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Suggest Treatment For Frozen Shoulder And Bleeding Gums While On Tenormin
Question: I don't know where to start being I have so many things going on with my body. Where I live, you can't go in and tell the dr all what's bothering you because they will only allow for only one or two things, and will only spend about 8 minutes, then their gone. I am hoping to at least find out what direction I need to take for what all's going on with me. I am a 55 yr old white female. I am 5 ft 6 and weigh 132. I have never been overweight and have always been thin. I don't smoke or drink. I have a history of SVT, MVP, PVC'S, PAC'S, and moderate Mitral valve regurgitation. I have been on Tenormin, 50 mg since the age of 22. I have a yearly echo to keep a check on it. I have been having trouble with my bones and joints aching and for about 6 months, I have been having trouble with my left shoulder/arm. I thought at first it was just the way I had slept on it, but it keeps getting worse. I went to a rheumatoid specialist and he did some blood work and ordered a shoulder x-ray and also a left hip x-ray too because it hurt all the time, especially at night when trying to sleep. Nothing showed up in the x-rays. He wanted to do an injection of cortisone but I didn't really want that being he didn't know what the problem was. I recently went to a chiropractor to see if I could get some relief from the pain of my arm, and he examined me and also did another x-ray and said I had frozen shoulder. He did an adjustment, but it was very painful and hasn't seemed to do any good. After that I went to a bone specialist, and he didn't do any x-rays, but has sent me to physical therapy. The pain seems to be attacking my whole arm, forearm on the inside has throbbing, shooting pains and my wrist hurts, and my thumbs on both hands are so painful and hurt all the time. Several fingers on both hands are now so tender to touch and ache. Also seems the tops of my feet where the bones are are painful and my knees and just about every bone on my body, almost like something is just attacking it. I stay to very tired all the time and have no energy to do anything and can't sleep at night either. I just want to sit down and cry because last year at this time I was walking and exercising and now I can't. It seems like overnight, something came on and started attacking my whole body with all kinds of weird symptoms. Another weird thing that happens every now and then will be I can taste blood in my mouth and not be doing anything, and when I spit, there will be bright blood. I can suck on my tongue at times and it seems to be coming from there and other times from my teeth. I have visited my dentist and she said it isn't tooth or gum related and she was really concerned and wanted me to see a dr, but my family dr doesn't seem to do any test to find out what is going on. Also the hair on my legs have stopped growing and I have NO hair on my legs at all plus my eyebrows are almost all gone. I have had thyroid test in the past, but it always comes back ok. Please, please help to point me in the right direction of what kind of dr I need to see and if you have any suggestions as to what u think might be going on with me. I would greatly appreciate it.
Brief Answer:
You need to perform some tests to check for medical conditions as following
Detailed Answer:
Hello XXXX!
Thank you for your question on HCM! I read it carefully and understand your concern.
Your troubles don't seem to be related to the heart. It doesn't cause this clinical scenario.
There are some other causes which can cause this :
1. A fibromyalgia is a disorder causing pain, chronic fatigue and other symptoms like yours. There are not specific tests to diagnose this disorder. It is more a diagnosis of exclusion, when every test results normal but you still feel all the symptoms. It can be treated with antidepressants. You need to consult with your rheumatologist or neurologist for this condition.
2. A neurological disorder. A polineuropathy or a radiculopathy can cause similar symptoms. So I would recommend to consult with a neurologist and have a neurological examination for neurological signs. Other tests like an electroneurography (nerve conduction study) may be needed to study the nerves of your limbs for possible disorders.
3. A metabolic disorder:
A dysfunction of the adrenal gland can cause low plasma levels of cortisol with this symptomatic.
Vitamin B12 deficiency can cause chronic anemia and polineuropathy mimicking your clinical situation.
So I would recommend you to perform a routine blood test for anemia, vitamine B12 levels and cortisol plasma levels.
I would also recommend to have coagulation tests for a possible coagulation disorder related to your mouth bleeding, and inflammation tests like fibrinogen, PCR, sedimentation, rheumatoid factor, Antinuclear antibodies to exclude a possible rheumatoid disorder.
Hope to have been of help!
Feel free to ask any questions whenever you need.
Greetings! Dr. Iliri
You need to perform some tests to check for medical conditions as following
Detailed Answer:
Hello XXXX!
Thank you for your question on HCM! I read it carefully and understand your concern.
Your troubles don't seem to be related to the heart. It doesn't cause this clinical scenario.
