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Karii11

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Feb 19, 2017
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Learn about ALS
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US
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FL
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Stuart
Hi there,

I'm a 27 year old woman who is absolutely terrified I'm developing signs of ALS. I'm also a medical student, so I'm subjected to extreme stress and anxiety on a daily basis, and this health saga I've recently been dealing with is really wearing me down.

It started 4 weeks ago when I had recurrent fasiculations confined to the right side of my face which I had experienced 8 months previously before starting medical school. I saw a neurologist, had an entirely normal neurological evaluation, and was told it was due to stress and sent on me way.

The facial fasiculations stopped completely, then returned a few weeks ago. I again saw my neurologist, and was especially concerned because my right arm began twitching as well during this time. My entire right arm also began to feel fatigued, and weak. As I'm a med student, I typically am sitting and writing for 15 hours every day, and also have a 2 hour drive to and from school every day, so I initially attributed the arm fatigue to that.

I saw my neurologist again for this issue, and he ordered a brain MRI which was completely normal. He again did testing and noted weakness (4/5) in my right arm. I had neck pain from studying as well, so he attributed it to a disc issue in my neck and was not concerned. I've been terrified of ALS and mentioned this to him, and he laughed it off and said "no way." I then saw an orthopedic surgeon who again checked me out, confirmed the weakness in the right arm, and ordered a series of x rays with results pending. He thinks my arm weakness is due to muscle strain and absolutely nothing serious, but I can't relax.

I am absolutely convinced that these fasiculations I'm experiencing in my arm, along with the confirmed clinical weakness means I'm developing ALS. I now feel the fasiculations in my leg, which is beginning to feel weak like my arm. I'm having trouble keeping it together because I'm so terrified by this disease. Can anyone help?
 
So you are second guessing your neurologist? Do you not trust him? Should you find another neuro? I think, as a med student, you might have too much info. Why not pursue the more benign options such as treating muscle strain and the disk issue before jumping to a very rare, fatal disease. As a med student, I am sure you have heard the phrase when you hear hoofbeats, think horses.....

You are absolutely stepping over many important steps but jumping to ALS based on some rather non-specific symptoms. Give your docs a chance and see if you can treat the more common causes first. You should also treat your anxiety. Med school is stressful and your commute is daunting. Fatigue and stress are also common triggers for your symptoms.

Best wishes.
Tracy
 
Yep, you're very right about thinking horses and not zebras. However, I think my issue is that I can't find a reasonable explanation as to why I would have fasiculations AND the weakness. I guess I should accept that the fasiculations in my face were anxiety induced, and so the ones in my arm and leg are likely anxiety induced as well, and are on top of an existing repetitive strain injury. My ortho suggested this is entirely from postural strain and tension, and noted that my right shoulder appeared higher than the left, indicating muscular compensation. What gets me though is that in reading, the only thing that causes fasciculations AND confirmed clinical weakness is ALS. If I just didn't have the weakness, I wouldn't be so horrified.
 
Electrolytes low, sleep deprivation, too much caffeine...
 
So how about two different causess, stress, AND postural strain? Entirely plausible. I have had two conditions at the same time, like a cold AND reflux, etc.... Again, treat the more common causes. If your symptoms don't respond to treatment, THEN pursue more differential diagnostic options. As a doctor, if a patient comes in with a headache, I doubt you would immediately jump to brain tumor without looking at other, more common, options first.

You need to treat your anxiety as well, really.
Tracy
 
Thank you again, Everyone! I'm just concerned that my combination of symptoms warrants further investigation, like an EMG. My neuro is definitely not interested in giving me one, and laughed when I suggested it, saying "I wanted to make him rich" as I guess it's expensive to do. I'm trying to manage my anxiety and will be starting some psychotherapy as well as physical therapy for my arm. Can anyone explain why my fasiculations would be relegated to one side of my body though? I also notice that they jump around in my arm. As in, my pinky finger will twitch, then my tricep or bicep will, followed by muscles in my forearm. Does ALS target multiple muscles in the same limb at the same time? Unfortunately my textbooks are all really lacking in sufficient detail for this disease.
 
