I have problems with my gait and my left hand is raising automatically. Why?

Hello doctor,

I have noticed recently that my left arm seems to be raised automatically. This is also about my waist height. I saw a neurologist three years ago, and everything was fine. I also had a brain magnetic resonance imaging (MRI) because I was having problems with gait, sometimes needing to put my hand on the wall when brushing my hair or teeth.

My orthopedic doctor found that I have a bit of cervical stenosis in my neck, at C3 and C4. I also hold my cell phone in this hand for many hours while typing.

Sometimes when I try to keep three things on my left side, it is a kind of clamp up, and I forget what I am holding (about five years like this). Intake blood pressure medicines, and I take a large amount of sleeping pills called Zolpidem 20 milligrams per day. I am finding it a bit difficult to work sometimes, and I also suffer from a sore neck sometimes.

Please help.

Thank you.

Hi doctor,

Thank you for your reply.

1. My primary question is, could this be caused by taking too much sleeping medicine as a withdrawal side effect?
2. For example, should I try to see if I have the problem tonight when I take my medication?
3. Also, could this be caused by excessive use of my mobile phone when lying in bed or on the couch?
4. It has been just over six months since my last MRI (magnetic resonance imaging). Should I still have another one?
5. I tried Mirtazapine, I slept wonderfully, but it gave me heart palpitations. Are there any other drugs you might recommend?
6. Can you recommend a program that could help me stop Zolpidem?

About tapering down on Ambien, it was recommended to taper over six months, but that was too slow. I need to stop taking it, as it has been more than five decades since I have been taking it.

Please help.

Thank you.

Hi doctor,

Thank you for the reply.

You are an excellent doctor. I have not heard of Trazodone, but I will ask my doctor here if he can prescribe it.

1. Can too much Zolpidem sometimes also cause substantial confusion?
2. I will reduce Zolpidem with your suggestions. Is there another term for the clumsy hand that a neurologist would understand?

Please help.

Thank you.

Hi doctor,

Thank you for the reply.

I took SSRIs (selective serotonin reuptake inhibitors) before, and they can make me a little bit hyper. Also, for neurological pain that sometimes comes. Should I mention this to the doctor?

They prescribed Lyrica, but it makes me too dizzy.

I am dealing with a sleepless night of only four hours. I am confident that I can get back to bed this morning, and I do not have much of a plan today. I was left open today, so it is good that I could sleep for maybe a couple more hours and then enjoy the rest of my day.

I think I need my psychiatrist here to deal with my sleeping problem or help me to make a plan. I believe the current sleeping pills I am taking are no longer working, and I have been taking them for too long. So, I am going to ask for something new and eventually try to find natural ways to get to sleep.

I am thinking seriously about starting another psychological medicine, but my psychiatrist here wants me to take time. You should seek the help of a psychiatrist if the neurologist does not seem to find a new problem.

Please help.

Thank you.

Hi doctor,

Thank you for the reply.

Thanks for your help.

Hi doctor,

Thank you for the reply.

I am really worried today, because the pain from my neck traveling all the way down to my fingers on my left arm is really bad. I did go to my orthopedic doctor yesterday.

He said that the problem with my clumsy hand would not be caused by cervical stenosis. Though when I used the grip test, my muscle strength on my left arm was quite a bit less, like 25 versus 40 on my right arm. I am also having pain in my left eye, which I had checked at the eye doctor's today. She said that it is completely ok. There is no bleeding or retina problem.

What should my next steps be?

I have made an appointment to see a neurologist, but it takes some time. I am finding it hard to concentrate at work because I keep thinking about the pain in my arm.

Please help.

Thank you.

Hi doctor,

Thank you for the reply.

I saw the neurologist yesterday. They did not feel that I had any neurological problems. I suppose that is good news, and they have referred me to a rheumatologist. I have also started the Trazodone with about 75 percent Ambien (Zolpidem).

Please help.

Thank you.

Hi doctor,

Thank you for the reply.

The Trazadone is not really giving me much better sleep. I am taking only a small dose of 25 milligrams. The first day, I felt much better afterwards, but the second day, not really. I am continuing to take 15 milligrams of Zolpidem.

Unfortunately, I am feeling pretty tired in the morning. Also, last night with the Trazodone, I did wake up with an erection, which seemed to last for about 20 minutes or more. However, it seems to stop afterwards. I was wondering if this is a condition of taking the medicine, as I also take Warfarin, which can cause this condition.

Please help.

Thank you.

Hi doctor,

Thank you for the reply.

It seems that I cannot send messages, is it okay to open a new chat?

Please help.

Thank you.

Hi doctor,

Thanks for your reply.

Your suggestions, especially on tapering Zolpidem. It seems I am pretty much adjusting just in these four days to using less Zolpidem.

Please help.

Thank you.