There are some other causes which can cause this :
1. A fibromyalgia is a disorder causing pain, chronic fatigue and other symptoms like yours. There are not specific tests to diagnose this disorder. It is more a diagnosis of exclusion, when every test results normal but you still feel all the symptoms. It can be treated with antidepressants. You need to consult with your rheumatologist or neurologist for this condition.
2. A neurological disorder. A polineuropathy or a radiculopathy can cause similar symptoms. So I would recommend to consult with a neurologist and have a neurological examination for neurological signs. Other tests like an electroneurography (nerve conduction study) may be needed to study the nerves of your limbs for possible disorders.
3. A metabolic disorder:
A dysfunction of the adrenal gland can cause low plasma levels of cortisol with this symptomatic.
Vitamin B12 deficiency can cause chronic anemia and polineuropathy mimicking your clinical situation.
So I would recommend you to perform a routine blood test for anemia, vitamine B12 levels and cortisol plasma levels.
I would also recommend to have coagulation tests for a possible coagulation disorder related to your mouth bleeding, and inflammation tests like fibrinogen, PCR, sedimentation, rheumatoid factor, Antinuclear antibodies to exclude a possible rheumatoid disorder.
Hope to have been of help!
Feel free to ask any questions whenever you need.
Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
What kind of disorder would I need to see a neurologist about? I guess I mean when I make an appt with one, which one of the many symptoms I am having that I should mention to him? I wouldn't want to go over all of them when obviously it wouldn't be in his field.
Brief Answer:
The throbbing pain in your limbs is suggestive for neurological disorder
Detailed Answer:
Hello again!
The throbbing pain in your arm, forearm, wrist, and thumbs on both hands, fingers.
Also the pain in your feet, knees and hips, including the chronic fatigue.
These symptoms are often related to polineuropathy or fibromyalgia. If the nerve conduction studies and a careful neurological examination result normal, fibromyalgia remains the most probable cause.
I would advise you to check for the above mentioned metabolic causes first before consulting with the neurologist. The chronic fatigue and loss of hair is very suggestive for adrenal gland dysfunction.
Hope to have been helpful !
Greetings! Dr. Iliri
The throbbing pain in your limbs is suggestive for neurological disorder
Detailed Answer:
Hello again!
The throbbing pain in your arm, forearm, wrist, and thumbs on both hands, fingers.
Also the pain in your feet, knees and hips, including the chronic fatigue.
These symptoms are often related to polineuropathy or fibromyalgia. If the nerve conduction studies and a careful neurological examination result normal, fibromyalgia remains the most probable cause.
I would advise you to check for the above mentioned metabolic causes first before consulting with the neurologist. The chronic fatigue and loss of hair is very suggestive for adrenal gland dysfunction.
Hope to have been helpful !
Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
What kind of dr do I need to see to get this metabolic disorder tests run? Also, do you think a dr would be opposed to me asking for these tests and the things you have mentioned? Will he view that as going on the internet and going over his head like he doesn't know what he is doing, just asking?
Brief Answer:
Hope that medical opinions will be helpful.
Detailed Answer:
Hello dear XXXX!
As I have explained you before, you need to check some lab tests to define properly the cause of your complains. You have to discuss with your GP or internist, and find the right modalities available to achieve the results.
Regarding the final step of your differential diagnosis, an appointment with your neurologist is necessary.
At the end, I would like to remember that we are on this site only for giving medical opinions based on available medical history and specific patients requests.
These opinions could not substitute the decision of attending physician, but may help to turn the discussion with your doctor more productive and to contribute in better diagnosis and treatment.
Hope to have been helpful. Dr. Iliri
Hope that medical opinions will be helpful.
Detailed Answer:
Hello dear XXXX!
As I have explained you before, you need to check some lab tests to define properly the cause of your complains. You have to discuss with your GP or internist, and find the right modalities available to achieve the results.
Regarding the final step of your differential diagnosis, an appointment with your neurologist is necessary.
At the end, I would like to remember that we are on this site only for giving medical opinions based on available medical history and specific patients requests.
These opinions could not substitute the decision of attending physician, but may help to turn the discussion with your doctor more productive and to contribute in better diagnosis and treatment.
Hope to have been helpful. Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I understand that I have to have some lab tests done to define the cause of my complaints. I was asking what kind of dr I need to make an appt with to do the metabolic disorder tests. In the previous message, you said I should have that done before doing some of the tests that would check the nerves in my limbs with the neurologist. I doubt my family dr would do these tests because is only a nurse practioner. Don't think I spelled that correctly, but sure u know what I meant.
Brief Answer:
You shoud talk with your attending physician.
