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Unanswered Questions, sickness and neurological symptoms

Greetings all,

This is a a bit long so bear with me.
I'm a 25 year old male. I contracted mono in November and got a very bad case of it and didn't take adequate time to rest. I was only out of work for 2 weeks and during that time was somewhat out and about.

Symptoms of a new illness presented in March, starting with a canker sore, and progressing to flu like symptoms. I noticed greenish/brown mucus and tooth pain and went to doctor for an anti-biotic (I think Bactrim). I took the antibiotic which seemed to clear up what I thought was a sinus infection but I still wasn't feeling better and my glands were very swollen (they still are too a degree). The doctor prescribed Augmentin due to the remaining swollen glands and remaining flu like symptoms.

On April 16th, I had tingling in my hands and feelings of pure exhaustion. My blood pressure was lower than normal (for me) and I felt somewhat light headed. I had my girlfriend bring me to the ER where I had labs, urine and chest x-ray, all of which were normal.

A few days later, I was working in art class (still feeling very sick) with an x-acto knife that wasn't especially clean and jabbed myself in the thumb. It'd been 11 years since my last tetanus booster. I didn't get one right away, and the next day, experienced a muscle twitch under the skin while I was at work. I immediately panicked and went first thing the next day for a tetanus shot.

Over the course of the neck few weeks, I noticed muscle weakness, twitching in the jaw and neck stiffness, and an increase in heart rate (especially with light exertion and going from sitting to standing position) and general feelings of exhaustion. I went to my primary care and expressed my concern about Tetanus, but Dr. said due to my proper vaccination history and treatment within 48 hours of wound was a near impossibility. My doctor suspected Lyme disease when I mentioned I had noticed a few red bumps on my neck upon waking a month or so earlier, and prescribed me a 3 week course of Doxycycline but symptoms did not improve.

I found that I had no temperature even though I was certain I must have a fever (hot flash feelings) and it was often subnormal (sometimes as low as 96.9) The highest I ever had was 99F. The weakness has since progressed to twitching all over my body and tenderness in muscles. I have some swelling or slightly increased muscle tone in the jaw and pain in the lower jaw and teeth (having two horizontally impacted bottom wisdom teeth that never got removed probably doesn't help) I was experiencing (and still am) jaw and throat tightness, neck stiffness, and what the doctor referred to as "trigger points" in my back. I've had some spasticity and my muscles feel heavy and I have burning sensations throughout my body that seem to come and go and affect different areas at different times. I was diagnosed with PAC's (benign heart palpitations) in 05' and they have since gotten worse, and I sometimes have feelings of shortness of breath or labored breathing and palm sweating. The symptoms seem to be getting progressively worse slowly. I'd been having some constipation as well as weight loss (a lot of which is due to poor eating habits from the severe anxiety that's been accompanying this). Dr.also put me back on Augmentin again for 2 weeks, and when I expressed further concern about the tetanus, a one week course of Keflex (I am basically a walking anti-biotic: could this be killing good bacteria and causing more harm than good?)

I'd have every test in the book (just about) including: multiple labs, CBC with differential, c reactive protein, sed rate, two lyme disease tiders, a comprehensive western blot lyme test, two HIV tests, multiple blood tests for muscle enzymes and functions, EMG muscle testing, MRI of brain (which revealed slight abnormality which neuro said was consistent with CFS or lyme), test for Lupus, rheumatoid panel, allergy test (blood test), CT scan of everything from base of lungs down (due to constipation and tenderness above groin area), and echocardiogram (heart ultrasound), two EKG's, and all results (except for the MRI) have been NORMAL. My white and red blood cell counts however were on the low end of the normal spectrum, my sed rate was very low (1) which I was told was good. I've been taking Lexapro and Xanax to try and manage the symptoms but I've been on the Xanax for several months and my body is building up a tolerance to the dose I'm on. I'm been taking tylenol like it's candy. The muscle symptoms range from painless twitching, to stabbing pain and tightness which can be quite painful at times.

I've seen two neurologists, both of which feel my symptoms are not a result of a neurological disease (though the second doctor had a much better bed side manner and is ordering a spinal tap to rule out anything potentially serious such as MS or ALS), and I'm having a soft tissue MRI of jaw and neck.  I've seen two infectious disease doctors who assured me Tetanus is impossible considering how long it's been since my injury.

