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What Causes Muscle Weakness In The Left Arm Post An Accident?
Posted on
Sat, 13 May 2017
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Sat, 13 May 2017
Answered on
Fri, 2 Jun 2017
Last reviewed on
Question : Mom is 92. 5ft , 110 lbs. Had tia's in 2009. Took plavix. Developed afib in 2013. Stopped plavix. Began Multaq and coumadin. Had a fall and hit head in 2013. Had surgery. Due to fall risk,and bleed risk cardio stopped coumadin . Continued Multaq. No blood thinner since 2013.
Main issue since then is high bp. Since then as taking 50 mg of metoprolol, 60 nifedipine, 800 Multaq, 25 hctz, and 320 valsartan. Due to high potassium, valsartan discontinued 1 month ago. Potassium normal since then.
In last 2 weeks, her htn has increased, and doc increased htn meds, (nifedipine from 60 to 90 mg daily)..
But-----in the last 2 months, she had 2 episodes on 2 separate days of left arm feeling weak and limp (resolved), one episode (one hour)where she could not complete thoughts, ( garbled words), had 2 bouts of rapid afib which resolved in one hour on its own. Yesterday her cardiologist put her back on plavix, increased metoprolol from 50 to 100mg daily. So her meds are now daily----
Plavix
Metoprolol 100mg
Nifedipine 90
Multaq 800
Hctz 25
Over the counter drugs are COq 10, vit e, Tylenol
Please give me your thoughts on her recent problems and the new medication list she is on.
Main issue since then is high bp. Since then as taking 50 mg of metoprolol, 60 nifedipine, 800 Multaq, 25 hctz, and 320 valsartan. Due to high potassium, valsartan discontinued 1 month ago. Potassium normal since then.
In last 2 weeks, her htn has increased, and doc increased htn meds, (nifedipine from 60 to 90 mg daily)..
But-----in the last 2 months, she had 2 episodes on 2 separate days of left arm feeling weak and limp (resolved), one episode (one hour)where she could not complete thoughts, ( garbled words), had 2 bouts of rapid afib which resolved in one hour on its own. Yesterday her cardiologist put her back on plavix, increased metoprolol from 50 to 100mg daily. So her meds are now daily----
Plavix
Metoprolol 100mg
Nifedipine 90
Multaq 800
Hctz 25
Over the counter drugs are COq 10, vit e, Tylenol
Please give me your thoughts on her recent problems and the new medication list she is on.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your question and based on your description of the two episodes, I would conclude about 2 repeated TIA (transient ischemic attacks), which have been caused by paroxystic atrial fibrillation.
Coming to this point, her CHA2DS2-VASc Score is 6, which indicates a very high risk for stroke and the need of anticoagulation.
I agree with all her medication, but Plavix is an anti-platelet agent and does not give a very high protection against stroke in her clinical situation, compared to anticoagulation therapy. But it has a lower risk of bleeding (considering her past medical history of head trauma and her age which predisposes her to falling).
Anticoagulation therapy like new oral anticoagulatns can provide more protection against possible stroke in the future for her. I would suggest Apixaban, which has a lower risk of bleeding to other drugs of this group. The dose should be adjusted based on her renal and liver function tests. A lower dose (2.5 mg twice daily) would be advisable at her age.
But, you should know that the risk of bleeding with Apixaban is higher compared to Plavix, although it provides more protection against future possible strokes.
If she starts Apixaban or any other drugs from this group (Rivaroxaban), you should be very careful to falling, because of the increased risk of bleeding. So, I would advise to employ a caregiver for her.
Regarding the other drugs, I would not recommend changing anything else.
You should discuss with her doctor on the above issues.
Hope to have been helpful!
I remain at your disposal for any other questions whenever you need!
Kind regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your question and based on your description of the two episodes, I would conclude about 2 repeated TIA (transient ischemic attacks), which have been caused by paroxystic atrial fibrillation.
Coming to this point, her CHA2DS2-VASc Score is 6, which indicates a very high risk for stroke and the need of anticoagulation.
I agree with all her medication, but Plavix is an anti-platelet agent and does not give a very high protection against stroke in her clinical situation, compared to anticoagulation therapy. But it has a lower risk of bleeding (considering her past medical history of head trauma and her age which predisposes her to falling).
Anticoagulation therapy like new oral anticoagulatns can provide more protection against possible stroke in the future for her. I would suggest Apixaban, which has a lower risk of bleeding to other drugs of this group. The dose should be adjusted based on her renal and liver function tests. A lower dose (2.5 mg twice daily) would be advisable at her age.
But, you should know that the risk of bleeding with Apixaban is higher compared to Plavix, although it provides more protection against future possible strokes.
If she starts Apixaban or any other drugs from this group (Rivaroxaban), you should be very careful to falling, because of the increased risk of bleeding. So, I would advise to employ a caregiver for her.
Regarding the other drugs, I would not recommend changing anything else.
You should discuss with her doctor on the above issues.
Hope to have been helpful!
I remain at your disposal for any other questions whenever you need!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr the reason they stayed awy from Another drug was the bleeding risk of falling since we had falls in past.
Should she still continue with 2000 iu of vitamin E??? AND plavix?? Shes taken E for years
....
She is to have sn epidural steroid injection in her lumbarback in 2 weeks... how long should she be off plavix before injection??
Should she still continue with 2000 iu of vitamin E??? AND plavix?? Shes taken E for years
....
She is to have sn epidural steroid injection in her lumbarback in 2 weeks... how long should she be off plavix before injection??
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Thank you for the additional information!
Regarding vitamin E, I would recommend performing first vitamin E plasma levels before deciding to discontinue it. Anyway, it has no interactions with Plavix, and it is quite safe to take them both concomitantly.
Regarding Plavix and epidural steroid injection, it is advisable to stop taking it 5 days before the procedure. There are no limitations after the procedure, so she can start taking Plavix right after the procedure.
Hope to have clarified some of your uncertainties!
Wishing good health,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Thank you for the additional information!
Regarding vitamin E, I would recommend performing first vitamin E plasma levels before deciding to discontinue it. Anyway, it has no interactions with Plavix, and it is quite safe to take them both concomitantly.
Regarding Plavix and epidural steroid injection, it is advisable to stop taking it 5 days before the procedure. There are no limitations after the procedure, so she can start taking Plavix right after the procedure.
Hope to have clarified some of your uncertainties!
Wishing good health,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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