Detailed Answer:
Hello XXXX!
Your questions are quite correct. Your spelling is right. As I said you before, it is the responsibility of your GP to guide the patient's diagnostic work up through necessary lab tests and subspecialty consultations. If this universal concept is different in your country, then you have to ask how is it working?! In my country, there are several modalities how to perform lab tests: guided by GP, or asking directly to a certain laboratory, etc.
Hope to have been helpful to you!
Best wishes! Dr. Iliri
You shoud talk with your attending physician.
Detailed Answer:
Hello XXXX!
Your questions are quite correct. Your spelling is right. As I said you before, it is the responsibility of your GP to guide the patient's diagnostic work up through necessary lab tests and subspecialty consultations. If this universal concept is different in your country, then you have to ask how is it working?! In my country, there are several modalities how to perform lab tests: guided by GP, or asking directly to a certain laboratory, etc.
Hope to have been helpful to you!
Best wishes! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Where I live, my family dr is only a nurse practioner, so I would have to find the right dr to make an appt with to do the metabolic tests, and I don't know what field that would be in. Would it be a neurologist, arthritis, or some other specialist?
Brief Answer:
a GP or a neurologist can recommend these tests
Detailed Answer:
Hello!
These lab tests can be recommended by the GP or a neurologist.
They can be performed in every hospital laboratory , not in small medical centers.
Hope to have been helpful to you!
Greetings! Dr. Iliri
a GP or a neurologist can recommend these tests
Detailed Answer:
Hello!
These lab tests can be recommended by the GP or a neurologist.
They can be performed in every hospital laboratory , not in small medical centers.
Hope to have been helpful to you!
Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I do have two more questions that don't relate to ones I already asked I try to walk for exercise when I feel like it and every time I go walking, after I get finished, I always smell this strong ammonia smell afterwards. I know it isn't actually ammonia, but it's like it's in my nose or something, but only after walking or the elliptical. I have asked the dr's what might cause this and they have no idea. The second question if something I have read many times and from what I read, it's an indicator of blockage or some kind of heart problem. I have a crease in my ear lope and I noticed it last year. I automatically wondered if I should be alarmed by this and have my heart checked out for blockage.. What do you think?
Brief Answer:
I would explain as folows:
Detailed Answer:
Hello!
Regarding your first question, I would suggest to consult a neurologist as this may be a sign of specific neurological disorders, like epilepsy or orfactory nerve dysfunction, etc. An EEG would be necessary, and eventually a head CT scan to rule out the above neurological disorders.
Regarding the second question, I would say that this is called Frank's sign and denotes an increased probability of coronary artery disease, but is only a helpful element for taking into consideration a careful screening. I would not be so alarmed, as a possible coronary disorder has more specific and obvious clinical elements to be detected, than just an incidental diagonal earlobe crease.
Best wishes! Dr. Iliri
I would explain as folows:
Detailed Answer:
Hello!
Regarding your first question, I would suggest to consult a neurologist as this may be a sign of specific neurological disorders, like epilepsy or orfactory nerve dysfunction, etc. An EEG would be necessary, and eventually a head CT scan to rule out the above neurological disorders.
Regarding the second question, I would say that this is called Frank's sign and denotes an increased probability of coronary artery disease, but is only a helpful element for taking into consideration a careful screening. I would not be so alarmed, as a possible coronary disorder has more specific and obvious clinical elements to be detected, than just an incidental diagonal earlobe crease.
Best wishes! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I would rather go ahead and have it checked and not wait until it's too late if that is a strong indicator of blockage being my Dad had blockage. What would be the best way to check for blockage?
Also, I have been having some problems with skipped beats, or whatever they are. I have had PVC'S and PAC'S for years, but they would always feel different than the way I am feeling them now. It feels like it just quits beating or is quivering or fluttering for about 9 seconds. When it happens I can feel it in my chest, and I will hold my breath and try to feel my pulse with my finger on my neck to see what it's doing, but I can't really feel a pulse, but when it goes back into rhythm, I can feel it in my chest. I don't know if it's a-fib, or runs of more than 4 or 5, but it's scary. I know it can be dangerous if there are bunches in a row and pauses. I recently wore an event recorder about three months ago for this, but my heart didn't really every do it when I was wearing it. It did pick up one time when the dr said for about 3 beats it was in tachycardia at 160 beats. I don't see how my heart could be at a normal heart rate and then go into tachycardia for three seconds for three beats, but maybe I not understanding the way it was explained. I just know it feels scary and like it's quivering or fluttering. I wish I knew whether I should be alarmed or not when it does this, because it sure is scary.
