In late August of 2006 I took a one week course of Levaquin for a gastrointestinal infection I believe I contracted from eating at a fast food establishment.  The reason I chose Levaquin was because I knew that it had a broad spectrum of bactericidal activity against enteric pathogens, and because after talking to one of my Doctor friends, he had some samples of Levaquin  which would save me a costly pharmacy charge.  My gastrointestinal infection was accompanied by fever, chills, nausea, weakness and diarrhea.  I did not want to wait a week to see a doctor and it is difficult for me to find someone to fill in at the operating room where I work as an anesthesiologist. 

Soon after taking the Levaquin I immediately seemed to worsen.   In the first days of starting the medication I began to experience feeling of burning heat in my skin and profound insomnia.  I developed the burning skin in all parts of my body an it became painful.  I developed  progressive anxiety, insomnia, a wierd buzzing sensation upon sleeping and waking, deep muscle pain, muscle fasciculations, mild diffuse tendon pain, cold extremities, tremor, muscle weakness tinnitus, mild jaundice, white stools, ongoing diarrhea, esophageal reflux and GI distress and weight loss, and eventually numb skin everywhere (particularly feet and hands).

The last 22 months have been the hardest experience of my life and I have suffered tremendously from taking Levaquin and have met hundreds of others who have also suffered.  My life was altered in many ways and I have difficulty enjoying life due to the physical limitations caused by the drug.  I developed the following problems directly attributed to the drug.

Central Nervous System:   I developed many CNS symptoms and abnormalities including elevated Intracranial Pressure measured on spinal tap.  Profound persistent insomnia and sleep transition disturbance, with attacks similar to hypnogogia (despite the fact that my sleep study showed no sleep apnea).   For many months I was unable to transition past stage 2 sleep.  I developed severe and persistent anxiety with panic attacks.  I had never experienced this until after age 43.  I have been in many stressful situations throughout my life and have been able to remain calm and focused.  I was an emergency room doctor for 9 years and have worked in the operating room since then.  I have been through two medical residencies receiving the highest honors in both.  I have been involved in countless life or death patient situations and have been known for my cool head and decisiveness.  I didn’t know what anxiety and panic where until after Levaquin. 

I developed tinnitus in both ears that progressively worsened for months and with loss of hearing.   I have visual photosensitivity and vitreous floaters.  I have numbness and paresthesias in the distribution of all the sensory cranial nerves (my whole head and face feels numb).  I have fasciculations and weakness in motor cranial nerves.   I have pressure associated palsies in nerves of the face and head.  The spinal tap that I had resulted in a post- dural puncture headache which necessitated that I undergo an epidural blood patch for resolution of the headache.  

 During the first months of the medical evaluation of my condition, I underwent the following tests:  Brain MRI, PET scan, EEG, sleep study, spinal fluid analysis.  The only abnormality on these tests was the finding of mildly elevated spinal fluid opening pressure which is a known adverse reaction to fluoroquinolones.   I was evaluated by a local neurologist and again by neurologists at the Mayo Clinic in Scottsdale, Arizona.   No firm diagnosis was made.  No one considered the possibility of a neurotoxic reaction to fluoroquinolones.

Peripheral Nervous System:  This has been my biggest struggle.  I have chronic painful peripheral neuropathy.  I have toxic small fiber neuropathy of all of the skin of my body, but my feet and hands and genitals have suffered the most.  I have continual loss of sensation in feet hands and skin everywhere with associated paresthesias of pain and burning.  I have had pain in many areas of sensory nerve distribution in particular in my back.  My feet are continually painful and this makes it difficult to walk any distance. Before taking the medication I enjoyed hiking, weight lifting, biking, canyoneering and running.  I am a father of young children and am no longer able to participate in activities with them which involve any prolonged standing or walking, let alone running or hiking.   I was active and physically fit before Levaquin.  The constant pain in my feet has made me sedentary.  I also have motor nerve involvement with body wide muscle fasciculations, weakness in many muscles and mild spasticity in my lower legs with activity.   During the first months of my illness from Levaquin I had 2 EMGs and nerve conduction tests which showed slowing of peripheral nerve conduction velocities.  My initial EMGS were before the continued and worsening progression of my nerve injuries.   I was also noted to have decreased sensation in my extremities on neurologic examination.

