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Fluctuating paraesthesiae, gastric symptoms, balance problems, coughing...
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Fluctuating paraesthesiae, gastric symptoms, balance problems, coughing clear gel like mucous

Am 37 yrs female, w allergies,bout of 'chronic fatigue' 3y ago.
9 months ago had Flagyl 400mg bd x7 for vaginal infection. During Flagyl had pins&needles in right hand/leg. On last day of Flagyl during (fish) dinner felt suddenly unreal, right cheek/throat/arm/leg went numb. Balance off, nausea, belching, mid back pains,electric shocks, extreme thirst&hunger. Temp up to 38, bp fluct btw 90/60-145/95, itchy rash. WBC 9.3 had 2x antib.  Brain MRI w contr,lumbar punct-normal. Blood normal excpt Eosinophilia 11%, prev Leptosp. Parasite tests negat (live in West Africa). Diagn Ciguatera or poss parasitic inf.Improved over wks/months. In March symptoms returned.

Symptoms now are (all symptoms fluctuate):
1. Paraesthesiae hands/forearms feet/lower legs. Worse from use ie. lifting.
2. Slight muscle weakness forearms after use
3. Dizziness, at times vertigo
4. Pain TMJ/temples
5. Coughing clear gel-like mucous balls.
6. Tightness in neck w. breathing bit obstructed
7. Belching
8. Hypoglycaemia like sympt
9. Tinnitus
10. Itchy rash and wheezing at times

Could Ciguatera do this? My tropical specialist thought Ciguatera would not fluctuate like this. Neuro wnts to do EMG/TT and poss oligcl bands. What would you recommend? Should I see a gastro/internal specialist?  Do you think this could be CNS related? MS? Lyme or some other entity that still produces neurotoxins?  Thanks
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Avatar_dr_f_tn
I am happy to address the questions that you pose, although it is important that you recognize that my impression is based entirely on the information you have provided in your posting and is by no means a replacement for an office visit with a neurologist.  Diagnosis is contingent on detailed history and physical exam and as such, the following information should be considered solely for educational purposes.

You have many symptoms that involve multiple body systems, mainly the GI tract and the nervous system. These symptoms are non-specific and can be the manifestation of variety of condition. However, your constellation of symptoms and the results of teh workup you had done so far ruled out many infectious and neurological diseases. it seems to me that Ciguatera poisoning is still a likely possibilty.

Typically Initial signs of poisoning occur within six hours after consumption of toxic fish and include perioral numbness and tingling (paresthesia), which may spread to the extremities, nausea, vomiting, and diarrhea. Neurological signs include intensified paresthesia, arthralgia, myalgia, headache, temperature sensation reversal and acute sensitivity to temperature extremes, dizziness, vertigo, and muscular weakness to the point of prostration. Cardiovascular signs include arrhythmia, bradycardia or tachycardia, and reduced blood pressure. Ciguatera poisoning is usually self-limiting, and signs of poisoning often subside within several days from onset. However, in some cases the neurological symptoms are known to persist from weeks to months. In a few isolated cases neurological symptoms have persisted for several years, and in other cases recovered patients have experienced recurrence of neurological symptoms months to years after recovery. Such relapses are most often associated with changes in dietary habits or with consumption of alcohol.

There is no objective test to establish the diagnosis, it is based on the symptomatology and ruling out other mimicers and possible infectious, metabolic disorders. Lyme disease can present with a wide spectrum of neurological manifestations, but it is usually more specific and focal than your symptoms. You also had an unremarkable neurological workup so far (MRI, CSF studies, EMG). I suggest you see an infectious disease specialist to revisit your illness and reevaluate the whole course. If the diagnosis of Ciguatera poisoning is established, management is typically by supportive care and symptomatic treatment. There is no effective treatment or antidote for ciguatera poisoning. Some medications, dietry supplements and natural therapies have been tried with variable results. There are no good data to suggest any of these as therapeutic options. Symptoms like nerve pain or the sensory disturbance can be managed by using some medications like Gabapentin.

Good luck, I hope you feel better soon.
6 Comments
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Avatar_f_tn
I get the self same problems but don't know the cause.

