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Skyhawk

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Is it true that ALS fasciculations only happen when the muscle is at rest and that these are very different in character to the standard muscle twitch?

I had a follow up with my Neuro yesterday and I was telling him the muscle twitches in my calf, biceps etc. have eased off but still happen quite often but the twitch in my little toe which twitched almost constantly has spread to a couple of toes next to it now and got worse. Yesterday my toes cramped pretty bad and also felt painful. Also when I spread out my toes and try and stretch them out then my little toe really goes for it and the muscles from the side of my little toe to the top upper side of my foot just fasciculate constantly.

He said "Well of course they will do if you stretch the muscle like your doing! and ALS is motor based not sensory, pain is not usually associated with it" He then said "You have no muscle wastage at all and even though you say your right leg and bicep feel weak, in all my tests I have performed on you they appear symmetrical in shape and I can detect no weakness at all, actually your a strong chap and your reflexes are also good, no Hoffmans, Babinski. Trust me you do not have ALS." He concluded by saying "Andy trust me I know an ALS twitch when I see one, I was just at the hospital this morning seeing an ALS patient. What most people don't realize is that ALS fasciculations 99.9% of time ONLY occur after there is evidence of atrophy - They can also easily be triggered most of the time by the examining Doctor by just flicking the skin with their finger and I cant trigger any on you. Finally they move up and down the muscle, normally the bigger ones like thigh, calfs etc quite distinctly, almost in a wave like motion that travels the entire muscle, kind of like if a worm was crawling just under your skin and all your symptoms have appeared in 3 weeks, way too fast in my opinion for ALS"

I was kind of satisfied with his answer but then I read where a few people who had ALS said they had intermittent fasciculations early on at rest and when they stretched the muscle and they just looked like normal twitches. Also that they got symptoms very quickly?

Cheers

Andy
 
hi andy.
oh dear "the" twitching question again
firstly everyone is different and the replys you get may conflict leaving you more confused.
i am not a neuro so can not give you an accurate answer,only my experience.

i get twitching in my feet(has calmed down a bit,atrophy in left foot/ankle)
my upper arms shoulders(arms very thin,atrophy in shoulders.again calmed down since atrophy)
calfs(left leg a little thinner/loss of contraction in that one)
left hand that started this year,palm has sunk in.

i am led to believe bfs twitching is more wide spread and the twitches stronger.
my experience are specific problem areas with other symptoms.
they are very fine and i feel only a slight tickling feeling,sometimes i can not feel them but see them.
i dont know what goes on when i am active as i only see or feel them at rest.
they happen when my muscle is relaxed not tensed.
my neuro taps the area to get a twitch,if i tap or lightly slap my calf it will twitch.
i do suffer bad cramping in my feet,epecially the one with atrophy.

i must stress i have pls not als,after 10yrs some slight atrophy can be expected as in my case.
your tests,exam ect was good,that is brilliant:D
 
Hi Andy, I am curious, how fast would you say your twitches come, when you get them?
 
Sometimes, I think that I read and analyze too much. :)

I read Andy's opening post and thought "Now I can find out once and for all if I have als with a simple test...flicking my calves with my fingers." Of course, I spent the next 5 min sitting with my calves relaxed, and watching the twitches to see how frequent they are and if they travel the length of my calf muscle. After that, I spent 10 min. flicking and slapping my calves to see if I could incite twitches. Of course I did get a twitch or 2 or 3 soon after doing that, but not always at the exact place I struck. I don't know what to think...sigh. Here's what I do know:

1. I can see every twitch as well as feel it.

2. They occur in areas all around my calves. I don't think they travel like worms under my skin (whatever that's supposed to look like) and if they do, it's not very far.

Has anyone ever been able to causes twitches by touching, slapping or flicking and have it NOT be als?

Man, I have to stop thinking so much.
 