I'm very confused, scared and am convinced I'm dying. Am I alone in this? Has/dose anyone else experienced these type of deabilitating symptoms here?  Do these symptoms sound like they could be a form of some type of toxicity?  I feel like I'm getting progressively worse.  Any advice on where to go next would be greatly appreciated.  Thanks so much in advance.

254 Responses
224986 tn?1189759424
"Lyme titers" are notoriously unreliable, and horrendous screening instruments. To definitively rule out Lyme and other tick-borne illness co-infections, it is VITAL that you INSIST on a Western Blot (both IgG and IgM) to be run by a laboratory specializing in tick borne illnesses (e.g., Igenex, MDL, Bown). "Big box" labs are NOT the way to go on this one. They typically do not report all bands, and diagnose strictly by CDC criteria (which is inappropriate, as the CDC criteria were NEVER to be considered diagnositic...only were to be used to surveillance purposes).

I strongly encourage you to seek out a lyme literate physician. Lyme is an extraordinarily complex illness with myriad manifestations which can mimic a number of other diseases.  The symtpoms you described above have been described by persons with Lyme disease and other common, tick-borne co-infections (e.g., erlichia, babesiosis, bartonella).

Best of luck to you,
Michele

p.s. Unfortunately, MANY infectious disease doctors (as ironic as this may appear) are WOEFULLY undereducated when it comes to the dx and tx of Lyme disease. Please do not fall into the trap of assuming that since a doc told you your lyme titer was negative, that you do not have lyme disease.
Avatar universal
Thanks for your input!  A lot of people have suggested lyme to me.  I used to go camping almost every year and never noticed a tick bite but that doesn't mean it didn't happen.  Does chronic lyme get worse before it gets better?  I thought the symptoms primarily affected the joints and not the muscles.  I'm going to have my spinal fluid tested for lyme as well.  How do I go about finding a LLMD?  I hear a lot of them are being persecuted by the insurance companies and are kind of "under the radar" so to speak.  Not sure how to locate one in my area, I'm in Massachusetts.  A family from my town recently have been very sick with no explanation, all tests normal.  They went and had to pay a RIDICULOUS amount of money for a test their insurance wouldn't cover which came back positive.  New England is notorious for lyme and it's getting worse.  I DID have a western blot test done (took two weeks) and my ID doctor seems very knowledgeable about lyme.  He assured me I didn't have it.  Any additional advice StrictlyTopSecret, as well as others?  Thanks so much.
224986 tn?1189759424
My first piece of advice to you would be to request the results of your Western Blot. Which bands (if any) were positive? The bands reported on a WB from "big box" labs such as Quest and LabCorp frequently do NOT include a few lyme specific bands (ostensibly because the ill-fated Lymerix vaccine, which a patient could have received,  could lead to a false positive on those bands).

My second word of advice to you would be to have your WB repeated if it was not performed by a lab specializing in the dx of tick borne illnesses. The leader in this area is Igenex in California. I cannot emphasize enough how important it is to have your WB run by a lab such as Igenex , MDL, or Bowen. It truly can make all the difference.

Thirdly, although finding a lyme literate physician can, indeed, be difficult, it can also mean the difference between getting better and deteriorating. I do not know whether or not you have lyme (or co-infections). I do know, however, that if you have lyme, that it is highly unlikely it will spontaneously remit on its own.

Borrelia burgdorferi (the spirochete shaped bacteria that causes Lyme diseae) is an infuriatingly clever, adapative organism. If you had it for any length of time, 3 weeks of doxycycline probably won't cut it (particularly if your dose was merely bacteriostatic rather than bacteriorcidal). This bacteria has a number of forms, one of which is the (alleged) "cyst" form which essentially enables it to "hide" from antibiotics. Certain antibiotics theoretically work as "cyst busters", while others are more amenable to conquering the other forms of this bacteria (spirochetal bacteria are the same sorts of bacteria that cause syphillis).

You are correct in noting that many LLMDs do not accept insurance. For good or ill, this is often the case. With some, you can be at least partially reimbursed at "out of network" levels.

