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What Causes Tingling Sensation And Swelling In The Fingers While On Lamictal ?

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Posted on Mon, 20 Nov 2017
Question: My fingers have been swelling for years, I have had masectomy,melanoma,squamous. Now my fingers started tingling about 1.5 weeks ago. Now my legs tingle sometimes, usually when I'm going to bathroom. My arms are starting to tingle a bit. I have been to 7 rheumatologists, 3 hand surgeons, they say osteoarthritis with inflammation but more than that. Yes, tingling fingers thought was carpal tunnel but in the last couple of days tingling got worse. Sometimes not as bad as others. I have nail problem that was diagnosed as I can't find paper right now. If you can give me a minute
I will be right back

Im on ritalin 20 mg 3 times a day for many years.

400 mg lamictal for many years

1 mg klonopin before I go to sleep

Very infrequently 2 mg ability

.gave me ciclopiirox olamine topical 2 times daily and My thumb was feeling a little pain by where doctor cut nail so gave me n clot rim & betameth dip.gave me ciclopiirox olamine topical 2 times daily and My thumb was feeling a little pain by where doctor cut nail so gave me n clot rim & betameth dip. I had stage 0 DCIS they led me to believe I should do double. My husband and I decided I should do it based on the doctors info. We didn't go for second opinion or look up online

I got a terrible Staph infection (not MRSA) was in hospital for 5 days emergency operation at Mount Sinai, New York. I was on keflex high dosage for 1.5 years. I had a rash on the "good breast, I will call it) that is the one that had the infection. When they did the transfer of the expanders to implants they found there was a years infection there. I was put on diflucan too for over a year.

Then,,, when he took out the drains that evening I was in terrible pain put in front of ever operation as they did with other one. That was a hematoma.
doctor
Answered by Dr. Ishu Bishnoi (5 hours later)
Brief Answer:
Tingling in extremities probable diagnosis and approach

Detailed Answer:
Hi XXXX000, thanks for asking from HCM.


I can understand your concern. You are a strong lady. You have suffered from mastectomy, melanoma, squamous carcinoma, MRSA, uterine bleeding and you are still Okay! It is good that you have taken care of yourself very good.

You are currently suffering from tingling in extremities. It can be due to

- Peripheral neuropathy - The reason could be drug induced, diabetes mellitus, old age, chronic illness, vitamin deficiency.

- Carpal Tunnel syndrome - It can occur due to osteoarthritis of wrist joint, osteoporosis, diabetes mellitus, idiopathic.

To know the cause, Few investigations are needed like

- Neurological examination

- Nerve conduction studies of median, ulnar, radial nerve.

- Electromyogarphy of hand muscles

- MRI of cervical spine to know any disc disease, cord compression.

- If there is still confusion, nerve biopsy of peripheral nerve like sural nerve can be done.

Kindly ask your doctor for these investigations. Let me know the reports.
Till then for relief, you can take few medications like

- Tablet Pregabaline or Gabapentine or Nortriptyline after prescription.
- Neuron specific vitamin like B12, folic acid, pantothenic acid, pyridoxine after prescription.
- Use hot fomentation.

Hope it will help you. If you are having any doubts, do let me know.
Thanks. Take care.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ishu Bishnoi (8 hours later)
I am taking Ritalin 20 mg three times a day. And lamictal. 400 mg a day. I hope you don’t think there’s any problem with this. I’ve been taking both for at least 10 years. And I know it is helping me. Thank you again
doctor
Answered by Dr. Ishu Bishnoi (3 hours later)
Brief Answer:
No problem with it

Detailed Answer:
Hi XXXX0000, welcome back.

You can take XXXXXXXXXX 20mg and Lamictal 400mg. There is no problem with that.

Thanks.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Ishu Bishnoi (2 hours later)
Thank you

Do you think I should see the neurologist and an endocrinologist. I have an appointment to get blood work again on Tuesday. They told me to fast after midnight night before

Hey tell me they did a blood test that showed my blood sugar was good and my vitamin B 12 is good. That was about a year ago and then went of the rheumatologist did one the other day she said everything looked good I don’t have the results of my hand but it was not fast. Is there a special blood test rather just testing the sugar to look for diabetes 2.Not sure you received last 2 follow up questions

Do you think I should see the neurologist and an endocrinologist. I have an appointment to get blood work again on Tuesday. They told me to fast after midnight night before

Hey tell me they did a blood test that showed my blood sugar was good and my vitamin B 12 is good. That was about a year ago and then went of the rheumatologist did one the other day she said everything looked good I don’t have the results of my hand but it was not fast

Is there a special blood test rather just testing the sugar to look for diabetes 2

Thank you
doctor
Answered by Dr. Ishu Bishnoi (20 hours later)
Brief Answer:
Endocrinologist and neurologist consultation

Detailed Answer:
Hi Meig1219, welcome back.


