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What causes sore throat followed by tingling in fingers and face and stiffness in jaw?

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Internal Medicine Specialist
Practicing since : 1980
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About 9 weeks ago had a sore throat, went to Dr and was diagnosed with Strep and took medication for it. After 2 weeks still tightness in throat. Started getting tingling in my fingers and toes. About a week later stiffness in jaw, difficulty opening jaw wide, tingling in face. This week my legs mainly my thighs have been sore and my legs feel really heavy when i walk. Also my back has gotten sore as if I have difficulty standing up straight. Also I feel shortness of breath with minimal physical activity. The past two weeks i've had an increasing shortness of breath to where I can't take a deep breath in. I also have a pain in my chest that gets worse at night and a tingling feeling all over my face throughout the day. I'm not able to do any strenuous physical exercise as a result. I've been to Dr and had EKG, Chest X-Ray, Blood tests to rule out vitamin deficiencies and other common illnesses. Gone to ENT and they put a camera in my throat and didn't find anything. Suggested it could be related to heartburn but I've never had it before and I am not convinced of this being the answer. The past two days extremely weak and feels difficult to take a full breath. If I run even a block I feel extremely winded. I'm feeling worse today feeling like I can barely take a breath, swallowing difficulty has been going on for about 3 weeks. Food feeling like its getting stuck in my throat. Extremely weak at night, I haven't been able to sleep much and after sleeping an hour am waking up out of breath. I'm very worried because symptoms appear to be getting worse. I had pulmonary function testing about a month ago and that came back okay, but I feel as if symptoms have gotten much worse since then. What can cause this?
Posted Tue, 18 Mar 2014 in Medicines and Side Effects
 
 
Answered by Dr. Rakesh Karanwal 2 hours later
Brief Answer: It's likely an emergency:consult doc immediately Detailed Answer: Hi friend, Thanks for your query. The symptoms and the sequence of events are suggestive of a disease of the Nervous System; either, Acute Idiopathic Demyelinating Polyradiculopathy (AIDP); or, Guillain-Barre' Syndrome- both being auto-immune diseases. Both conditions (which share a similar presentation) are believed to be precipitated by a viral or bacterial infection. The body's own defense mechanism (Immune system) attacks the covering (myelin sheath) of certain nerves. IT IS A MEDICAL EMERGENCY and can even be fatal if PROMPT MEDICAL ATTENTION IS NOT SOUGHT. I would therefore strongly recommend that you consult your doctor IMMEDIATELY and apprise him of my opinion. I am certain that he will agree with me and will HOSPITALIZE YOU IMMEDIATELY for close observation, carry out urgent, relevant tests; and- based on the reports- will arrive at a certain diagnosis and initiate aggressive medical treatment. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Take care and DO NOT IGNORE MY ADVICE, Col (Dr.) Rakesh Karanwal
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Follow-up: What causes sore throat followed by tingling in fingers and face and stiffness in jaw? 8 minutes later
Thanks, I have seen a neurologist and had neurological evaluation and he did not think that GBS was the case in this situation. Its been almost 10 weeks since symptoms started and from what I understand those conditions get worse over 4 weeks and then usually better? Is it possible that PFT testing came back okay 4 weeks ago and then has gotten much worse since then?
 
 
Answered by Dr. Rakesh Karanwal 51 minutes later
Brief Answer: Have a repeat PFT test done Detailed Answer: There is a variant of GBS in which the paralysis/weakness starts from top --> downwards. In either case, the symptoms are suggestive of AIDP (or sub-acute or chronic variants). However, neurological examination is the cornerstone of narrowing down the options. Sub-acute/chronic variants of Idiopathic Demyelinating Polyradiculopathy, evolve more gradually, with a variable course progression. You have neither mentioned the neurologist's impression, nor whether he has advised MRI of spine/brain; Nerve Conduction Velocity (NCV) test to evaluate nerves' involvement; Electromyogram (EMG) to assess muscular disease; and, examination of cerebrospinal fluid (fluid present in the spine + brain). Since the lung functions are compromised at a later stage of the disease, PFT test should be repeated even though the earlier one was reported as normal.
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Follow-up: What causes sore throat followed by tingling in fingers and face and stiffness in jaw? 49 minutes later
Thanks, the neurologist did not think any scans were necessary. He tested my reflexes and did not think that any further tests were necessary. I also mentioned the possibility of auto immune conditions and GBS to my Dr but he didn't think this is the case either. If I had either of those wouldn't I have problems walking and such? My legs are sore but I'm able to walk... The pulmonologist thought it was all anxiety causing this but I don't think so.
 
