Old 04-17-2016, 04:08 PM #1 (permalink)
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Default Initial Dr. Appointment Coming up, worrying myself sick

Good afternoon. I have an upcoming appointment for a referral to an neurologist but I am consumed with nerves and worry. I felt I need to write this out

I noticed some clumsiness in my pinky and ring finger on my dominant hand. There's some perceived weakness, namely it "feels" weak and my grip feels like it is not as robust as my left hand (I am right handed). There was also some numbness and sensation changes I think. I was looking into ulnar nerve issues initially before noticing what appears to be some muscle atrophy in my right arm and forearm. The muscles are smaller and less defined, there are less prominent veins as well. Placing hand flat on a surface though it is not drastically different than my left. I have some symptoms of ulnar nerve impingement, however and a year and half injury to my thumb that could be the cause of these symptoms. But I've had some slightly notable weakening of my right arm as well, it seems to tire quicker than my left. Nothing like clinical weakening I think. I can still do everything like open jars, keys, type. Though the anxiety seems to be attributing to some continued clumsiness.

I also now noticed that basically my entire right (dominant) side seems to be less developed or smaller than my left. It's noticeable in my ankles and calves, upper arms, and chest muscles. I have a slight upper eyelid droop as well, but that has been present for a very long time. I want to say this isn't new, but my memory (coupled with my nerves) can't seem to pull that together.

My wife has complained that my breathing is heavy when I lay down to sleep, and I have a hard time catching my breath lying down sometimes. I've gained about 25 lbs since this time last year and my breathing is short when I am full. I have had a general tightness in my chest when I run as well sometimes, like i cannot take a deep enough breath. That is intermittent and has happened over the year or so as well.

Similarly I've noticed my legs feel heavy and tight. In particular after exercise and sitting for a long time. I was seeing a chiropractor for back problems last year and she thought I had tight quads and hamstrings, but nothing concerning. I don't stretch regularly from running so I've always attributed some of the stiffness to that.

I've had some sporadic muscle twitching as well on and off. Noticeably in my tricep, hand in the area below my thumb, calf and upper inside of my leg. I've always thought these were normal and they will last a few seconds and usually subside if I move or touch the area. These don't seem like they are the type that is described as a symptom of MND.

So it feels like every time I find some symptom of MND I can find a corresponding personal symptom somewhere on the spectrum. I haven't really slept in the last three nights due to being consumed with worry. I'm going to my PCP this week and hopefully get a referral to a neuro. It just seems like there have been a cascade of awareness of potential symptoms since I noticed my hand and now looking back I can see connecting potential dots. Not sure what I'm looking for here, but I felt like I needed to type it out.
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Old 04-17-2016, 06:27 PM #2 (permalink)
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Default Re: Initial Dr. Appointment Coming up, worrying myself sick

CO, I suspect losing the weight and doing a stretching (nothing irritates muscles like going from 0 to 60 too fast when you run)/de-stressing regimen would alleviate many of your symptoms, nor does ALS seem high on the list of possible "one ring" explanations. Tai chi, ballet and classical stretch are some modalities to consider. Meanwhile, you might take the Epworth inventory on line to see if you should ask your PCP about a sleep study.

Best,
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Old 04-27-2016, 10:43 AM #3 (permalink)
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Default Re: Initial Dr. Appointment Coming up, worrying myself sick

Thank you for your reply. I had an initial appointment with a Physician's Assistant at my PCP who put in for a referral for a neurologist to check for ulnar issues. She said the fascinations are likely just my normal given I've had them for a long time all over my body and the very quick reflex and strength tests she did looked normal, she noticed no weakness or any difference in strength in my hands, arms, and legs and said my reflexes were good. The neurologist is going to do an EMG and nerve conduction study on my arm, as she was thinking there is some ulnar impingement or irritation.

I am bouncing between being embarrassed that I've wasted your and the doctors time and nerves on the upcoming tests. I feel hyperaware of every movement and muscle at this point and seem to notice "new" symptoms every day. I've been stumbling over words, worried I am dragging my leg, and wore out my arm doing my own strength tests on my fingers. After the EMG and neuro appointment, assuming everything is ok I will be making an appointment to see about anxiety. I'm sorry for taking up your time.
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Old 05-24-2016, 08:42 PM #4 (permalink)
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Default Re: Initial Dr. Appointment Coming up, worrying myself sick

I had my EMG. The neuro tested various muscles in all four of my limbs. There was no fibs, +waves, or fascs in any muscles. Though there was significant chronic denervation in my right hand (APB and 1st DI muscles with gr. increase in duration, and amplitude, and reduced recruitment on the right, and a slight increase in duration and amplitude and reduced recruitment on the left side. No poly's.

Similarly chronic evidence in two muscles of my forearms. Completely clean right deltoid, bicep and tricep. She attributed these arm findings to severe carpal tunnel and chronic c7-c8 radiculopathy, with more prominent C8 involvement on the right.

My legs were also clear of any fibs, +waves, poly's and fascs, but again showed significant chronic increases in duration and amplitude with reduced recruitment consisted with a chronic moderately sever S1 radiculopathy. The Nerve conduction was pretty bad on my left tibial and sural nerves as well.

My understanding is that the absence of any active issues, the fibs, +waves, and fascs would be inconsistent with ALS given the evidence of chronic denervation. Is that correct?

I am a bit concerned that there was chronic denervantion in both the APB and 1st DI muscles, as that would be evidence of "split hand" btu again, there were no findings consistent with anything active.

The neuro concluded the report by stating that clinical correlation is required. I'm assuming I'll need MRI's or Xrays to confirm there are reasons for the chronic issues.

Is this a good or bad EMG?
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Old 05-25-2016, 01:52 AM #5 (permalink)
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Default Re: Initial Dr. Appointment Coming up, worrying myself sick

Great results concerning no ALS.

The NCS showed some things to follow up. The NCS will be clear in ALS, so findings there indicate something they can either fix, or at least something is NOT a terminal condition.

Keep working with your doctors now and forget about ALS as it is not indicated in your tests. I'm very happy for you
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Old 06-16-2016, 12:49 PM #6 (permalink)
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Default Re: Initial Dr. Appointment Coming up, worrying myself sick

Thank you for your reply. I appreciate the response. Unfortunately, I've been frustrated with my care so far because I think it has been haphazard to a certain extent.

I had a cervical MRI that came back only showing minor or minimal degenerative changes at a few levels with very small disc bulging that is not impinging on any nerves. I asked my doctor whether we could get an MRI of my lumbar area, where there was more significant EMG findings and she refused.

Mainly, I feel like she humored me with the cervical mri, but didn't order a lumbar mri, compounding the issue of having ordered an EMG without referring me to the neuro for a full clinical exam first. I know I have anxiety about this and I'm on medication for it, but I don't think I'm being unreasonable. I have some slight muscle atrophy that was noticed in PT, chronic reinnervation and reduced recruitment in multiple muscle groups, and continuing (though lessened since I've been on meds) diffuse facilitations. No one has checked my reflexes thoroughly, nor has the strength in my fingers or legs been tested.

I also made an appointment with an neuromuscluar specialist on the recommendation of some family members to hopefully get something I can be confident in, but that appointment is not until the end of next month. I recognize I am being driven by anxiety, but I do not feel like I've been taken seriously.
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