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Suggest treatment for chest pains, dizziness, fluctuating BP and pain in left arm

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Posted on Mon, 11 May 2015
Question: Hello, my boyfriend is 24 and is a Line Cook. He had a sinus infection earlier this month and as time went on he was experiencing some strange out of place symptoms. Other than the sinus congestion we expected, he was having chest pains, light headedness, fluctating blood pressure and pain in his left arm. I can tell he had 2 panic attacks on two separate occasions and he's been experiencing anxiety which is not normal of his behavior. His respirations, temperature and pulse remained pretty steady and within range, but he sincerely thought he was working toward a heart attack. The first time he went to Urgent Care they prescribed him Amoxiclav. The biggest issue at this time was his sinuses. The second time, he went because he was having severe chest pains and dizziness but after a few tests they prescribed Levaquin, indicating he was probably still getting over cold. His sinus infection started to clear up but he was noticing other symptoms haven't subsided. He is no longer experiencing the chest pains, but the muscles in his left forearm are very tight causing occasional twitches in his hand. It is uncomfortable and sensitive to the touch. I tried massaging it for him thinking he may have just strained it due to the lifting he did that day (which he normally doesn't do too much of) but it hasn't helped. His arm and overall nerves feel fine in the morning but as the day goes on it gets worse and by the evening, he is very worried and the pain increases. He went to the ER yesterday and they took an Xray to make sure he didn't hurt his arm and they told him "All looks negative. We're going to prescribe you Ibuprofen and Flexeril to ease the pressure." He asked if they can look into it deeper (hoping they would run a blood test at least) and they simply said "what else do you want?". Now, the reason this is significant, is because of his history. He does have ongoing cases of ingrown toenails. The last time he had one, we took care of it, but while it was still healing, he went into work and the kitchen was flooded. He stood in the water for several hours and by the time he got home, his feet were white. I bring this up because he is worried he may have contracted some kind of infection. As a teenager he did have MRSA in his left knee and now he is worried about the possibility of having a similar issue in his arm. He has no rash, fever or redness. However, he has moments where he feels his arm is almost numb, he just today expressed that in the hot kitchen he works in, he's really cold, he feels a lump in his forearm near his wrist, his tendon feels very tight (we did read that Levaquin causes tendinitis) and overall he is very worried. The last thing I want to bring up is that on Feb 15th he was attacked by 5 strangers while on break at work. They held him down and 3 of them kicked him in the head several times. We read that having an infection is quite common after head trauma, thus adding to the worry. Not sure if there is any correlation between the two. I am very sorry for all the information, he is just concerned that with all the antibiotics he's been taking it could be masking a serious issue and we can't seem to get anyone to listen and it will be at least another 2 weeks before he can see a doctor. Is there any advice you can give us in the meantime or steer us in the right direction? I mean, does this sound like an emergency issue? If so, what questions should we ask, he is sincerely ready to go the ER again tonight.

Thank you VERY much for your time.
doctor
Answered by Dr. Vasudha Jayant Athavale (5 hours later)
Brief Answer:
A complete health check up followed by ENT/ Spinal doctor's consultation.

Detailed Answer:
Hi XXXXX,
Thanks for posting your query under HCM.
I have gone through your query carefully & understand your concern.
Your boy friend seems to have an array of symptoms, making him tense, nervous, which in turn recycle the symptoms thus forming a vicious circle. I am sorry for him, I also understand your concern.
1) his primary complaint is sinusitis- which was treated by Amoxyclaav/&levaquin. Chest pain, lightheadedness followed- which can be attributed to sinusitis itself( it's effects in blood & ear)/ side effect of Levaquin.
I would suggest - to find cause of allergy & remove it ( allergy testing & desensitization )Or add mast cells blockers to medicines -so as to control sinusitis effectively
Also blood DLC may show Eosinophlillia - which can reflect as chest pain /dry cough.
Light headedness because of Eustachian tube block results in dizziness - for this usually decongestants/ vicks vapor inhalation suffices.
* he should consult an ENT specialist get investigated( blood, X ray sinuses,allergy testing Antibiotic sensitivity test) & get a proper advise to
contol & cure sinusitis.
2 ) his second complaint is about his arm pain/stiffness/numbness.
Though levocetrizine does have side effect of creating muscle spasms, It can not cause other arm symptoms.
I feel these symptoms are pertaining to his profession- long working can cause cervical spinal problem. causing the aggravation of muscular & nerve symptoms with exertion.
For this a consultation of Orthopedic doctor & Xray spine followed by pain killers/ calcium/vitaminD/ physiotherapy would help.
To get rid of cardiac phobia an ECG would act as screening test.
2)In grown toes -
SElf care like nail care:Soaking ,trimming, using proper shoes to avoid pressure on toe nails This helps in prevention.
Surgical treatment by Podiatrists is some times needful
3) soaking of feet in flood water/ attack by people - are accidental things, which need to be managed tactfully & scientifically.
Use of effective antibiotics with doctor's advise & Management of stress are the thing needed .
** I don't think he needs to visit ER -instead, he should plan for the checkups under the headings I have narrated before.I have tried to detail on important health aspects he has. To sum up He needs-
* A complete Medical l check up/ investigations advised by an experienced physician.Get him investigated as per his advise which may include- investigations to-,
- Investigations to rule out heart ( ECG), cervical spondillitis, Eosinophillia, low calcium/vitamin D levels, Thyroid tests, diabetes.Culture & sensitivity of nasal discharge.
- Physician then will refer you to ENT/ Allergy/ spine doctor as he finds it needed.
* Apart fro this he needs self help in form of-
-Healthy lifestyle- with nutritive food avoiding allergens/ plenty of water drinking/nasal vapor inhalation, saline gargles/respiratory exercises,proper nail care, yoga ,physiotherapy meditation for positive thoughts & health.
I have tried to give detailed information to find a way out of the problem Hope it's useful to you.Any follow up query is welcome.
Thanks.


Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Vasudha Jayant Athavale (3 hours later)
Thank you very very much for your help and your time on this subject!! I will be discussing this information with him and we will be sure to seek care as you've suggested. Hope you have a wonderful weekend!
doctor
Answered by Dr. Vasudha Jayant Athavale (9 hours later)
Brief Answer:
Thank you!It was my pleasure to help you!

Detailed Answer:
Hi XXXXX,
Thank you for your generous feed back to my answer! Such reactions from the users definitely boost up feel of satisfaction & enthusiasm in doctors like me.
I am sure both of you will solve the health problem that is nagging you & your boy friend will be back to perfect health soon !
Wish you both a happy companionship full of satisfaction ,health ,wealth ! Wish you all the best!
I am happy that you are satisfied with the answer given. for any other query in future through HCM, I will be happy to help.
Thanks.
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Answered by
Dr.
Dr. Vasudha Jayant Athavale

General & Family Physician

Practicing since :1970

Answered : 8615 Questions

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Suggest treatment for chest pains, dizziness, fluctuating BP and pain in left arm

Brief Answer: A complete health check up followed by ENT/ Spinal doctor's consultation. Detailed Answer: Hi XXXXX, Thanks for posting your query under HCM. I have gone through your query carefully & understand your concern. Your boy friend seems to have an array of symptoms, making him tense, nervous, which in turn recycle the symptoms thus forming a vicious circle. I am sorry for him, I also understand your concern. 1) his primary complaint is sinusitis- which was treated by Amoxyclaav/&levaquin. Chest pain, lightheadedness followed- which can be attributed to sinusitis itself( it's effects in blood & ear)/ side effect of Levaquin. I would suggest - to find cause of allergy & remove it ( allergy testing & desensitization )Or add mast cells blockers to medicines -so as to control sinusitis effectively Also blood DLC may show Eosinophlillia - which can reflect as chest pain /dry cough. Light headedness because of Eustachian tube block results in dizziness - for this usually decongestants/ vicks vapor inhalation suffices. * he should consult an ENT specialist get investigated( blood, X ray sinuses,allergy testing Antibiotic sensitivity test) & get a proper advise to contol & cure sinusitis. 2 ) his second complaint is about his arm pain/stiffness/numbness. Though levocetrizine does have side effect of creating muscle spasms, It can not cause other arm symptoms. I feel these symptoms are pertaining to his profession- long working can cause cervical spinal problem. causing the aggravation of muscular & nerve symptoms with exertion. For this a consultation of Orthopedic doctor & Xray spine followed by pain killers/ calcium/vitaminD/ physiotherapy would help. To get rid of cardiac phobia an ECG would act as screening test. 2)In grown toes - SElf care like nail care:Soaking ,trimming, using proper shoes to avoid pressure on toe nails This helps in prevention. Surgical treatment by Podiatrists is some times needful 3) soaking of feet in flood water/ attack by people - are accidental things, which need to be managed tactfully & scientifically. Use of effective antibiotics with doctor's advise & Management of stress are the thing needed . ** I don't think he needs to visit ER -instead, he should plan for the checkups under the headings I have narrated before.I have tried to detail on important health aspects he has. To sum up He needs- * A complete Medical l check up/ investigations advised by an experienced physician.Get him investigated as per his advise which may include- investigations to-, - Investigations to rule out heart ( ECG), cervical spondillitis, Eosinophillia, low calcium/vitamin D levels, Thyroid tests, diabetes.Culture & sensitivity of nasal discharge. - Physician then will refer you to ENT/ Allergy/ spine doctor as he finds it needed. * Apart fro this he needs self help in form of- -Healthy lifestyle- with nutritive food avoiding allergens/ plenty of water drinking/nasal vapor inhalation, saline gargles/respiratory exercises,proper nail care, yoga ,physiotherapy meditation for positive thoughts & health. I have tried to give detailed information to find a way out of the problem Hope it's useful to you.Any follow up query is welcome. Thanks.