Sorry for replying late. I think you should consult a Neurologist first. S/he will evaluate you for peripheral neuropathy. If there is doubt of endocrinological disorder like diabetes or Cushing's syndrome, he/she might refer you to the endocrinologist. No need to consult the endocrinologist until then. Also, your blood sugar is normal which is good for you.

Another thing is you should repeat your blood sugar and B12 level. The reports are quite old (1 year). For diabetes confirmation, fasting blood sugar, post-prandial sugar and glucose tolerance test can be done. Other then this, no test is needed.

So you can ask for fasting and post-prandial sugar. If the report is okay, don't worry at all.

Hope it will help you. If you have any doubt, do let me know.
Thanks. Take care.




Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Ishu Bishnoi (2 hours later)
Thank you!

I really trust your advice makes so much more sense than the doctors I have gone to.

doctor
Answered by Dr. Ishu Bishnoi (9 hours later)
Brief Answer:
Thank you

Detailed Answer:
Hi XXXXXXX thanks a lot for the appreciation.

I hope you recover well. Best wishes for your recovery.
You appreciation will motivate me to treat patients with utmost care.

Please feel free to contact me if any doubt.
Take care.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ishu Bishnoi (10 hours later)
Now I have one black toenail
doctor
Answered by Dr. Ishu Bishnoi (36 minutes later)
Brief Answer:
Black Toenail cause and need some information

Detailed Answer:
Hi XXXXXXX welcome back.


Black toenail at your age could be due to many causes like

- Trauma - Direct hit can cause accumulation of blood under toenail. It is painful. No need to do anything for it. It will resolve completely with time.

- Infection due to bacteria or fungus - Fungal infection is painless. It does not cause any fever. While bacterial infection is painful and causes fever.

- Vascular insult - Dry gangrene can occur due to arterial damage like peripheral vascular disease, atherosclerosis. It can cause thinning of toe and black toenail.

- Diabetes and peripheral neuropathy can cause painless injury and black toe.

As I don't have any other information, so I need to some answers of questions

- What is the duration?

- Send me its picture?

- Do you have any pain, redness of toe, fever?

- Any history of injury, pus discharge?

Please give me answers of these questions. I will try to make conclusion and guide you further.

Hope it will help you. If any doubt, do let me know.
Thanks. Take care


Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ishu Bishnoi (26 hours later)
not sure how to send picture

just got back from abdominal ultrasound should get results within 72 hours,

going for fad]sting blood test tomorrow

Hope I can ask one unrelated thing.

Plan on taking family which includes my 1 year and 8 month old grandsons to Hawaii.
Business class and they have their own seats if that helps your answer.

It is about 5 hour flight to San Francisco, a 3 hour layover there, and another 5-6 hour flight to Hawaii.

What are your thoughts on this?

Thank you again!
Me again.

would you be able to list what my GP should be testing for ? Any special diabetes blood checks?

I would like him to check if I have any vitamin deficiencies too?

Thanks so much again.

Best,

XXXXXXXXX
doctor
Answered by Dr. Ishu Bishnoi (20 minutes later)
Brief Answer:
Diabetes mellitus and vitamin deficiency tests

Detailed Answer:
Hi XXXXXXX Welcome back.


First I will answer your query about journey. Your grandsons can accompany you on flight. Your 8 month old grandson might need special attention on 6 hour flight duration. Make sure, they don't eat too much during flight. Sometimes, small children can vomit. Please carry antiemetic like domperidone and paracetamol syrup with you in case of vomiting or pain. Otherwise, no need to worry.
Another important thing is pressure change in ear. You know that when flight ascend or descend, there is change in air pressure that can cause ear pain. In children, due to straight Eustachian tube, pain can occur more. So to prevent it, ask them

- To lower their head during pressure change
- You can ask them to drink some water or swallow saliva.
- Use paracetamol syrup if pain is severe.
- Continous chewing can also help in getting relief.