Hi doctor,

Thank you for the reply.

Okay, I will get some melatonin ordered up today. Here was last night's sleep result.

Please help.

Thank you.

Hi doctor,

Thank you for the reply.

It is the rainy season here, with high pressure in the air. Also, with the pain, I have been having some really bad headaches that are so bad that it feels like my left eye is in pain and pressing out of the socket.

1. Should I see my GP about this, or is it better to see a specialist?
2. Also, what kind of treatment for these?
3. I am already taking 1000 milligrams of Acetaminophen. Is there something else that should be done?

It has been a week and a half, and it started before I started Trazodone.

Please help.

Thank you.

Hi doctor,

Thank you for the reply.

I am taking Acetaminophen now. I did not tolerate the Trazodone well and woke up two or three times last night with horrible nausea and pains; also, my heart rate went to 113 to 118 while walking in the hallway.

I think, similar to Mirtazapine, it may take some time to adjust. I think I will need to give up Trazodone tonight.

Please help.

Thank you.

Hi doctor,

Thank you for the reply.

I have ordered melatonin. My doctor gave me the results of my rheumatology tests. They did not find anything significant. So I am in the same place as before, but I know that I have nothing major, which is something to be happy about.

My arm clumsiness is still pretty bad, and it is very weak to grip. I’m also having extreme headaches and pain around my eye, which does not go away. I am getting muscle twitching in my lower forearm every two to three days that lasts for about an hour or two and then just stops.

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

I have started Amitrypline 20 mg for headaches, which has helped. Now my problem is vertigo.

1. What neurological studies can be done for vertigo?
2. Had an MRI a year ago; it was normal. How about a nerve block or other strong treatment to put the balance system back in place?
3. It was closed after heavy vomiting. I have also taken a goblet for cervical stenosis, for you. Could that also be making it suggest worsening from Pregabalin, making vertigo worse?

Please help.

Thank you.

Hello,

Thank you for the reply.

Dimenhydrinate, I will use. Also, the doctor gave me betahistine. For Pregablin I will take it only before bed, so no damage or dizziness is expected. It seems the ENT doctor is not comfortable giving Meclizine. Need to go to a neurologist, maybe.

1. If I cannot get relief in another week, I may ask for a video or telephone call. How about vitamins?
2. Is B12 really helpful?

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

So, just vitamin B and Betahistine are okay, right?

Okay, I will stick with that.

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

I also normally suffer from migraine headaches and currently take Amitriptyline 20 mg by mouth every night before bed.

Since this episode of vertigo started, my migraine headaches have not been occurring as often.

1. Is it normal for vertigo to supersede or replace severe migraine headaches?
2. Also, how long should muscle relaxants typically be taken?
3. I started taking them last week, but I do not want to use them for too long because I am concerned about becoming dependent on them. Is that a valid concern?

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

1. Would antibiotics be useful in this situation?
2. I am guessing that since the problem started after food poisoning, my gut bacteria are probably already disrupted, so antibiotics might make things worse. Is that correct?

At the same time, I use a CPAP machine, so my ears sometimes become easily infected. However, the ENT doctor said that he did not see any evidence of an ear infection this time. I am also not having any nasal discharge or similar symptoms.

By the way, I forgot to mention that I take Pregabalin and Amitriptyline. I take Pregabalin for neck pain and pain in my hands caused by cervical stenosis.

Do you think Pregabalin could make my dizziness worse, or could it actually help in this situation?

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

1. Okay, I will continue Pregabalin; I might skip one day mid-week next week. I have cervical stenosis. Do you need an MRI?Are we sure that this is not something to do with cervical instability?
2. Cervical instability and pinching of the carotid artery can cause this. I’ve been in bed 12 to 15 hours some days and sometimes 24 hours. So my neck may be weak. How do we impact the spine getting pinched at C3/C4, etc.?

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

Oh, I see. I get numbness and kind of shock in my left arm only. Please help.

Thank you.

Hello doctor,

Thank you for the reply.

I am finding that helpful. I take Amitriptyline for headaches. Originally prescribed 10mg and increased to 20mg at night.

1. If I am feeling a slight headache in the morning, would it be ok to add another 5 mg to take the total dose a day to 25 mg?
2. Or will it be too much and make me drowsy?

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

Okay, I understand. So the two medicines I take for migraine are Amitriptyline 20 mg and Propranolol 40 mg. I will try a bit higher dose, 5 mg, of Amitriptyline.

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

It is covered under a health insurance plan, but if I am ever to leave, I am not so sure about other places.

Please help.

Thank you.

Hello,

Welcome back to icliniq.com.

Yes, those insurance companies in rich countries are also rich and available to cover such things.

Okay, back to Pregabalin. Does 75 mg really do much, and how do the effects of drugs like Amitriptyline affect it?

I hope it helps.

Thank you.

