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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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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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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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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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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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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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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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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Brief Answer: I will be waiting Detailed Answer: Hope all goes well. God Bless You

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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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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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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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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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