Now coming to your second query, you GP should advise few tests like

- Fasting blood sugar (already done), post-prandial sugar. If any doubt of raised sugar, then HbA1c test to know about sugar status in last 1-2 months. It is for diabetes.

- Vitamin B12 level
- Complete blood count and peripheral smear for B12, iron, folic acid deficiency
- Vitamin D level
- Ultrasound doppler of lower limb vessels on the side go black toe nail (if no history of trauma to toe nail).

Only these tests are needed in your case.
And you can write me your blood investigations reports.

Enjoy your daily trip.
If any doubt, do let me know.
Thanks. Take care.
Brief Answer:
Interpretation of your lab tests

Detailed Answer:
Hi XXXXXXX welcome back.


Thank you for providing me the details of all metabolic workup. I will explain you every test and its interpretation

- Glucose is 85, which is totally normal (it should be less than 120mg/dl)

- NA 141 K 4.3. Your sodium (Na) and potassium (K) are normal. In kidney or liver damage, sodium and potassium value can rise.

- Liver function test - ALT 23 AST 24 ALKP 54 TBILI 0.5, these values are in normal range. In chronic alcoholics, ALKP (alkaline phosphtase) enzyme rises. It is normal in your case. Your Ultrasound abdomen is not showing any enlarged liver, portal vein thrombus or splenomegaly, that means your liver is totally Okay. Don't worry about it at all.

- Kidney function test - Your USG is showing normal size, shape and texture if kidneys and your blood urea, creatinine, GFR are all in normal range. Your BUN ratio is high normal. It does not mean you are having any kidney issues. Don't worry about it at all.

- Diabetes is also ruled out as your HbA1c is normal, your sugar is normal. No more test is needed to confirm Diabetes.

- Your B12 is 1024, which is normal. It also rules out nerve damage due to its deficiency.

- Folate is slightly raised. As folic acid is a water soluble enzyme, it excess can not cause any damage. Fat soluble vitamin excess can cause toxicity like Vitamin D, E and K. So don't worry about it. And stop taking folic acid supplements if taking any.

- No fungal infection as KOH mount is negative.

- Your abdominal organs like aorta, intestines, peritoneal cavity are all normal. It is a good thing.

- Doppler study is normal that means no vascular pathology.

Final interpretation is - You are quite fit as per your age. The amount of alcohol, which you have on routine days, is not causing any side effects on liver, kidneys.
However alcohol can directly damage nerves and can cause neuropathy. So control its amount on weekends. And rest continue your life style. I am impressed with your reports.

Hope it will help you. If any doubt, do let me know.
Thanks. Take care

Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
Dr.
Dr. Ishu Bishnoi

Neurologist, Surgical

Practicing since :2007

Answered : 901 Questions

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What Causes Tingling Sensation And Swelling In The Fingers While On Lamictal ?

Brief Answer: Tingling in extremities probable diagnosis and approach Detailed Answer: Hi XXXX000, thanks for asking from HCM. I can understand your concern. You are a strong lady. You have suffered from mastectomy, melanoma, squamous carcinoma, MRSA, uterine bleeding and you are still Okay! It is good that you have taken care of yourself very good. You are currently suffering from tingling in extremities. It can be due to - Peripheral neuropathy - The reason could be drug induced, diabetes mellitus, old age, chronic illness, vitamin deficiency. - Carpal Tunnel syndrome - It can occur due to osteoarthritis of wrist joint, osteoporosis, diabetes mellitus, idiopathic. To know the cause, Few investigations are needed like - Neurological examination - Nerve conduction studies of median, ulnar, radial nerve. - Electromyogarphy of hand muscles - MRI of cervical spine to know any disc disease, cord compression. - If there is still confusion, nerve biopsy of peripheral nerve like sural nerve can be done. Kindly ask your doctor for these investigations. Let me know the reports. Till then for relief, you can take few medications like - Tablet Pregabaline or Gabapentine or Nortriptyline after prescription. - Neuron specific vitamin like B12, folic acid, pantothenic acid, pyridoxine after prescription. - Use hot fomentation. Hope it will help you. If you are having any doubts, do let me know. Thanks. Take care.