:lol::lol::lol::lol::lol:sorry rhythman your post had me in stiches.
i was imagining you beating the hell out of your calfs,of course eventually they may twitch...........would'nt you flinch if someone was slapping you:roll::lol:

seriously now,its been said hundreds of times before on the forum..............twitching does not mean zilch without obvious clinical weakness and/or atrophy.
those with als dont pay any attention to the twitching,its the other symptoms they worry about.
to a neuro twitching is not a major symptom only a tiny one to add to many other more serious signs and symptoms.
relax:)
 
"Man, I have to stop thinking so much."

You said it buddy!
 
:lol::lol::lol::lol::lol:sorry rhythman your post had me in stiches.
i was imagining you beating the hell out of your calfs,of course eventually they may twitch...........would'nt you flinch if someone was slapping you:roll::lol:

seriously now,its been said hundreds of times before on the forum..............twitching does not mean zilch without obvious clinical weakness and/or atrophy.
those with als dont pay any attention to the twitching,its the other symptoms they worry about.
to a neuro twitching is not a major symptom only a tiny one to add to many other more serious signs and symptoms.
relax:)

I've always been told that I'm a funny guy. Glad that I left you in stitches. :)

I did kind of beat the hell out of my calves...they're all red now. That is funny.

Thanks for your reassurance. I'm not as well read as many of you here, so I really appreciate it.

The internet is a double edged sword (actually my use of the internet is the problem). Four weeks ago, it led me to 'bulbar onset als' when I simply Googled 'excess saliva' and 'speaking issues', and that's all I've thought about since. The internet also has enabled wonderful people on this forum from the U.S., Canada, the U.K. and other places to be able to discuss and share.

I think I have to learn to enjoy every minute of every day regardless of worry and circumstance. That is something I've always admired in some of my friends and relatives and I've read posts by people on these boards who are able to do this as well. There are so many strong and caring people here...it's amazing. as I said the other day in my first post, they are true heros in my mind. :)
 
Halfin,

How fast they they come when I get them? Not quite sure what you mean but they are constant all over, when I say constant I say frequent. Mainly where I feel weakness in my right calf, foot and thigh. However I will be laying down and I will feel a twitch in my bicep or my back. But my main concern is my right foot - My little toe twitched almost constantly but now its 3 or 4 of them. I can see my Neuro corroborates what Olly has said as he does not seem concerned about the twitches at all - He said if I had hyper reflexes, Hoffmans or Babinski responses then he would be much more concerned but to date none of them are present in me. He says my weakness in my right leg may well be real but it sounds more of a trapped nerve sensation issue where as ALS is motor not sensory and atrophy normally occurs which triggers the weakness!

Rhythman,

I agree maybe you and I are analyzing everything far too much and the internet does not help. I am at the point where I am aware of every muscle twitch, movement sensation over my entire body which I know is not healthy at all. I also feel like when I come on here and say what I say I feel like I am insulting those who have been diagnosed with ALS and this is something I am not trying to do. I just feel so stuck in this phase and I cant kick myself out of it.

For example this morning sitting on the toilet I raised my right leg up and tensed it and because my thigh muscle kind of shuddered and rippled a little when I held the leg up high and shuddered a little when I let it down again I convinced myself this is ALS.

I think what is a very damaging side effect of all this worry is my family are suffering. I am deeply depressed and feel I so down inside I have this illness and people just cant see it yet because maybe it's too early (a possibility.) I just lay on my sofa all day not talking to anyone, interacting with my children and I sleep for 19 hours out of every day because I just don't want to do anything anymore because I think what's the point? I would say for the past 2 weeks I have only got off my sofa to go out and see the Neuro and that's it! My wife tells me if I just lay like that on the sofa doing nothing for 24 hours a day I will naturally have some atrophy as my muscles are doing nothing at all, it's like I have made myself bedridden - This will then make me even worse. I think she has a very valid point :)

Sorry I am waffling again...

