Is clinical exam enough?

[GGKK]

Hello!

Do you think it is possible a good neuro (specialized in neuromuscular diseases) rule out ALS just with an half hour of clinical exams?

I'd appreacite the opinions...

Be well,

GGKK

 

[joelc]

Yes, if there are no indicators for ALS it doesn't take long to rule it out.

 

[glenn gavanaugh]

what about a regular Neuro? The community neuro I saw a few months ago ruled it out, just based on strength, reflexes, etc. (after noticing symptoms for about 6-7 months) . . . but unfortunately problems have progressed since then...

 

[GGKK]

Hello!

Do you think it is possible a good neuro (specialized in neuromuscular diseases) rule out ALS just with an half hour of clinical exams?

I'd appreacite the opinions...

Be well,

GGKK

He is very specialized in ALS.

I asked it because he tested my reflexes (all normal), my strength (no weakness), no babinski, no clonus...and tested others signs, all fine.

When I asked to perfome an EMG, he refused immediately and said me: 'no way, it is totally unnecessary, you do not have any signs of ALS'.

But I have fascics for 4 years (not constants, just sometimes)...and from the last months I noticed 'a dip' (atrophy?) in my right thigh that I do not remember I had it before.

He did not give any attention to this...said this 'dip' is normal. But in my other thigh I do not have it!


GGKK

 

[kylisa]

By the time my mother saw a neurosurgeon, the doctor told me that she suspected ALS based on the tests she did in the office. We did not get a definite dianosis until she had the EMG and Nerve Conduction tests. The day she had the tests, I asked the doctor that did them if there was any sensory problems showing. He wouldn't give me an answer in front of her. Instead, after my father was pushing her wheelchair out of the exam room, he took me aside and told me that there was no sensory problems showing in the nerve conduction studies. I had already researched ALS and knew a lot of what was to come. I had read that nerve conduction studies showing motor problems with no sensory problems pointed to ALS. I knew she had ALS the day we walked out of that office. The official diagnosis came 3 weeks later when the test results came back.

You have to realize, She was playing softball with the grandkids in April 2007. She developed a dropfoot in May 2007. She wasn't diagnosed until Feb. 2008. By that time, she was using a cane and/or in a wheelchair when she would have to walk longer distances. She was affected all over to some degree from May 2007 through Feb 2008. In nine short months she went from running to barely able to go using a walker. From Feb to October 2008, she lost her voice, got a peg , then eating ability was lost. She hasn't ate since late October 2008. She had been bedridden Since late November 2008. She is now on neurontin, oxycodone, and morphine for pain. The one thing she doesn't have is a bi-pap machine. She refused it at the outset. She has good days and bad days (for her). There have been times when we were sure she was leaving us....only to have her bounce back.

With that history stated, I do believe a neurologist can diagnose ALS, if you are affected to the same degree my mother was, without actual testing. However, I do not believe any neurologist will diagnose ALS without standardized testing. As for ruling it out without testing, I would say that in the really early stages, most doctors, including neurologists, would not go into depth testing for it. Remember, the doctors attempt to rule out everything else it could be before giving such a sad diagnosis.

My advice to you is to live your life to the fullest now.....if you have ALS, you will be glad you did what you could do while you could do it. If, it turns out you don't have ALS, you will have had a full life when your time does come. Either way...... no regrets!

 

[GGKK]

By the time my mother saw a neurosurgeon, the doctor told me that she suspected ALS based on the tests she did in the office. We did not get a definite dianosis until she had the EMG and Nerve Conduction tests. The day she had the tests, I asked the doctor that did them if there was any sensory problems showing. He wouldn't give me an answer in front of her. Instead, after my father was pushing her wheelchair out of the exam room, he took me aside and told me that there was no sensory problems showing in the nerve conduction studies. I had already researched ALS and knew a lot of what was to come. I had read that nerve conduction studies showing motor problems with no sensory problems pointed to ALS. I knew she had ALS the day we walked out of that office. The official diagnosis came 3 weeks later when the test results came back.

You have to realize, She was playing softball with the grandkids in April 2007. She developed a dropfoot in May 2007. She wasn't diagnosed until Feb. 2008. By that time, she was using a cane and/or in a wheelchair when she would have to walk longer distances. She was affected all over to some degree from May 2007 through Feb 2008. In nine short months she went from running to barely able to go using a walker. From Feb to October 2008, she lost her voice, got a peg , then eating ability was lost. She hasn't ate since late October 2008. She had been bedridden Since late November 2008. She is now on neurontin, oxycodone, and morphine for pain. The one thing she doesn't have is a bi-pap machine. She refused it at the outset. She has good days and bad days (for her). There have been times when we were sure she was leaving us....only to have her bounce back.

With that history stated, I do believe a neurologist can diagnose ALS, if you are affected to the same degree my mother was, without actual testing. However, I do not believe any neurologist will diagnose ALS without standardized testing. As for ruling it out without testing, I would say that in the really early stages, most doctors, including neurologists, would not go into depth testing for it. Remember, the doctors attempt to rule out everything else it could be before giving such a sad diagnosis.

