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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 56357
Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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4/18/13.USA.64 yr old woman.Neuromuscular D/O since late 1980s.W

Resolved Question:

4/18/13.USA.64 yr old woman.Neuromuscular D/O since late 1980's.Work-up for MS.Lupus.Carpal tunnel,etcRheumatology.Currently having severe neuro burning,cramping and soreness with impairment of strength and mobility-worse in both hands but felt all the way up to the shoulders. (EMGs abn.but not diagnostic.spinal tap ,Mult.MRI.CT scan but not recent.Have no med.insurance.Improves with steroids but takes 10 days before felt improve.Immediately detriorates as steroid is weaned.Could meds exacerbate this condition, ie clonazepam combined with diltiazem ER or prolonged treatment with Desipramine (x 25 yrs.)??Toxicity symptoms or intolerance?? Now so severe pain is constant,more severe with trying to grip,turn doorknob,drive,brush teeth.getting very scared?HELP.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Thomas, MD replied 1 year ago.
Hello from JA
Thanks for the very interesting question.
be sure to use reply
I don't think this is from your medications

Did you start any right before this happened?

Yes it can be toxicity, heavy metal toxicity can act like this.
;
Polymyalgia rheumatica can do this, a rhematologic problem.

Problems in the cervical spine can do it, best revealed by MRI of the cervical spine.

I would look at all of these and:
B vitamin deficiencies.
Autoimmune neuropathies
Idiopathic neuropathy


As far as medications that might case such symptoms.
clonazepam and desiparamine would be what I would look at carefully.

This would be rare.

OK. If you have further questions or details, use reply to expert.

Otherwise please choose a positive rating . But, still come back if you need to…think of something later, etc. Bonuses are appreciated.

Customer: replied 1 year ago.


4/18/13. dr thomas. Rheumatology workup always neg for lupus. Other tests like RA factor,CRP abn. Sed rate high normal.No one has checked cpks.Now with chest tightness,SOB mostly w exertion (asthma-bronchitis now flared x 3 months.)CBC,Met.panel, uA all normal.What to do ?Have no money. No insurance.If wean desipramine, what other med in like family to use for nerve pain ?unable to tolerate elavil,amytrypt,etc.SVTs.SOB.??So frustrated and miserable.Marti

Expert:  Dr. Thomas, MD replied 1 year ago.
For polymyalgia there are no specific labs, but what should be checked is a CPK.

You need immediate assessment t in the case of chest pain.

What to do.
Join a teaching hospital medical clinic....this will be on a sliding scale, and tie you into specialists.

Gabapentin and lyrica are excellent for nerve pain.

OK. If you have further questions or details, use reply to expert.

Otherwise please choose a positive rating . But, still come back if you need to…think of something later, etc. Bonuses are appreciated.

Customer: replied 1 year ago.


dr thomas.I did not tolerate Neurontin.And it didn't help.I am leary of lyrica.What about plaquinal?? not eligible in colorado for teaching hosp clinic as i don't live in Denver city limits-so i am told.I guess i will continue to check on that.you don't have to reply.Looks like I need to do more research myself.Chest pain i am sure is not cardiac (i am a CCU nurse of 40 years).Should I talk to a rheumatologist or neurologist.??? I will continue to pursue on my own.Maybe I will try another question within 7 days.No NEED for YOU to Reply-don't want to use up all my 5 questions w/o more though behind them.Thanks again. God Bless.Marti

Expert:  Dr. Thomas, MD replied 1 year ago.
Plaquanil is specific to an identified autoimmune disease, not for neuropathy per se, and you would not have an indication for it.

I would pursue this first with a rheumatologist or internal medicine doctor to look at the causality and get a CPK, MRI of the cervical spine if not done.

Please note...we are ONLY paid for our time for a positive rating.
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 56357
Experience: Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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