Oh, I also meant to mention that I'm globally hyperreflexive. The neuro noted it and didn't think much of it however, chalking it up to anxiety. In ALS, is the hyperreflexia everywhere, or only in the extremity manifesting the initial symptoms?
 
Hyperreflexia can be present in any affected muscle but can also be non-existent. I think you can see from your own hx (3 periods w/ fascics, eps 1&2 separated x 8 months), weakness secondary to overuse, etc.) that PT and addressing the anxiety is the way to go in the absence of other evidence. PT can give you arm/neck ex to do at some points during your day as well.

Best,
Laurie
 
Thank you! So you don't think this sounds like ALS? In reading posts by other members where they too had weakness in an arm and no evidence of a pinched nerve in their neck, and the neuro thinking ALS, I'm still just so worried. I have PT scheduled and psychotherapy for anxiety management as well, but am wondering if I should pursue a nerve study.
 
Have you had the Hoffmans and Babinski tests done? How did your reflexes react?
 
If this is keeping you awake at night, just get the EMG and have your worries put to rest. If you suspect nerve compression (which I think is a million times more likely than ALS) get an MRI on your C-spine, too. If you have ALS in the back of your mind, just get it ruled out with a NCS/EMG on the weak arm. 4/5 is common in many normals, by the way. Regarding global hyperreflexia, my neuro has this. He also has twitches in both thighs.

I'm sure my suggestions won't be popular, but you don't need to be worrying about something when it can easily be ruled out.

THEN.....after it is ruled out, make sure you focus on stress management so you won't get the next disease or condition you read about.

Best wishes.
 
Have you had the Hoffmans and Babinski tests done? How did your reflexes react?

I am globally hyperreflexive. My neurologist suggested it's due to anxiety. Babinski sign is negative.
 
Would the EMG definitely show any abnormalities at this stage, or would it be too early? I saw an orthopedic surgeon and he took x-rays, which showed everything at least from a skeletal standpoint was totally normal. His suggestion is muscle strain and 4 weeks of physical therapy, but I don't think I can wait that long dealing with this constant anxiety.
 
Yes it should show but would you believe it? Many worried people here do not. Be honest with yourself as to if it would help

Btw the sticker price of an emg at my hospital is 1800 dollars ( doctor and facilty charge). Insurance pays less but it would still be a good amount of money
 
Karii,
I say this with all due respect, please stop. You are clearly working yourself into a tizzy and have seem to have been on this site all night. I know this because I was up all night dealing with my husband who is in the end stages of his disease and needs tending to all night. Your anxiety is getting the best of you, your symptoms do not point to ALS, you have not tried any ways of treating other, more common causes of your symptoms and you are pursuing reassurance from strangers on the internet instead of going back through your doc. Is there a reason that you don't trust your neuro's diagnostic approach? Your history indicates that you have seen him at least 3 times.

Kim's suggestion of an EMG is valid only if you will acccept the results, but your response "Would the EMG definitely show any abnormalities at this stage, or would it be too early" suggests that you know that the results would be normal and so it would not ease your anxiety. An EMG is an expensive, involved test and you are already questioning whether it would confirm the absencse of ALS, so no I don't think this is the way to go.

You say that you can't deal with your anxiety for weeks. You are right, it is clearly impacting your life. Go to you GP right away and address the anxiety portion of your symptoms. Then keep your appointment with your PT and follow their guidance for 4 weeks and then follow-up with your doc. ONLY after you do these things should you post again to update us. Seriously. See if you respond to treatment. Let's face it, even if you had ALS, which you DO NOT, there is no treatment, so an early diagnosis is of no benefit.

Now sign off here and best wishes.
Tracy
 
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