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Majahops

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Learn about ALS
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Ca
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Los Angeles
First off, I want to say that I am a General Internal Medicine physician and, while I have cared for many ALS patients suffering through the later stages of ALS, I know relatively little about the various ways that the earliest manifestations of ALS can present themselves (I know the classic basics - foot drop, swallowing difficulty, but in medicine the classic presentation is not the only presentation).

Secondly, I just wanted to say that most [actually ALL] of the individuals I've met with ALS have truly inspired me with their perseverance and strength in the face of horrifically undeserved circumstances. You are all truly heroes to me, and I mean that.

Thirdly, I must say that I realize that I am probably asking this question far too early in the process and it would be most reasonable of me wait for a few weeks at least to see how my symptoms develop before considering such a rare, worst-case-scenario diagnosis. But the reality of the fact is that I have a propensity toward concluding the worst based on limited evidence when it comes to my own health, even though I am able to be much more objective when considering the health of others.

So with that said. I just wanted to present what's going on with me and hope that any of you chime in on whether this could be compatible with the earliest signs of ALS. I fully expect I will get some people who say "you're a doc, you know you shouldn't be asking people on the internet about symptoms, you should go see a doctor," and you're absolutely right... but that would require me asking a colleague to evaluate me for something I'm worried they'd think I was nuts for asking them to consider. That, and frankly, as a physician I've come to trust actual patient experiences of symptoms more than the bullet-point list of "classic" symptoms we get in medical school and residency.

To paint my health background: I have no chronic illnesses that I know of. I am 6'3 and 185 pounds. I am incrediably luck to say that I do not have a history of diabetes or neuropathies.

About 3 weeks ago. I noticed that whenever plantarflexed my right foot (i.e. rotated the foot downward), the muscle-in my foot would spasm and take a long time to relax. This was reproducible and happened every time. It especially happened when I walked up stairs, but it could even happen while I was stretching out of my feet in bed. Around the same time I noticed that the veins that I believe were once quite prominent in my right foot had become much less so, especially compared to my left foot. The muscle just anterior to my lateral ankle (you know that one that makes sort of a "ball" when you contract your foot) was smaller vs the one of my left foot. I mentioned the part about my foot spasming to a neurologist friend of mine in passing, and he said "eh, prolly dehydration or something." So, I accepted that and sort of just forgot about it and moved on (even though it continued to happen). So at that time, I was working in the ICU for a month, where I wear my lightweight tennis shoes with my scrubs. But just three days ago, I started working in the clinic again, where I need to wear dress clothes, a white coat, and nice shoes. I've been wearing the same dress shoes I've always used, they are little heavier than my tennis shoes but nothing out of the ordinary. I realized right away that they felt so heavy and it was harder for me to walk in them, especially upstairs, but even walking on flat ground... it felt like my my feet and ankles were working so hard. My shins started to get real sore, like they had been doing the work that my foot muscles should have been doing for me while walking. I didn't think about it much until last night, when it dawned on me that I've also been having the spasming in my right foot and [perceived] atrophy in the muscles and definition in my right foot. I'm sort of concerned that all of these things may ultimately be due to foot weakness, which I can't think of any reason why I should have.

I really trust the opinions of patients. You're the human beings who have been through these things and who have your own stories and experiences. I thought I'd come to you and ask if you thought this sounded at all compatible with the very earliest stages of ALS or if I am clearly WAY off-base.

So sorry for the long post. I certainly don't expect replies 1/100th of the length of my post. I just hope to have someone offer me some input on this. Thank you so much for everything in advance and for being an inspiration to me and others.
 
Sorry I should have specified when I said the "muscle-in my foot would spasm and take a long time to relax" I meant the midline muscles and tendons that attach the superior aspect of the foot to the superior aspect of the ankle.
 
Spasm/cramp in my arm when rotating my hand downwards from my wrist or using the back of my hand to close a door was the first neurological symptom I observed three years ago. Mine turned out ALS but only after I had spent a year and a half excluding all other possibilities (which there are plenty of) and another six months in the diagnostic process. My logic was that if it's ALS, I will eventually find out and if it is something treatable, the treatments will probably take care of it. Did not stop me from becoming a dad and did not rob me of normal life as long as it was physically possible.

I suggest you take a similar approach and let the time sort it out. There's nothing to be gained by worrying.
 
Sorry, I don't believe this post for a minute.

Every med student would know ALS is a diagnosis of exclusion, not one that you jump to after a couple of vague, perceived symptoms. What medical school did you graduate from where you didn't learn this, most basic thing about ALS? A real doctor would know there are scores and scores of diseases tat have to be eliminated... and you haven't had a single test!

"I have a propensity toward concluding the worst based on limited evidence when it comes to my own health." Sounds like an anxious, hypochondriacal personality to me... though I don't claim to be a doctor.
 
:) -- see stickies at top of DIHALS :)
 
:) -- see stickies at top of DIHALS :)

Max, I actually did read each and every one of those. Was the response to my question answered in them?

Thanks so much for everything!
 
I'd actually say that I do have hypochondriasis to a degree (I think DSM calls it "Health anxiety" or something now). My fears are always about having cancer though, never about having anything else. The reason I came on was to ask if any of you thought my symptoms were compatible with the earliest signs of ALS. I didn't mean to offend or poke fun or anything. Of course ALS is a diagnosis of exclusion, but that doesn't mean that there aren't some different characteristic patterns that ALS onset falls into, and I was just wondering if the symptoms I mentioned fell in light with one of those patterns. I had a feeling there would be some that just felt I was being a jackass for asking, though. I had hoped I was wrong...
 
Doctor heal thyself. When u did your workup on "many" ALS patients, what did they tell you? When you took your boards, did you skip the ALS section?

I'm all in with Dusty on this. What do you do with a new patient who presents with vague yet possible MND involment? Ask a group of lay people to advise you? Are you kidding?

Go find a doctor.
 
Just wanted to say that you guys are right and I'm sorry for bugging you about this.
 
I know I am an old cynic. However, as I've told my wife, "Yea, but how many times have I been right?" Half way through reading his Thread my cynicism kicked in so bad I had to stop and quickly scroll down to the replies. Whew!
 
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