Joe A Shaw PA-C - 10/17/2008

Question
Dear Joe,

 I am writing this letter in much desperation. I am a 54 year old woman that has been suffering with a situation that cannot be explained by the doctors that I have seen. It started off in May 2008, I was being treated for a sinus infection with Levaquin. I started to have a stinging pain in my left upper arm, like on the outside area, after the fifth day I ended up going to the emergency room, I felt like my arm was going to explode, it hurt so bad. They took an exray and said it was tendonitis, gave me some pain meds, morphine in my IV, and told me to follow up with the Doctor. The pain just kept getting worse, my arm swelled up more, and I began to have trouble lifting my arm, behind my back, and over my head. The outside of the arm continued to swell and it had quite an indentation area in it that was very visible. I followed up with the ENT that put me on the antibiotic, and he called a friend of his that was a shoulder specialist, he examined me, also did an ex-ray, prescribed anti-inflamatory meds, and said to come back in 3 weeks, I suffered like you would not believe, the meds did not help and I asked him for an MRI, which I had done, and he said he was baffled, it showed tendonitis and he did not know how to help me after this, the pain that I was experiencing and the results of the MRI did not add up he said, and so he did not know what to do...Oh, I didn't mention that he also put me on the medrol pac steroids, which did not help. I was experiencing tingling up and down the arm, couldn't sleep on my left arm...and I cannot tell you how much crying I have done over this. I also had a MRI of left arm, and a bone scan of humerous. I saw a neuroligist for another situation{sleep disorder} and I told him what was going on, he ordered some tests himself, blood work, and EMG which showed carpal tunnel in both hands, he ordered MRI of spine and xrays of neck, showing arthritis. THe one blood test that he ordered, {aldolais spelling? sorry! was elevated, ordered another and it was down. My medical Doctor{family} injected cortisone in outside of arm area that was swollen in July, situation is still the same, it has been like 5 months and I still have the same problem. My shoulder hurts, can't sleep on it...have to position arm in such a way, when I am on my right side, so that it doesn't pull in any way. The indentation is still there in outside of upper left arm, with two visible bruise spots that have never gone away, and the areas look like there are little pin prick dots, and it looks like the skin layers are disapearing.....My medical Doctor and another one of his associates think it is from the Levaquin antibiotic, they had ordered physical therapy, but after two visits the therapist closed my case and said that she felt this was nothing mechanical, and could not help me....at the present time, I went back to medical Doctor {family physican} and he prescribed Cymbalta
to block the nerve endings for the pain, I had to stop it because I started having diareha and then the increased dose caused me to start vomiting, so the Doctor put me on Licra for pain, and the neuroligist wrote me a script for a pain patch to put on outside of the arm to wear at night. Well here I am almost 6 months later and I still have this horrible thing going on, and don't know what really it is , I didn't mention that I also have pain in the exact same area of right arm that started right after the left did, but not to this degree...I am so lost right now, I don't know what to do, I missed two months of work, with no pay, I am a toddler teacher, and I know that lifting is making this worse. I don't know if I should get a second opinion, the neurologist thinks I should, the Doctors that I have seen are all from the CLeveland CLinic, he as much as told me to see someone at University Hospital in CLeveland, Ohio. I don't know of anyone, and I am at my last rope. It hurts so bad, and no one can find anything on MRI's or xrays to explain to me what is going on. I don't know you, and I don't even know exactly how I found this page, if you have an suggestions please tell me what to do. Thank you very much. Mary Ann

Answer
Mary ann,
You have really been through the wringer for sure! I also think it could be linked to the leviquin some how, although that drug is widely used. You may try a physiatrist(Fizz-i-ah-trist)they specialize in pain and rehabilitation medicine or you might try a pain management doctor. I dont know if you will ever know what it is or caused it but hopefully they can control the pain. Your drs have done everything that seems possible to me..I would keep trying other opinions though.