One important caveat: there are SOME LLMDs (note: I said SOME, not all) who practice on the fringes of medicine. If you are not "into" alternative healing (I am not), you would be well served to overtly ask the practitioner (before plunking down $350 or more for an initial consult) whether or not he/she condones/uses "holistic" or "alternative" type approaches. I am of the opinion that hard science is the way to go with this disease. I recently had the unfortunate experience of running into an LLMD who was one of these "fringe" type docs. After asking her if she was nuts, I walked out of her office.

ILADS.org and LDA.org are two places to start if you need a referral for a lyme literate physician.

Again, I don't know whether or not Lyme (or other co-infections) are a factor for you. I really encourage you, however, not to rule out the possibility.

Best of luck,
Michele

p.s. It is often the case that you feel worse before you feel better if you have Lyme and are on antibiotics. This has to do with neurotoxins being released as the bacteria die off. It is called a "herxheimer reaction", and it is not at all uncommon.
224986 tn?1189759424
p.s. Lyme can manifest itself in a number of ways. One common manifestation, as you mentioned, involves joints and muscles. Neuroborreliosis, however, manifests itself neurologically (e.g., neuropathic pain, encephalitis). My lyme disease has manifested both neurologically and in terms of joint/muscle issues.
Avatar universal

Hello!

Thanks for the quick response.  Is there any chance of Tetanus, do you think? A mild form or a slowly progressing form?  I know how severe and potentially life threatening that disease can be and my first neurological symptoms was a DAY after my wound, the Dr. said I'd be dead within a week with that kind of infection, but I was on Augmentin at the time and received a tetanus shot within 24 hours, which I've been told can slow down the progression of the disease, but no doctor seems to be able to tell me by how much.

A lot of my symptoms seem to mimic the early stages of that disease, and it is so rare and uncommon in this country now that most doctors have never seen it, let alone have the qualifications to diagnose it.  Every doctor I've seen assures me that is impossible though I feel like there is something coursing through my veins, slowly poisoning me.  I just don't know what do to.  I've written to the foundation about finding an LLMD and will have my WB repeated.  I'm wondering if this could be Lyme, or perhaps some kind of poisoning.  All input is appreciated.  Thanks to everyone. :)
187799 tn?1219613173
You should thoroughly investigate the lyme disease.  My sister in law was the first reported case in Illinois 17 years ago.  She was so very, very sick for more than a year before they dx'd her (she was about 25 at the time).  She had meningitis three times and, as you, just felt as though she was dying.  No one could figure it out and I don't know how they finally pursued the test for lyme as it was very uncommon and just coming to the forefront back then.  But she had been in Minnesota for business and that is where she was bit - she never realized she was bit either.  The disease  did manifest itself in many different illnesses but most serious was the menengitis.

Follow the testing from the above post and best to you........

Avatar universal
There is no chance you have tetanus.  Tetanus is a very serious, life-threatening disease.  If you had it, you would be dead already or paralyzed and on life support,or  nearly dead.  You can x this one off of your list.  I've been a nurse for more than 20 years.  I have never seen a case of tetanus.  I think lyme disease is a very likely probability.  I agree with the above posters about the testing etc.. Do not rule this out based on testing alone.  Good luck.
Avatar universal
Patsy,

Yes, I realize how unlikely it is.  I find it interesting that this all seemed to start with dental pain, and infection, and now my jaw is swollen and I'm having these muscle symptoms and jaw tightness, bad taste in mouth.  I had read that if an infection (such as a dental infection or sinus infection) becomes anaerobic it can produce these kind of potentially serious neurological symptoms and can cause all kinds of problems.  I had my teeth looked at a few months ago but there was no sign of abscess.  I'm having a lumbar puncture on tuesday and an MRI of my neck and jaw next week so I'll see what that shows.  I'll post my results.  Would the MRI show any kind of infection, or pockets or abscesses in the jaw or anything like that?  Thanks!
Avatar universal
Yes, please post your results.  We are all trying to find out what we have.  It helps to talk to others and find out what they have had done, results etc..Good luck with the spinal tap.  Make sure you stay flat on your back for the time period they tell you and drink lots of fluids so you don't get a spinal headache.  I got one.  It was so bad I had to be admitted.
Avatar universal
Patsy,