Hello doctor,

Thank you for the reply.

This is very informative, thank you very much. I have regular ECGs already, so there is no worry.Please help.

Thank you.

Hello doctor,

Thank you for the reply.

I am still experiencing dizziness and saw an ENT doctor today.

He was happy to refer me to a middle ear specialist, but he felt that I would benefit more from seeing a neurologist for a brain MRI.

My previous cervical spine MRI scans were performed, and they showed cervical stenosis from C3 to C7.

My last brain MRI was performed less than six months ago, and I also had another brain MRI about a year before that. Both were reported as normal.

1. If I undergo another MRI, a PET scan, or a newer type of imaging study, what would the doctors be looking for?
2. Also, are there any newer treatments that are effective for light sensitivity, dizziness, and headaches? Is there anything that works particularly well?

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

Okay, I will ask her about Flunarizine 5 mg. Yes, we will discuss here and consult with you from time to time.

Thank you so much for your help.

Hello doctor,

Thank you for the reply.

Also, when I visited a neurologist. She mentioned to me that I have hyperreflexia, and she said I probably have it for my entire life.

Are there any examinations I should take to see if that has become worse or otherwise?

Please help.

Thank you.

Hello doctor,

Thank you for the reply.I want to see my neurologist here, but before I show this video here, is there any truth to what he is saying?As you know, I have cervical stenosis, and I have felt very different in the last five years since it has gotten worse, especially with headaches for the last three years.

1. Any idea if I take this to my doctor here, who is not a native English speaker, and ask her to listen to it?
2. Is she going to think that not only is this doctor, but I am too, or are there some valid points here?

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

So the pain is pretty much solved by Pregabalin and Amitriptyline. But I am feeling so much better that I did not think of writing to you. Pain is less frequent.

1. What is the recommended dose for Pregabalin if I am taking it with 20 mg of Amitriptyline at the same time?
2. Do you think that 75 mg of Pregabalin is fine?

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

When I do curls with a 22-pound weight, my left arm is much weaker, and it is almost difficult to do 5 reps, but my right arm is much stronger. The left arm/hand also has a weaker grip, and I get tingling and numbness in the left arm only. Does that mean that my cervical stenosis is affecting my muscle development in my left arm?

Please help.

Thank you.

Hello,

Thank you for the reply.

Okay, but a regular orthopedic doctor says no need for surgery. I will try to find a spinal surgeon in the area.

Thanks

Hello doctor,

Thank you for the reply.

Symptoms have improved since taking a bit higher dose of Amitriptyline and other pain medicines. Does stretching help with physio?

Please help.

Thank you.

Hello,

Thank you for the reply.

Okay, entering a new hot and bright-light office environment.

What do you recommend to further prevent headaches?

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

Okay, I will try tapering them after a couple of months.

What is the best medicine for heel pain in the left foot?

Steroid injection seems difficult to obtain here.

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

My son came down with a high fever four days ago. The first day, he even had a fever of 39.5 degrees, but after that, the fever went down, and he felt better two days later. After one day, he got sick again. Should I take him to the doctor or the hospital?

He has a deep cough. The COVID-19 test was negative. He ate pretty well yesterday, but not so much today. I have been giving him Acetaminophen 500 mg every day and changed to Ibuprofen. What is recommended? Also, as I have asthma, should I be extra careful?

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

He recovered okay without antibiotics. Thanks for your help. It was really tough, but he completely recovered and seems as strong as ever now. Regarding myself, I am still taking 20 mg Amitriptyline and 75 mg for headaches, and I have cervical stenosis.

Is that a good level for a man of 200 pounds, or should I take more?

Headaches are only bad when it snows or rains. Otherwise, the frequency is much less lately.

Please help.

Thank you.

Hello doctor

I am having ringing in my ears and high blood pressure. I have just started restarted a stronger dose of blood thinners at 4.5 mg.What else can I check in my brain for carotid artery flow, proper blood circulation, and good flow of blood to the brain? Also having horrible tinnitus, especially in the evening.

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

I checked my thyroid three years ago.

1. What will I tell doctors to get an angio-MRI?
2. I get MRIs for my headache, and things look fine. How is an angiogram MRI different?

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

I have COVID. I take Amplolidine and Warfarin. Should I just skip taking Warfarin for a couple of days and start the new Pfizer Paxlovid? All my vitals are okay, but my headache and throat are a bit bad.

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

Okay, I already stopped Warfarin. Should I restart with the same dose I started?

As you know, Warfarin is a bit delayed in both its startup and how long the effects of Warfarin remain in your body.

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

When you said check PT/INR, I went today to check it and will get the results tomorrow. I will finish the COVID medicine today and start back on Warfarin.

Do you think COVID will come back next week after Paxlovid is stopped?

Many people say it will come back.

Please help.

Thank you.