Hope you are all having a good weekend

Andy
x
 
hey andy.
your wife is very tolerant,if it was me i would kick your butt of the sofa:smile:

i am so sorry you are so depressed even though your tests and neuro exam are ok and you have the all clear for als....................seriously,what are you depressed about:!:
there are people here with als,everyday losing a small peice of independance yet they dont feel sorry for themselves but just get on with things.

look at glenbrittle,he has such a great sense of humour and always joking. he brightens my day when i read his posts.
but then read his blog,behind the scenes he has many daily challenges.
this is the same for so many like bethu,rose,barry and hoping for cure ect who despite what there going through give us so much joy.

sorry to be blunt.......but get a grip of yourself,get some antidepressants if need be.
i dont mean to sound harsh,i just think you need a bit of a push to get you out of the dark place your in.
please for the sake of your wife and kids.....get out and live:)
 
Hi Caroline,

Nice to hear from you again :)

I think I do need to get some kind of medication to sort my head out! After reading your post I decided to get up and move my butt off to the gym.

What I found odd is while I ran I got shivers in my head and lots of goosebumps raised on my arms. Guess what I did...? Yes when I got home I googled and found goosebumps and chills whilst exercising can be Neurological :( oh dear sent me on a big downer again :(

Oh well at least i got off my backside for once in 2-3 weeks :)
 
Andy, if you are sleeping 19 hours a day, sitting on the couch, and doing nothing other than going to doctor's appointments, then I would bet that you are dealing with a clinical depression, which can cause many physical symptoms. Also, are you unemployed? were you laid off or something-- that can definitely lead to problems with depression and anxiety.

I, too, have had an 8-month or more history of muscle weakness, twitching, fatigue, etc, etc, and two neuros say unlikely to be ALS at this time, but are not completely ruling out a neuro disorder, either. still, I am out every day with my daughter and working from home and doing all the things one needs to do as an adult. the people on this forum who have been diagnosed are dealing with so much more, yet, as Olly says, they are still trying to live their lives to the fullest, despite enormous challenges. and they are kind enough to take the time to respond with advice and suggestions to all the people in undiagnosed-land.

say the worst case scenario happens: you have ALS or some similar disease and you eventually lose the ability to move, etc. I think you would seriously regret these months spent wasted on the couch.

I'm with Olly on this one: go see a counselor and MD who can prescribe antidepressants. They can make a world of difference.

Sandra
 
hey andy.
your wife is very tolerant,if it was me i would kick your butt of the sofa:smile:

i am so sorry you are so depressed even though your tests and neuro exam are ok and you have the all clear for als....................seriously,what are you depressed about:!:
there are people here with als,everyday losing a small peice of independance yet they dont feel sorry for themselves but just get on with things.

look at glenbrittle,he has such a great sense of humour and always joking. he brightens my day when i read his posts.
but then read his blog,behind the scenes he has many daily challenges.
this is the same for so many like bethu,rose,barry and hoping for cure ect who despite what there going through give us so much joy.

sorry to be blunt.......but get a grip of yourself,get some antidepressants if need be.
i dont mean to sound harsh,i just think you need a bit of a push to get you out of the dark place your in.
please for the sake of your wife and kids.....get out and live:)

Olly , Big Hug for ya .

Andy, Olly has got it correct. The only person that will get you out of that damned darkness is you. I have seen it from both sides (Wanda and I) . Dont give up and stay where you are , get some help from a doc.
 
andy,i was worried about my post. i am glad you did not take it the wrong way.
you know us northeners are a tough as old boots,we tell it as we see it.
see........you still have a sense of humour:lol:

honestly,laying on the sofa and sleeping for hours on end its no wonder your poor body reacted the way it did:rolleyes:
build up the exercise and just focus on sorting your head out.


glen. (((hugs)))back:)
 
Caroline, we all know that you're not as tough as old boots! In fact, we know that you are really a softie, almost as much as Glen. :razz:

Andy, I really do think that while the internet is a wonderful thing that allows us to learn many things and connect with friends it can also be a nasty source of misinformation. The more that you google, the more symptoms you will connect to all kinds of things. You need to get up and do physical things like going for a walk, playing with your kids or even chasing your wife around the house.

My wife will not me sit around all day, she tells me to get up and wobble around the yard because even though it tires me I feel better after. And we have big, bad Mr. Winter with snow, cold and darkness coming to visit soon and there will be plenty of time to sit around then.
 
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