 
Answered by Dr. Rakesh Karanwal 11 hours later
Brief Answer: Other possible medical conditions are listed below Detailed Answer: Sorry for the delay in reply, which is due to difference in our Time Zones. Your Neurologist had probably found normal reflexes during neurological examination, based on which he had excluded GBS. If that is the case, I agree with him. Summarizing your problems : throat infection followed by tingling in limbs and face, soreness in thighs/legs and back, rapidly deteriorating breathing problem, difficulty in swallowing, extreme tiredness/fatigue and breathlessness during sleep. The symptoms suggest involvement of nervous system, lungs/heart, muscles and possibly, joints. Stiffness of jaw with difficulty in opening the mouth wide can be due to inflammation of the jaw joint (Temporo-mandibular joint-TMJ), which may- or may not- be part of the disease complex. Apart from auto-immune diseases such as GBS/AIDP (which are less likely in the presence of normal reflexes), similar symptoms- in different combinations- are found in other conditions, such as, (a) Lyme Disease (tingling, soreness of muscles, difficulty in swallowing, breathing difficulty, extreme fatigue) (b) Polymyositis (pain/soreness and mild weakness of thigh muscles, back muscles, difficulty in walking, shortness of breath, extreme fatigue and involvement of one or more joints, such as, TMJ. (c) Systemic Lupus Erythematosus (SLE)- though much less common in males, can have an acute onset and manifest with tingling, soreness of muscles, shortness of breath, fatigue. (d) Connective tissue diseases, such as, Ankylosing spondylitis which can- in a few cases- present in an acute form, with some of the symptoms similar to those of yours; and, (e) A viral infection (such as, Cytomegalovirus or Epstein Barr virus) with prolonged complications (called post-viral asthenia) in the form of extreme fatigue, soreness of muscles, shortness of breath. Since your neurologist has apparently excluded abnormality of the nervous system, I would therefore suggest that you consult a Rheumatologist and apprise him of the possibilities mentioned by me. He will order various specific tests to exclude- one at a time- the above-mentioned disorders, and detect the exact cause by way of exclusion. It is NOT possible for me to do so online, without examining you thoroughly. Take care, Col (Dr.) Rakesh Karanwal
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Follow-up: What causes sore throat followed by tingling in fingers and face and stiffness in jaw? 3 hours later
Thanks so much ill check back with my PCP. is it pissible for anxiety to cause all
 
 
Answered by Dr. Rakesh Karanwal 37 minutes later
Brief Answer: Anxiety can indirectly cause numbness in limbs Detailed Answer: No. Anxiety can only cause 'hyper-ventilation', that is, voluntary rapid, deep breathing which causes excessive expulsion of carbon dioxide from the blood. This in turn, frequently causes pins and needles sensation in the extremities and, dizziness. I sincerely hope that your PCP will give you a patient hearing, actively consider my opinion and get the relevant tests done.
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Follow-up: What causes sore throat followed by tingling in fingers and face and stiffness in jaw? 1 hour later
Thanks, I'll get back with my PCP. Breathing seems to be getting worse by the day. I can barely breath at all and have been getting chest pains. Is it possible I had normal PFT testing last month and its gone bad so fast? This sounds extremely urgent to me but the Pulmonologist and a second PCP that I saw for 2nd opinion blamed anxiety as the cause. At 29 years are these rare? How common are these at my age?
 
