Brief Answer:
Continue antibiotics. Arthritis pain shifting.

Detailed Answer:
Hello,
Welcome to XXXXXXX

Thanks for your query.
I have gone through your query and understand your concern.

The symptoms what you are experiencing now is arthritis pain in left shoulder, left hip and both elbow joints.

In lyme disease, pain in arthritis shifts from one joint to other joint. It is very common in people with lyme disease who are not taken any antibiotics in earlier stage.

It seems not have any relation with chewing of tobacco.

Please continue antibiotics. It will be usually for 2 to 4 weeks.
If not helpful please consult your treating doctor regarding Intravenous antibiotics.
It is common to have persistent fatigue and malaise for few months even after treatment in Lyme disease.
Most of patients with lyme disease experience full recovery. So you need not worry about the sequelae of the disease.

You may get infection again if you do not take proper preventive measures.
1. Wear long sleeves and tightly woven clothing.
2. Wear your shirt tucked into your pants, and your pants tucked into your socks or boots.
3. Walk in the center of trails through the woods to avoid picking up ticks from overhanging grass and brush.
4. Keep grass trimmed as short as possible.
5. Apply tick repellents with DEET to your clothing, shoes and socks before going out. Another tick repellent called permethrin.
5. Check yourself, your family, and your pets routinely for ticks, especially after a trip outdoors.
6. Shower and shampoo your hair if you think you may have been exposed to ticks.
7. Check your clothes for ticks and wash them immediately in order to remove any ticks.

Hope this helps.
Please reply for further queries.
Wishing you good health.

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Brief Answer:
Peripheral arterial disease. Consider Doppler scan

Detailed Answer:
Hello,

I suspect the pain and swelling may be due to peripheral arterial disease.

It is most common in Smokers and tobacco chewers.

My advise is do Doppler scan of both upper limbs and lower limbs.
Upper extremity peripheral arterial disease may affect the large arteries that course through the armpit into the upper arm, along with smaller arteries in the shoulder, arm, elbow, forearm and hand.
One of the most common causes of peripheral arterial disease is atherosclerosis or the hardening and blockage of arteries.
The same problem may be seen in the small arteries supplying the lower limb especially in the arteries in buttock muscles.

Please do Doppler scan of both limbs and review with a vascular surgeon and neurologist.

Hope this helps.
Please reply for further queries.
Wishing you good health.

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Brief Answer:
Yes consult with PCP regarding this issue.

Detailed Answer:
Hello.

Yes, Please consult your Primary care Physician regarding the possibility of Peripheral vascular disease.

I appreciate your life style change of leaving the habit of tobacco chew.

Hope this helps.
Please reply for further queries.
Wishing you good health.

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