkinson's disease, nebivolol 23 hours later

Another concern I have, what if all these symptoms have been caused by Lyme Disease, as everything started with a fever 5 years ago. I have been reading and all his symtoms look like that. How can we know? Also, how can he safely be treated for bacterias in his body given that he is old?

Answered by Dr. Shiva Kumar R 1 hour later

Thanks for bringing in Lyme disease in to the picture.

Usually Lyme disease starts with a characteristic rash which is not evident on the details provided to me. Also 5-10 % of people suffering from Lyme disease can have chronic neurological symptoms like burning feet, pain, fatigue, arthritis, stiffness of the body without the characteristic rash. They have additional findings like facial palsy, meningitis, radiculoneuritis and so on. But it is very rare.

Rare presentations of common diseases are always considered than a rare presentation of a rare disease.

Though most of the symptoms described by you do fit in to the diagnosis of Lyme disease but I feel he is not suffering from Lyme disease. We can test his blood to confirm the same.

If by chance he turns positive we can safely treat him with antibiotics without major side effects. So you get him evaluated if Lyme disease is prevalent in your area and try the treatment if it is positive.

Hope this answers your query.

Wish your father a speedy recovery.

Above answer was peer-reviewed by
Follow-up: Tachycardia, verapamil, heat sensation, shingles, peripheral neuropathy, celebrex, normal brain scan, basal ganglia, Parkinson's disease, nebivolol 53 minutes later
Which is the name of the test to diagnose for Lyme Disease, so I request it for my father.
Answered by Dr. Shiva Kumar R 41 minutes later

Good to hear from you again.

Commonly used test is to test for the antibodies i.e., IgM and IgG antibodies. If these are positive can be confirmed by Western blot test.

So first do the Lyme titre antibodies and if it is negative no need for western blot test. If its positive go for western blot testing and if that comes positive we can treat him for Lyme disease.

Hope this answers your query.

Above answer was peer-reviewed by
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