 
Answered by Dr. Rakesh Karanwal 3 hours later
Brief Answer: Consult a cardiologist at the earliest. Detailed Answer: Hi, Since all possibilities given earlier, tend to affect the heart too, given the progressive shortness of breath, associated with chest pain and a normal PFT test (done earlier)- possibility of heart involvement cannot be ruled out. Therefore, it would be advisable to consult a cardiologist PRIOR to visiting the Pulmonologist. If there is a problem getting an urgent/early appointment, I will strongly recommend to get an ECG and 2-D Echo study of the heart done AT THE EARLIEST. You may send the reports to me by uploading them on this website. I will go through the reports and advise you accordingly. Further, it is extremely important for me to know if are you actually going through acute anxiety?? But, on the face of it, your symptoms do NOT suggest anxiety. You should however, continue taking Ativan thrice a day in the current dose. Lastly, it is common for all the possible causes enumerated earlier, to occur at your age. regards,
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Follow-up: What causes sore throat followed by tingling in fingers and face and stiffness in jaw? 2 hours later
I don't feel that I am going through anxiety, but the Pulmonologist and my PCP are extremely convinced that it is anxiety. I've made an appointment back with my PCP in two days to try and get referral to Cardiologist. I feel as if my breathing is getting worse by the day. I don't know if I can continue to go on like this much longer. Could this be as serious as something as an oncoming heart attack or anything like that at my age?It feels as if I can't breath properly through my diagphram and that I'm breathing through my mouth all of the time. I feel as if I can't breath properly at all. I don't really appear to have any swelling, weight gain, or fluid buildup anywhere that I can tell. It feels as if my stomach is full of air though and that I can't breath properly only through the top part of my chest.
 
 
Answered by Dr. Rakesh Karanwal 8 hours later
Brief Answer: Take a 5 days' course of Xanax as advised below Detailed Answer: Unfortunately, sitting thousands of miles away from you, I cannot comment further without examining you thoroughly. Since your PCP and Pulmonologist are fully convinced that your problems are due to anxiety, here is a simple diagnostic test :- Take Xanax(0.5mg) tablet thrice a day. YOU WILL SEE THE RESPONSE WITHIN 24 HOURS. If you feel much better, then it is anxiety. START TAKING THE TABLET IMMEDIATELY and let me know how you feel. And, don't worry! There is no impending heart attack. As such, you will be seeing your PCP in two days' time.
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Follow-up: What causes sore throat followed by tingling in fingers and face and stiffness in jaw? 8 hours later
Thanks ive tried the xanex 3x a day for a week or so with no change. ill refer back to my pcp.
 
 
Answered by Dr. Rakesh Karanwal 3 hours later
Brief Answer: Diagnosis of anxiety has been excluded Detailed Answer: So, anxiety has been EXCLUDED! Discuss my opinion with your PCP. It would be wonderful if you give me the feedback after meeting your doctor and the cardiologist.
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Follow-up: What causes sore throat followed by tingling in fingers and face and stiffness in jaw? 24 hours later
Thanks, I'm going back into my PCP tomorrow. I feel horrible though as if I can not breathe well at all. Breathing appears to be getting noticeably worse by the day as if I can't take a deep breath. Will any of the things you mentioned cause this severe worsening of breath over 1 month?
 
 
Answered by Dr. Rakesh Karanwal 2 hours later
Brief Answer: Heart's involved in early stage of viral infection Detailed Answer: It is difficult to predict at what stage would the heart be affected in the above-mentioned conditions, EXCEPT in viral infection, which can affect the heart muscle (condition called Viral Myocarditis) at an early stage and can rapidly result in heart failure. Please do apprise my opinion with the doctor tomorrow and INSIST on getting ECG + Echo done at the earliest. Do not forget to upload the ECG tracing and Echo report, once available.
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Follow-up: What causes sore throat followed by tingling in fingers and face and stiffness in jaw? 23 minutes later
Ok thanks, I'll upload this for you once i have it done.
 
 
Answered by Dr. Rakesh Karanwal 9 hours later
Brief Answer: I will be waiting Detailed Answer: Hope all goes well. God Bless You
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Follow-up: What causes sore throat followed by tingling in fingers and face and stiffness in jaw? 11 hours later
Went to PCP he doesn't think echo is necessary given my age and symptoms. I'm pretty sure that something is off though. I'm feeling extremely weak and weaker by the day/week. I'm not sure what to do. If I go to ER they won't do much as my heart sounds fine when they listen to it and last 2 EKGs turned out without any issues. Is it possible that EKG is normal but still issues?
 