Autonomic Nervous System:  I developed postural hypotension that took over a year to improve.  I had abnormal sudomotor (sweat response) and Sinus tachycardia for many months.  I had temporary incomplete bladder emptying and temporary erectile dysfunction for months.   I had autonomic testing which showed abnormal sweat response.  I continued after the autonomic testing to have postural hypotension, erectile dysfunction and bladder dysfunction.  Fortunately these problems have somewhat resolved.

Cardiovascular System:  In the first several months after taking the Levaquin I developed persistant sinus tachycardia which gradually resolved.   I have suffered from Raynauds phenomenon with very uncomfortable almost painful cold feet and hands.  I believe this is probably secondary to the autonomic dysregulation of vascular tone in my extremities from nerve damage.  I am sure that the sedentary lifestyle imposed by my painful feet is not helping my cardiovascular risk profile.  In the first months of my drug reaction I which showed good cardiovascular fitness.  This was before the progressive neuropathy reached its peak and before the 2 years of sedentary lifestyle.

Musculoskeletal System:  I developed wide spread tendon, joint and muscle pain which has persisted for nearly two years.  I have painful ankle, knee, hip, hand and wrist, and shoulder joints and tendons.  The joint and tendon pain was not apparent immediately but came on gradually within a week of stopping the medication.  I had an avulsion injury of my ulnar styloid with just minimal lifting and chronic pain associated with it.  Many of my ligaments and tendons have a “loose” feeling and I am careful about undue stress on them.   I know that tendon and joint injury are the more well known adverse reactions to fluoroquinolones but they have been secondary compared to my nerve injuries and pain.

Endocrine Sytem:  Soon after taking the Levaquin I had a thorough endocrine workup.  I was found to have a very low testosterone.  I was also found to have anti-thyroid antibodies and Hashimoto’s thyroiditis, but my thyroid function was still normal. 

Gastrointestinal System:  Initially for many months after taking levaquin I had severe ongoing abdominal discomfort, bloating, diarrhea, and heartburn, and I lost 31 pounds.  In the first days after taking the Levaquin I developed white stools, and dark urine.  I was found to have elevated liver enzymes.  I had 2 CT scans, of my abdomen, 1 CT of my pelvis, 1 CT of my chest, and an upper GI with small bowel follow through. 

I was evaluated by many doctors during my initial workup.  None of them were able to link my condition to my Levaquin use.  I was prescribed antidepressants and sleep aids and much head scratching and poor follow up was done.   In the first 3 months I saw 1 ER doctor, 3 internists, 2 Endocrinologists, 2 Neurologists, 1 gastroenterologist, 1 psychiatrist, and 1 pulmonary and critical care specialist.  I had thousands of dollars of blood tests, urine tests, radiological tests etc.   I became frustrated with my colleagues in their inability to find the problem and began researching my condition on my own.  I corresponded with many other doctors and finally was able to recognize fluoroquinolone toxicity after talking to Dr. David Flockhart of Indiana University.

As you can probably tell this has made a negative impact in many areas of my life.  Just after becoming ill I was nominated to be the chairmen of my local anesthesia group and had to turn this down because of the health issues.  I have greatly cut back on my work and have had to take many days off and try to work as little as possible.  This has reduced my income.   My duties to my family have been difficult since I have barely been able to provide for them.

I have also found many other patients who have suffered the same symptoms from Levaquin and other fluoroquinolones.  A few months ago I began to keep a tally of patients who I know in my local community.  The list is growing and includes 3 other members of my local medical staff, two of whom had serious tendon rupture.  This is obviously much more common than the public and doctors are led to believe and the cellular damage done by the fluoroquinolones is not limited to tendon disruption in select population.  The true damage to patients involves multiple body systems in patients of all ages.