Is it possible that I have a viral infection that is attacking my skeletal muscles?  Would it be worth having a muscle biopsy if my doctor is willing to order it?  EMG is normal, but I don't think that would show muscle abnormalities as a result of a virus, though I could be mistaken.  I understand they often times only have to take small tissue samples.  Everybody is trying to reassure me that I'm not dying because almost every single test result so far has been negative, but I truly feel like something terrible is going on.  How does the spinal feel?  From what I've been told it's a feeling of pressure and it's uncomfortable but not excrutiating or anything like that.  Drink lots of fluids before or after? (or both?)
147426 tn?1317269232
Hi, I'm sorry for all you're going through.  It sounds truly dreadful.  I think the suggestions that you've been given are good ones.  I think you should have the definitive Lyme testing with Igenex .  However, I have one idea that is a little off the wall, especially since 2 neurologists have felt you do not have anything neurological, so that implies your neuro exam was normal.  I was also told by a highly respected neuro that nothing was wrong with me, when I did, in fact, have MS, so I know that docs are fallible (and sometimes lazy or stupid...)

I would like to ask a couple questions.

I saw the reference to a normal EMG, but I did not see a NCS Nerve Conduction Study ( also called a Nerve Conduction Velocity).  Have you had one of these?  It would certainly be proper to do with your history of paresthesias.

Are your reflexes normal, hyperactive or reduced/absent?

Your need to find out more about the abnormality on MRI.  As far as I know there are no abnormalities characteristic of CFS.  Lesions consistent with Lyme also are consistent with MS. (and some other things - see below)

The reason I ask these questions has to do with an illness called Guillain-Barre syndrome and it's more chronic relative, CIDP - Chronic Inflammatory Demyelinating Polyradiculopathy.  They both can follow a viral infection and have both been known to follow EBV infections.  CIDP is a disease of the peripheral nerves in which they undergo auto-immune attack on the myelin (like in MS, but in the peripheral nerves instead of the central nervous system).  They are characterized by muscle weakness, sometimes paralysis, and often severe muscle pain.  Some forms may also have strong sensory (parasthesia) components.  The MRI's may be normal (or may show some non-specific white matter irregularities)  but the NCS will show slowed conduction velocities.

There may be a tight feeling to the muscles, but not true spasticity.  The tendon reflexes are usually absent (whereas they are more likely to be hyper in MS).

CIDP can affect the autonomic nervous system and cause cardiac arrhythmias, gastrointestinal disturbances, abnormal sweating, orthostatic hypotension, etc.

Cranial nerves are also often affected and can cause facial, jaw pain spasm, paresthesias, etc.

GBS typically follows the infection fairly promptly and resolves over a few months.  CIDP is persistent, but tends to have a relapsing-remitting (up and down) course.

The spinal tap usually shows elevated protein levels.

You can search for CIDP - but I should caution you about one of the main sites you'll find.  cidpusa.org has some good discussions of the disease itself, but they are way off the wall when it comes to the other claims that most diseases  are autoimmune and that they can cure them all with diet.  I would use them, if at all,  only for their descriptions of the disease.  But, there are also scientific articles such as the one on emedicine.com.

Also, as a physician, I can tell you that you do not have tetanus.  That's one worry you can drop.

A muscle disease would be very unlikely given your normal muscle enzyme tests.  When there is so much muscle pain it's hard to believe the muscles aren't being destroyed, I know.  I don't think a muscle biopsy is your next best test.  You need a spinal tap.  I had mine under guided fluoroscopy and it was a painless breeze.  I've had others unguided and had not problems with them either.  Be well hydrated and stay flat.  Bring along a caffeinated drink.  If you have to pee before it's time to get up, doing it lying down - you're so lucky you can do that...

Good luck, Quix
Avatar universal
Thanks for the advice!

I'm going to ask my doctor about that CIDP.  Does it get progressively worse before it gets better, and is there treatment for it?  These neuromuscular symptoms have been going on for about 3 months now and seem to be getting steadily worse.  I had the nerve conduction study with the EMG where they sent electrical charges through me, and all the results were within normal range.  Should I have this test repeated?  Also, to the best of my knowledge, there is no history of motor neuron disease in my family.  I also had a comprehensive neurological exam and my reflexes were normal.  The doctor said my reflexes would be much worse if I had true spasticity, but I do have muscle stiffness and burning sensations, and weakness upon repeated movement.  Could I have been poisoned or something?  I'm going to have a heavy metals test done by my primary care.  Thanks for any advice!
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