Is an EEG a test I would have to have or is there another way? I am asking this because I read where electrodes have to be attached to your scalp, and I have very thin hair and it comes out so easily.
Also, I have been having some problems with skipped beats, or whatever they are. I have had PVC'S and PAC'S for years, but they would always feel different than the way I am feeling them now. It feels like it just quits beating or is quivering or fluttering for about 9 seconds. When it happens I can feel it in my chest, and I will hold my breath and try to feel my pulse with my finger on my neck to see what it's doing, but I can't really feel a pulse, but when it goes back into rhythm, I can feel it in my chest. I don't know if it's a-fib, or runs of more than 4 or 5, but it's scary. I know it can be dangerous if there are bunches in a row and pauses. I recently wore an event recorder about three months ago for this, but my heart didn't really every do it when I was wearing it. It did pick up one time when the dr said for about 3 beats it was in tachycardia at 160 beats. I don't see how my heart could be at a normal heart rate and then go into tachycardia for three seconds for three beats, but maybe I not understanding the way it was explained. I just know it feels scary and like it's quivering or fluttering. I wish I knew whether I should be alarmed or not when it does this, because it sure is scary.
Is an EEG a test I would have to have or is there another way? I am asking this because I read where electrodes have to be attached to your scalp, and I have very thin hair and it comes out so easily.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Dear XXXX! You are right about your palpitations. Those rare ectopic heart beats sometimes are difficult to detect even with an event recorder. Nevertheless, they are not dangerous for your health, nor life-threatening. As you have MVP and associated mitral valve regurgitation, those ectopic beats may appear time after time. I would recommend to keep an eye open on left atrial volume (if it is already enlarged), and to possible paroxysmal atrial fibrillation or any other supraventricular arrhythmias. You need to take prophylactic antibiotics each time you undergo an invasive medical procedure, to prevent endocarditis.
Regarding the Frank's sign, it should make us more alert but not so alarmed, as the main indicators for a future coronary event are the well known coronary risk factors, like hypertension, diabetes, dyslipidemia, smoking contacts, heredity for CAD, etc (and these remain also the targets to control the risk for ischemic heart disease development, except heredity which is a non modifiable risk factor).
So, the right thing to do is to control possible hypertension, avoid smoking contacts, control any possible blood glucose intolerances, treat dyslipidemia, modify your life style to a healthy one (take into consideration frequent physical activity), and follow healthy diet (I would strongly recommend Mediterranean diet), control possible overweight, etc.
That ammonia smell, and all the other associated complains we have discusses above are not cardiac related, so I insist you should contact with a neurologist for a comprehensive differential diagnosis. EEG is an appropriate test to rule out any cerebral focal electrical activity, so to rule out some neurological disorders (responsible for your complains, like bad smell, etc).
EEG has nothing to do with your hair, and is a harmless examination.
I hope to have fulfilled your expectations, and to have clarified your topics.
Wish you a good health! Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Dear XXXX! You are right about your palpitations. Those rare ectopic heart beats sometimes are difficult to detect even with an event recorder. Nevertheless, they are not dangerous for your health, nor life-threatening. As you have MVP and associated mitral valve regurgitation, those ectopic beats may appear time after time. I would recommend to keep an eye open on left atrial volume (if it is already enlarged), and to possible paroxysmal atrial fibrillation or any other supraventricular arrhythmias. You need to take prophylactic antibiotics each time you undergo an invasive medical procedure, to prevent endocarditis.
Regarding the Frank's sign, it should make us more alert but not so alarmed, as the main indicators for a future coronary event are the well known coronary risk factors, like hypertension, diabetes, dyslipidemia, smoking contacts, heredity for CAD, etc (and these remain also the targets to control the risk for ischemic heart disease development, except heredity which is a non modifiable risk factor).
So, the right thing to do is to control possible hypertension, avoid smoking contacts, control any possible blood glucose intolerances, treat dyslipidemia, modify your life style to a healthy one (take into consideration frequent physical activity), and follow healthy diet (I would strongly recommend Mediterranean diet), control possible overweight, etc.
That ammonia smell, and all the other associated complains we have discusses above are not cardiac related, so I insist you should contact with a neurologist for a comprehensive differential diagnosis. EEG is an appropriate test to rule out any cerebral focal electrical activity, so to rule out some neurological disorders (responsible for your complains, like bad smell, etc).
EEG has nothing to do with your hair, and is a harmless examination.
I hope to have fulfilled your expectations, and to have clarified your topics.
Wish you a good health! Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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