I have had the same as you but also have unequal pupils and sinus tachycardia which is constant with right bundle branch block.  

I have had balance problems on and off (a couple of times a year), gastric symptoms, coughing gel like mucous which is clear, stuffy nose, pressure on sinuses, paresthesias which fluctuate.
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Avatar_n_tn
acidophilus is a vitamin which really helped my GI tract
1 -3x a day or Frenagreek tea
you may have  yeast in GI tract
can give bloating gas bleaching.
I also have that cough
I 'd go to an allergist or Holestic DR.
antibiotics can cause GI tract discomfort.


lyme disease is something to check
though I have found it doesn't always show up but ya
may have it.

for my cough I bought a saline nasel spray to flush out my nose
I also take bendryel for the postnasel drip which has
helped my coughing
but I have lyme disease and the cough is due to that.
Lyme also effected my GI tract big time.

this is what has helped me.though I am not a Dr.
good luck feel better
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Avatar_n_tn
Mydvg - I definitely have candida in my digestive track, been taking high strength probiotics for over a year. I have seen a doctor who specialises in nutrition and when tested, was found deficient in various B group vitamins (not B12 though), zn, mg, manganese, copper, iron etc, which we are now trying to correct (as well as eradicate the yeast). So far no change though.
Yes, tested Lyme negative, but I know that doesn't mean anything, want to see a Lyme literate doctor.

Quills - I also get blurred or double vision, comes together with the balance problem.  Do your symptoms all fluctuate? I just had about two weeks of coughing the gel balls and more paraesthesias but now they are gone again, but I have more feeling of pressure in cheeks, teeth, TMJ, temples etc, sometimes feel like inside my palate is numb.
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Avatar_f_tn
Yeah mine fluctuate but some symptoms remain constant.  I seriously think I have an allergy.  I figured out that I am worse when in the house than when I'm outside.  I have constant post nasal drip, red irritated looking throat, throat is swollen on one side but I have had a swab taken and there was no infection.  It was suggested to me that I have an allergy possibly to cat hair as my symptoms started when my husband got a cat.  A long haired cat.

I was also itching all over.  I know that I am breathing inadequately.  My breathing is shallow and steady, but I am not getting enough oxygen.  I tend to yawn a lot a night.  Like every couple of minutes.  I get sinus tachycardia and high blood pressure as well and I never had that until after he got the cat too.

My nose/sinuses are always blocked. I am often clearing my throat and i have had problems with my balance in the past and it has been cured by taking decongestants.  

I am not sure if I have candida or not.  I did have a heavily coated tongue but that started when I lost my appetite through anxiety.  I was getting frequent mouth sores too after eating when I started to try and eat again.  

Candida usually is white patches on the tongue and mouth but I didnt' have that, I had a furry tongue for a while, but not anymore.  I also have spider like veins all over the inside of my mouth and on my gums.  I had an x ray done by the dentist and he said there was no sign of gum disease.  Something is irritating me and making breathing difficult.  

I have heard that allergies also cause clear mucous.  
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Avatar_n_tn
I saw an allergy specialist who did spirometry and nitric oxide testing, Nitric oxides were abnormal at 90ppb, but spirometry was normal. Allergy tests were also repeated. Her conclusion was that the clear gel like balls that I cough are a sign of an eosinophilic asthma-like inflammation in my lungs and her guess was that it was possibly due to exposure to moulds and storage mites.

Neuro did EMG which was normal and TT which was slightly abnormal indicating small fibre neuropathy.

Tropical specialists repeated parasite testing at it was all negative, so based on the allergy results does not want to treat for parasites empirically. He also thinks Ciguatera is unlikely to cause these symptoms, been eating salmon recently, no aggravation.

I still wonder about the underlying cause, as all my symptoms started at the same time a year ago after the course of Flagyl. Recently I have had more belching and pareaesthesias again, in the past week also heart skipping beats (all day long),which happened a few tiimes during the past year but never for more than an hour at the time.

When I use my muscles I now have sensory disturbances afterwards.
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A related discussion, Dr.(sorry, I have forgotten your last name) was started.
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