 
Answered by Dr. Rakesh Karanwal 2 hours later
Brief Answer: Get clean chit from Psychiatrist. Then approach ER Detailed Answer: I am totally at a loss of words. Medical ethics dictate that the patient should be satisfied completely, without any bias or prejudice, which the PCP has failed to do. EKG is done on a resting individual with a minimal load on the heart. Even a moderately failed heart would work normally in resting conditions. EKG reflects primarily the electrical activity, while auscultation with a stethoscope may not reveal significant findings in a resting position. I seem to have run out of all unexplored options. Since the ER has been repeatedly passing your problems as due to anxiety, the only option is to insist the ER to refer you to a Psychiatrist. Let the Psychiatrist rule out anxiety conclusively. Thereafter, armed with a clean chit from the Psychiatrist, you may confront the ER and exercise your legal right for being denied proper medical care, due to bias and negligence. Lastly, the symptoms of rapidly progressive breathlessness, chest pains, generalized weakness and breathlessness during sleep are primarily due to either a cardiac or lung disease. Refusal to evaluate cardiac and lung functional status tantamount to deficiency of service. Further, if the ER is totally convinced that the symptoms are due to anxiety, it is his duty to refer you to the Psychiatrist for his expert opinion. He has NOT done so. You may therefore take an appropriate action as per existing relevant Healthcare Rules and Laws of your country.
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Follow-up: What causes sore throat followed by tingling in fingers and face and stiffness in jaw? 24 minutes later
I've been to psychiatrist and they think its all anxiety or are almost certain that anxiety could be causing this as I have a history of anxiety in the past. However it has been different in the past and hasn't felt like this. I'm going to try and get a 2nd opinion from another PCP I guess. I don't know how much longer i can go on like this I could barely sleep all last night. I am on PPO insurance in US so I guess I could make my own referral to cardio but I'm not sure. Thanks,
 
 
Answered by Dr. Rakesh Karanwal 25 minutes later
Brief Answer: Re-start Xanax in increasing doses Detailed Answer: In that case, I would strongly advise you to re-start anti-anxiety drug, such as, alprazolam, clonazepam or the drug prescribed by the Psychiatrist. The dose should be progressively increased till maximum permissible dose is reached. See the response, as it is possible that the dose of Xanax, that you have been taking earlier, was grossly inadequate and required upward revision.
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Follow-up: What causes sore throat followed by tingling in fingers and face and stiffness in jaw? 1 hour later
I've been on the anti anxiety medications the whole time and ran the gambit of them all. I was able to make a direct appointment myself with a Cardiologist for monday as I'm on PPO insurance in US and don't require my PCP to refer for specialist visits. I'm only hoping its not anything serious and I don't have to go to ER at all this weekend. I'm not sure how long after the visit I'll get the test done but probably sometime next week I hope. Thanks again.
 
 
Answered by Dr. Rakesh Karanwal 9 hours later
Brief Answer: Forward ECHO report once available Detailed Answer: Excellent!! I will be eagerly awaiting the outcome of your visit to the cardiologist and the echo report.
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Follow-up: What causes sore throat followed by tingling in fingers and face and stiffness in jaw? 1 hour later
Thanks will do been up all night here with chest pain burning sensation on left side and numbness in hands/tingling as well as lightness in head feels as if I'm getting worse by the day and could pass out at any minute... Highly concerning. I hope they find something soon
 
 
Answered by Dr. Rakesh Karanwal 11 hours later
Brief Answer: Wish you all the best Detailed Answer: It's just a matter of 2 days before you meet your cardiologist. Hope of a positive outcome and a definitive conclusion.
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Follow-up: What causes sore throat followed by tingling in fingers and face and stiffness in jaw? 23 hours later
Thanks so much I feel as if im not breathing at rest is that possible? or only breathing through my mouth
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