I have discomfort on my left arm and neck. Help.

Question

Hello doctor,

I have been having crazy, unexplained symptoms for over a year, such as weakness and tightness in my left arm, side of neck, and face choking gagging sensation, and feeling like my body is crashing from not eating. But the difficulty in swallowing is the worst one. I have been through numerous tests including, chest X-rays, CTs, brain and neck MRI, echocardiogram, EKG, PFT, and multiple blood tests. The only thing that has remained abnormal is my monocyte percentage. It is always high, but my absolute monocyte is normal. Any idea what this could indicate or what direction I should head in next? Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I went through your records and history (attachment removed to protect the patient's identity). Your pain symptoms seem related to gastric issues or neuromuscular involvement due to vitamin B12 deficiency. It might be related to myelosuppression due to compromised nutritional status. Relative monocytosis in the absence of absolute leukocytosis is not a worrisome sign.

I hope this helps.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Good to see you again. I hope you are doing well. One abnormality I found is transient lymphopenia (decreased concentration of lymphocytes in the blood). It is seen in viral infections and vaccinations, especially related to COVID-19. Rest of the things have no clinical value. Vitamin B12 needs to be restored, better though injectable route for good levels. It should be maintained around 1000 pg/mL.