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What causes tingling sensation in hands, confusion, migraine and chest pain?

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Dr. Tushar Kanti Biswas

Internal Medicine Specialist

Practicing since :1975

Answered : 1653 Questions

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Posted on Fri, 16 Oct 2015 in Medicines and Side Effects
Question: I have been having problems since May of this year. The first symptom was feeling lightheaded and just kind of 'foggy'. After approximately two weeks of that, I began vomiting and having diarrhea. This landed me in the ER with a gastroenteritis diagnosis. I began having sleeping issues, heart arrhythmias (Echo and EKGs were fine, but Holter and event monitor showed tachycardic episodes every time I moved and sometimes while sleeping), confusion, anxiety, throat/neck pain (carotid Doppler and CT of neck revealed nothing abnormal), pain when breathing, shortness of breath, it took every bit of strength to get off the couch to simply go to the bathroom, dizziness, random nerves feeling pinched, my lymph nodes felt enormous (this symptom remains along with the intermittent neck pain), low grade fever along with periods of temp in the 96 range, blood pressure was high for a couple of weeks (has been low recently) pain and pressure in my jaw, ear, and behind my eyes, back pain (I would wake up feeling as though my back was completed twisted) pain in shoulder blades, the worst migraines (I would get pressure and then numbness and tingling in my hands and feet, confusion where I would even forget what I was saying and basically 'freeze' in place, then I would have diarrhea), and chest pain. The only things that have showed up in my testing (MRI of brain, CT scans of abdomen, chest, head, so much blood work, urine tests, ultrasounds of abdomen) is a consistent low WBC (prior to February of this year my WBC was always normal), occasional low RBC, a cyst on my spleen, an umbilical hernia, a high EBV result (pcp insists it is from a past infection), two equivocal ELISA Lyme tests (which led to one negative western blot with only 2 reactive bands and second western blot pending results). I'm not sure if it is important or not that the second ELISA Lyme test had a higher reading than the first (first was .91 and the second was 1.07). I have seen 2 cardiologists, 6 pcp/internists, a hematologist, and more ER doctors than I ever cared to know and they either admit they simply don't know what is going on or they tell me it's stress! I must admit, I became stressed after having my life taken from me by this! I have three children, I led 4H clubs, and I was finally close to earning my bachelor's degree when this illness took over. That is stressful! However, prior to this, I was fine! I had GI issues which were treated with PPIs and occasionally Carafate, but that was it! The symptoms that are still taking place to this day (most came, wreaked havoc, and left) are the lightheaded/foggy feeling, poor memory, pain in hips and back, lymph nodes feeling enlarged, fatigue, and the migraines. Any help is GREATLY appreciated! I need my life back!!
doctor
Answered by Dr. Tushar Kanti Biswas 9 hours later
Brief Answer:
?Lyme disease

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

You have myriad of symptoms related to cardiovscualar, musculo-skeletal, GI,Neurological system and hematological abnormality . You have undergone extensive work-up probing all involved system but nothing positive conclusion could be drawn as they are mostly normal.
Only pointer is ELISA Lyme tests which showed higher reading on successive tests..Positive ELISA Lyme tests should be followed by western blotting (IgM & IgG).
Chronic Lyme Disease may be associated with chronic fatigue syndrome or fibromyalgia.
To my mind ,you have to exclude treatable cause before labeling the symptoms functional or stress related.





Regards

Dr. T.K. Biswas M.D. XXXXXXX
     

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Tushar Kanti Biswas 56 minutes later
Thank you so much for your time!! Actually, it turns out that my second western blot had the same results as the first. The only reactive bands were 41 kD igg and 23 kD igm on both of the western blot tests. I saw somewhere that an ELISA can have false positives. Is that true? I forgot to mention that they discovered my spleen is enlarged last week. I am not sure what that means at this point. I truly appreciate your help!
doctor
Answered by Dr. Tushar Kanti Biswas 9 hours later
Brief Answer:
Lyme disease-diagnostic work-up

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

I agree Lyme disease may cause diagnostic confusion.

Serologic testing may yield negative results during the first
several weeks of infection;however almost all patients have a positive antibody response to B. burgdorferi after that time.
You are having symptoms since May i.e more than 20 weeks or so.

ELISA can have false positives in Lyme disease.
In persons with illness of >2 months’ duration, a positive IgM
test result alone is likely to be false-positive and therefore should not
be used to support the diagnosis.

Western blot:
According to current criteria adopted by the CDC, an IgM western
blot is considered positive if two of the following three bands are present:
23, 39, and 41 kDa. However, the combination of two such bands
may still represent a false-positive result. Misuse or misinterpretation
of IgM blots has been a factor in the incorrect diagnosis of Lyme disease
in patients with other illnesses.
In your case western blot IgM had only one band of 23 kDa.

An IgG blot is considered positive if 5 of the following 10 bands are present: 18, 23, 28, 30, 39, 41, 45,58, 66, and 93 kDa.
In your case western blot IgG had only one band of 41 kDa.

Since the serological tests (standard two-test approach) so far done are equivocal ,you may go for second-generation serologic test - the VlsE C6 peptide IgG ELISA, which employs a 26-mer of the sixth invariant region of the VlsE lipoprotein of B. burgdorferi (causative organism of Lyme disease).

Enlarged spleen indicates possibility of Disseminated Infection/Early Infection: Stage 2.





Regards

Dr. T.K. Biswas M.D. XXXXXXX
     

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Tushar Kanti Biswas 13 minutes later
Thank you so much!!! I was unaware of the fact that other tests (for Lyme) even existed! You have been wonderful! Thank you!
doctor
Answered by Dr. Tushar Kanti Biswas 7 minutes later
Brief Answer:
Lyme disease-second-generation serologic test

Detailed Answer:
You are most welcome
regards
Dr Biswas
Above answer was peer-reviewed by : Dr. Prasad
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