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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 35748
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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Dr. Arun Phophalia, Could you go back and look at our prior

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Dr. Arun Phophalia,Could you go back and look at our prior conversations regarding the dizziness I experienced when I woke up the morning of 2/6/17, concurrent with a cold for about 10 days. I was diagnosed with viral vestibular dysfunction disorder. Since that time I had a VNG test that showed no problems (although ENT still said the nerve could be inflamed). I also had a brain MRI which was normal.The ENT said my case was unusual (I think based on time for recovery and normal VNG test), but he said most patients recover completely (I believe he said completely) in time either through healing or compensation. He said I would most likely improve in increments with peaks and valleys. I have found this generally true as the dizziness has become less severe.However, more concerning to me know is muscle weakness and fatigue. The ENT said he does not associate vestibular disorders with muscle weakness or fatigue, although the American Vestibular Association does make an association: e http://vestibular.org/sites/default/files/page_files/Fatigue%20Stress%20and%20Responsibility.pdfWhat has me concerned was that during the summer months I could not take the heat at all. Walking in 100 degree heat after work for just a couple blocks would make my muscles so weak that I would lay in bed waiting for them to reover for a couple hours. Thank goodness the heat has dissipated as we enter September, but ever since at least May I have noticed leg weakness, particularly evident if I go down staris. My aerobic capacity seem alright, but not my legs and to a certain extent my biceps at times but to a much lesser degree.MY PCP and physical therapist have attributed my condition to muscle atrophy as I was not very active during the months of dizziness, basically going to work, and then coming home and going to bed reading a book. I have had about about six physical therapy sessions and can do the exercises and usually feel good that night, but then feel weakness in my muscles (usually upper hamstrings and glutes, sometimes for days). After the last session the PT reduced the number of exerecies and sets.Prior to this vstibualr disarder I was failry athletic, at least to the extent that I climbed seven flights of stairs up and down twice a day and rode 2-30 minutes on my recubmant bike three times a week. However, I have not run since I tore my menisus abut seven years ago and also had a chondroplasty. I want to get back to that level.My question is whether this is in the realm of normality, or could there be another explanation for the muscle weakness? My blood tests were normal on 2/6, but I have not had them again since then. I had my PCP order the following tests, he had just ordered the basic tests.Let me add that I have a history of tachycardia, but I wore a halter for 48-hours and the few episodes of tachycardia (highest pulse 130) were said to be benign (I believe sinus tachycardia due to stress). I am about 6'1"-6'-2" and weight about 185. My blood pressure is normal to low.Tests To Be Done Expected Expires Ordering Clinician Pre-test Instructions
COMPLETE BLOOD CELL COUNT 06/26/17 10/24/17 Michael A. Flaningam
COMPREHENSIVE METABOLIC PANEL 06/26/17 10/24/17 Michael A. Flaningam
CARDIO IQ ADVANCED LIPID PANEL 08/30/17 12/28/17 Michael A. Flaningam
SEDIMENTATION RATE (ESR) 09/13/17 01/11/18 Michael A. Flaningam
VITAMIN D LEVEL 09/13/17 01/11/18 Michael A. Flaningam
COMPREHENSIVE METABOLIC PANEL 09/13/17 01/11/18 Michael A. Flaningam
URINALYSIS 09/13/17 01/11/18 Michael A. Flaningam
Testosterone, Free Total Bioav SHBG, Adult Male 09/13/17 01/11/18 Michael A. Flaningam
HEPATITIS C ANTIBODY TEST 08/30/17 08/30/18 Michael A. Flaningam
THYROID FUNCTION (TSH) 09/13/17 09/13/18 Michael A. Flaningam more info

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Customer: replied 1 month ago.
Thanks. Let me know if you have any other questions that would help you with your response.

Okay. I will look at the previous interaction.

Please give me some time to look at them.