My advice to you is to live your life to the fullest now.....if you have ALS, you will be glad you did what you could do while you could do it. If, it turns out you don't have ALS, you will have had a full life when your time does come. Either way...... no regrets!

Kylisa,

I really sorry for your mom. I hope your family enjoy the fullest with her.

I agree with you the neurologist have to do all standards testes (clinical, EMG, MRI,...) to confirm a diagnose of ALS.

I just keep worried how he could ruled it out (said 0% chances). And if it is in early stages, could he notice something wrong just with clinical exams? He said yes...

Be well,

GGKK

 

[rose]

GGKK,

Perhaps it will help you to remember that a short description of ALS is that it is a progressive disorder of the nervous system which causes degeneration in both upper and lower motor neurons and results in muscle weakness. Its been 4 years that you've been twitching and you don't have signs of motor neuron degeneration (your reflexes are normal) or weakness from what you've said here, or what your doctors have discovered.

Good luck to you, I hope you're able to put this to rest.

 

[GGKK]

GGKK,

Perhaps it will help you to remember that a short description of ALS is that it is a progressive disorder of the nervous system which causes degeneration in both upper and lower motor neurons and results in muscle weakness. Its been 4 years that you've been twitching and you don't have signs of motor neuron degeneration (your reflexes are normal) or weakness from what you've said here, or what your doctors have discovered.

Good luck to you, I hope you're able to put this to rest.

Rose,

Thank you for your attention.

Yes, I know and it helps me to put my worries out of mind. But my worries back when I touch my right tight. It is noticeable there is a 'dip' there when comparing with the left one. The doctor did not give attention to it...(last week).

If it was atrophy, the reflexes in my right leg would be abnormal?

Be well,

GGKK

 

[hopingforcure]

Clinical exams mean a lot, I would surely think that als should be low on your lists of what you may have. Good luck..

 

[GGKK]

In the early stages of ALS, reflexes should be abnormal?

Thanks for the attention!

 

[Al]

GGKK. If your doctor says you don't have ALS then you most likely don't. Trying to find someone to agree that a dent in your thigh is atrophy is pointless and silly. Maybe it's flesh eating disease! That's about as much sense as you're making. Stop obsessing about the fasiculations and they will lessen. Quit trying to convince yourself you have ALS. You do not want this, trust me.

AL.

 

[GGKK]

GGKK. If your doctor says you don't have ALS then you most likely don't. Trying to find someone to agree that a dent in your thigh is atrophy is pointless and silly. Maybe it's flesh eating disease! That's about as much sense as you're making. Stop obsessing about the fasiculations and they will lessen. Quit trying to convince yourself you have ALS. You do not want this, trust me.

AL.

AL,

I am so happy hearing from my neuro that I am fine, nothing is wrong!


I do not want to find someone to agree that my thigh is atrophied. But it is a bit hard to put all the worries out of my mind when I fell there is a 'dent' in my right thigh, even my neuro said it is all fine.


Due this reason I asked if it is possible to rule out ALS with clinical exams and if in the early stages of ALS reflexes should be abnormal.

Thanks for your attention and patience!

Be well,

GGKK

 

[rose]

GGKK,

If you've been twitching for 4 years, you would not be in the "early stages" if ALS were the cause. And yes, if your fasciculations were an indication of a MND, your reflexes would have been off by now, how could they not be as it is a progressive disease?

No one has arms or legs that are perfectly matched with each other, even a face is not a mirror image of each half.

Doctors are gathering information from the moment you enter the exam room or their office. What they notice goes way beyond taking note of your answers to the questions they ask of you. If you had atrophy, a neuromuscular specialist would have investigated if anything looked suspicious at all with your thigh.

Please try to find peace with this, and move on with another focus in your life. Life is too short, and NO ONE gets out alive, so, as Kylisa said, you might as well enjoy, or make the time meaningful that you have. There are no guarantees, no one has an expected "shelf life" stamped on them at birth.

Good luck to you

 

[brooksea]

Sigh...

Please take everyone's advice. Go live your life to the fullest with your wife or your family and friends.

I used to get really peeved at people for insisting their symptoms pointed to ALS. Now I just feel sorry the internet has provided them an avenue to perpetuate their fear!

I wish you luck!

PS-

To answer your question:

4 years of "symptoms" is not early stages of ALS. My husband had problems about a year before diagnosed that were overtly obvious. But, we did not know they were symptoms of ALS and indeed they could have been symptoms of any condition.

He is going on 3 years now since diagnosed. His left arm and hand are very atrophied now (right arm and hand getting there) and his speech is getting much worse. (by atrophy, I mean you can see the bones)

Everyone is different. After 4 years of symptoms though a clinical exam should be sufficient to rule out ALS.

But what do I know?

 

[Zaphoon]

GGKK,

I love the way your neuro stated 0% chance of it being ALS.

Reflexes by now would have been abnormal. The EMG would have picked up abnormalities associated with ALS and you would be experiencing difficulty with ordinary, everyday tasks. Your twitches are benign (bothersome but benign). I wouldn't worry about them.

If it would help your anxiety, you can always seek a second opinion.

In the meantime, I'd be finding someone to do the "happy" dance with!

Zaphoon