This is all new to me so if anyone can help it can’t be worse than the 14 doctors I have been to. When I was 18 i would become shaky inside and out at work maybe every couple months. As the years went on the shakiness became much more. I now work in a busy nursing home as a CNA. 6 yrs ago I got pregnant with my son. The shakiness became extreme muscle weakness in my legs, rapid heart rate. I ended up having a hyper thyroid. But that came and went and over the last few years I have daily bouts of my legs giving out my arms going limp, 160 plus heartrate. In the last few months it has turned into times where I can barely move at all, can’t speak, can’t swallow. My hands and feet tingle, my tongue tingles. I sometimes can’t grasp for words or even get foggy. I have been to 3 neurologists, 4 heart specialists, 4 different family doctors, 2 blood doctors, and a stroke specialist. I have had an MRI, MRA, Cat Scan, EKG, EMG,TEE, Echo, Bubble echo,sleep study, heart monitorssssss, Brain scans with those little sticky things in my hair. I have a a muscle biopsy. All have been normal except occasional low K., skipped beats while my heart is fast., and a calcium deposit in my brain I am currently going to Hershey Medical Center…I have them stumped as well. They thought it was hypokalymic periodic paralysis dis., but the biopsy was good, They are now tossing around early MS. As time goes on this all gets worse, although currently I am on a 1 1/2 month rest, it comes and goes. I am on Lithium,&Acetozolomide .
Could it be the lithium even though my levels are normal…I have been on and off it for 15 yrs.
Thanks for listening Any help would me great,
Dr. Joshua’s Answer:
Thank you for your question.
As you said, you’ve been examined by a number of specialists, there’s really not much I can add, so I’ll just offer a couple of suggestions.
As you correctly noted yourself, any prolonged undiagnosed symptoms always warrant a review of medication, possible interactions and side effects. I recommend that you review your medication with your prescribing doctors. Do NOT stop taking any of your medications before seeing your own doctor about it. Some points to discuss: What is the acetazolamide for? What alternatives could be used? Acetazolamide is not a widely used drug in outpatient treatment — it is sometimes used for lung or brain edema, and glaucoma. Is it possible that lithium/acetazolamide interaction could cause fluctuations in your blood lithium levels? Such an interaction has been described, but it’s considered poorly documented and mild. Acetazolamide may, in some cases, cause blood lithium levels to fall below therapeutic levels. What was the lithium described for? Bipolar disorder? Are there any alternatives?
Both acetazolamide and lithium can have adverse effects on the nervous system, especially in high doses, sometimes resulting in symptoms similar to some of those you’ve described. This, of course, does not necessarily mean that your symptoms are caused by the drugs.
Do you personally see a connection between periods of medication use and the symptoms? If so, it is theoretically possible that you may be suffering from drug side effects. Individuals react to drugs differently. Some may even experience idiosyncracy, which in English means an unexpected and extremely rare side effect. Note that while possible, this is indeed rare.
As you have been very thoroughly examined, I will not make any attempts to try to diagnose your symptoms, it would not be possible over the Internet anyway. However, you mentioned having seen various specialists, but you did not mention a psychiatrist, although I’d expect Lithium treatment to have been initiated by a psychiatrist.
Your symptoms, while not specific to, also have characteristics of anxiety / panic attacks. Has this possibility been taken into account? I should expect it has — but has it been properly evaluated by a psychiatrist? Has treatment with an SSRI (selective serononin reuptake inhibitor, such as Prozac) been considered?
Again, these are just some ideas that I’m providing in trying to give you the best answer that I can given the information I have. I emphasize that you MUST discuss these issues with your own doctor, because any medical information given over the Internet is inherently biased and as such should not be taken as medical advice. Some pointers, though, for you to discuss with your doctors.
Good luck!
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