Customer: replied 1 month ago.
I turned 61 on 8/26/17, buy look younger. What bothers me is the lack of muscle strength or endurance (e.g, taking stairs although have not tried for a while; I can do the PT or descend the stairs; it is the effect on my muscles the following days). This is when my legs feel "heavy." That is the best way I can describe the feeling.

Okay, allow me some time to give you a concrete information.

Customer: replied 1 month ago.
Ok, thank you.
Customer: replied 1 month ago.
I have a follow-up with new ENT on mid-October. The first ENT who I did not care for has offered a referral for vetibular exercise and for a neurologist. The second ENT did not think the vestiubular exercises wise in my case as it may cause regression. My PCP, who is very conservative, does not want me to see a neurologist, the thought being that the brain MRI was OK, although the first ENT said neurologists look at things differently, although she said she was 99.9% sure I did not have MS.
Customer: replied 1 month ago.
As an example, around mid-July I had a date and walking just a couple blocks in the heat, and my legs were sore/weak for the first part of the movie; later that night when it cooled I felt ok, and went up and down stairs at her apartment with no problem. I had PT last Friday, and still fell in legs. Deciding whether to do the exercises or part of them tonight, or just ride bike for ten minutes or so, or just walk for a while. Currently taking odds and ends to curb for neighborhood clean-up appointment.
Customer: replied 1 month ago.
Prior to 2/6 and following months, I had done similar exercises with none of this heaviness the following days as I sought to ensure leg/knee is good condition to finally resume jogging.
Customer: replied 1 month ago.
From 6/26 with PCP who did not advise an MRI (I went ahead with anyway):Gregg,My strong sense is that we're not going to find a cause to the dizziness, weakness, or palpitations. I think we've done enough testing on each, including an examination in the office, to reassure me that there are no serious conditions to cause any of these, though also no quick and easy fixes, and maybe no fixes other than time. My preferred treatment and management of these issues are for you to try to live with them. I recognize that this is easy for me to say, and again, this is all just my strong sense; it's certainly possible I'm wrong. I do worry about false positives, and I feel compelled to point out that while you may not have to spend money on the MRI, the system dose, and a large reason for the health care system mess that this country is in is due to excessive testing and treatment. I'm not sure if more tests in your case is excessive, but I don't have a high suspicion that the MRI is going to give us an answer. I'd give PT more time, and I'm encouraged that they
apparently didn't see anything on their evaluation that was concerning that there was some underlying sinister cause. I'll go ahead and order labs.Mike----- Message -----
From: Me
Sent: 6/26/2017 2:05 PM PDT
To: MD
Subject: Health Status / Medical Test Request - Message 5For example, when the A/C was not working in my house and I knelt for few minute to pick up some broken glass, I needed to rest in bed for the fatigue to go away.I appreciate you reading all this, and giving me your medical opinion based on your education and experience. Should I go ahead with the MRI on Friday or give the PT a few more weeks. The cost is not a concern since I have a PPO and likely to go over my co-pay for the year regardless. Only concern would be risk of contrast, and false positives. I do not have sufficient knowledge to know all the pluses and minuses. If this was happening to you or one of your children, what would you advise? Please feel free to ask me any questions. Thank you for your care.

My impression is that this fatigue of muscles is not normal. The cause for it should be found (vestibular nerve inflammation may be related to it). But MRI is not the right investigation for it. I would do;

1) Creatinine Kinase

2) Autoimmune panel.

Both of these are blood work.

3) EMG (electromyography).

These may be able to give you the cause of it.

You may meanwhile continue the PT.

Customer: replied 30 days ago.
Thank you for your response. What could these tests show or rule out? Could it just be muscle atrophy or do you suspect something else? Thanks. I will ask new questions as follow-up. I appreciate your diligence.

You are very welcome.

These investigations tell;

If there is any muscle fiber injury associated on physical activity.

If there are some autoantibodies which have decreased the muscle strength.

It is privilege associated.

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