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Tingling in palms and soles, hot feeling, headache. No chest pain. ECG and blood test okay. Is it Ciguatera poisoning?

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Orthopaedic Surgeon
Practicing since : 1994
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I think I have a good dose of ciguatera poisoning (which I have had 3 times before in my life) but this time there are some different symptoms and it has been going on for 8 weeks now.
I have tingling/burning in the palms of my hands and sometimes the soles of my feet.
I have the uncomfortable 'hot' feeling when i touch something cold, and putting my hands in cold water is very irritating.
I have had headaches but they are rare now.
All of these are what I would expect from Ciguatera poisoning, but I have others which are much more concerning....
In the mornings when i wake i have to be very careful to not exert myself in any way or i have an "attack" - this feeling starts in my neck area and radiates across my upper chest and down the inside of both arms to the palms of my hands. this feels like a 'nerve' pain and it is very severe pain. During these attacks, my heart appears to beat very slowly - i have a BP machine and have measured it at about 50 - 56 bpm. there is no pain in my chest and i can breath normally etc. it's just the incredible pain... It last for 10 - 15 minutes. When it is over i am usually fine for the rest of the day, but i still cannot exert myself up to about 11am or i'll have another attack or part-attack. After about mid-day i feel so well i reckon i could run 5 kilometres with no effect.
Then in the evening, as i slow down after dinner, i can have another attack or maybe i'll just get this 'feeling' that i have right before an attack.
I have even been woken in the middle of the night by an attack coming on.
My GP said it may be Angina or anxiety attacks, but he had never heard of Ciguatera. He gave me an ECG and said it was 'perfect' - sent me for blood tests and all looks ok. I have a referral to a cardiologist for a 'stress-test' but haven't been yet (i've recently had an operation on my calf and could not walk properly until now).
i do not think it is my heart, although my heart does feel weird and sort of shaky during an attack.
Sorry for the long description.... hope you have some ideas.
Posted Mon, 21 May 2012 in Brain and Spine
Answered by Dr. Praveen Tayal 39 minutes later
Thanks for posting your query.
Your symptoms are suggestive of chronic ciguatera poisoning.
The treatment is usually given according to the symptoms. Mannitol infusion is recommended along with atropine to counteract intermittent bradycardia.
For pins and needles sensation and hot flushes, multivitamin supplements, nifedipine and amitriptyline are found to be helpful.
All these are prescription drugs and do need careful monitoring. You can ask your cardiologist to give you the specific treatment after related investigations.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Dr. Praveen Tayal.
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