texastracy
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  • Thanks, I never knew that was there.

    Yes, based on the pictures, I would say your FDI and APB are definitely atrophied. Did they include these muscles in any of your EMGs? Did they show active and chronic denervation? When did you first notice the atrophy and how fast is it progressing? Did neuros ever think it waas carpal tunnel before your ALS diagnosis or did the ALS come first?

    I thought my weakness and denervation was all in my lower body, but an EMG last August showed denervation in the FDI and OP (opponens pollicis, which is a little to the outside of the APB). I had never noticed it, but when I was studying my EMGs in December or so, I noticed it and realized I had been favoring my left hand. The pincer grip is failing and sometimes the thumb just sort of gives out. I never trust my left hand with important things... like a glass or bottle of wine. Neither of my muscles is as atrophied as yours, but overall I think I am fairly slowly progressive.
    Part 3.......
    If you can direct me to your pictures, I can take a look, but frankly you can probably be a better judge by looking at those 2 muscles yourself. You can also Google "FDI atrophy" or "APB atrophy" and click on [images] and you'll see lots of pictures of what atrophy in those muscles looks like. I hope this helps some.
    It is what it is, so live life to the fullest!
    Part 2.....
    On the palm side the major ALS atrophy is generally in the APB (abductor pollicis brevis). That is the muscle at the base of the thumb on the palm. If you flex your thumb, touching the tip of the thumb to the middle of your middle finger, you will feel that muscle flex firmly... or you will notice a difference between the two hands. When the APB atrophies, it leaves a bit of a hole or indentation in the palm that you can see and feel.
    These two muscles, the FDI and the APB are 2 of the muscles used in determining the Split Hand Index, which is still an experimental technique for diagnosing ALS. There are, of course, other potential causes of atrophy in these muscles, like Carpal Tunnel, but a number of people have suffered the CTS surgery only to have no improvement. The the doctor figures it must be something else and... voila, ALS.
    Tracy, I don't know how to get to your profile to look at your atrophy pictures.
    I will say it is hard to judge atrophy from pictures when you can't see how "fleshy" the person is, how their two hands compare, how it changes when flexed, etc. I'm sure a hand specialist could, but I'm not a specialist. What I have seen in myself and others with ALS/MND is a withering of the FDI (first dorsal interosseus), the muscle between the thumb and index finger on the back of the hand. When I flex my thumb hard against the index finger, that muscle bulges up nicely on my right hand. On my left hand, no bulge, just kind of flat.
    Graham Harrell, former Tech quarterback and NFL player, has applied to coach football at our dinky 2A school next year. He is a buddy of our new AD. It caused a bit of excitement at the high school when they took him on a tour of the school last week. Senior girls plotting to fail and unmarried teachers planning to move to teaching high school. All I could think was Yea not another pot-bellied good ol boy who never played football past 10th grade.
    >How well do you know Texas Tech football? I ask because I don't know how long you've been in Texas or if you are a football.

    :)

    I sit amidst Aggies and Tea Sips. I am a hardcore Wolverine, married to a Spartan (house divided!). On the NFL side I am married to someone who bleeds Green & Gold. After 22 years in Colorado, we still cheer for the Broncos :).

    >Texas Tech

    only 150 days until kick off !

    Max
    Gerri, Glad to have you. I can still walk, just not very far without getting out of breath. My speech is slower and voice is scratchy. I can't use zippers or buttons, but can pull up my pants.

    Winters in Texas are so much better than in the north. My mom was from Indiana and we spent every other Christmas there. Even got snowed in a couple of times. Enjoy the wedding plans.
    Hi Tracy, Thanks for the welcome. I am wintering in Weslaco TX near my parents and our youngest daughter. I had to quit practicing anesthesia as my speech became unintelligible. It was a huge loss but I have adapted. I have started with Dr. Carlayne Jackson in San Antonio ALS clinic and really like her. It certainly was a great winter to not be in Lansing Michigan! I have tried to change my city to Weslaco on this site but hasn't worked so far. I cannot speak and have a Peg tube for the majority of eating and all of my drinking. We can't choose what happens to us but we can choose how we respond! is my mantra. I am enjoying all the time with my parents and planning our daughters wedding. She is getting married May 24 2014. SO much to do yet SO exciting! Enjoyed your photos! My daughter teaches seventh grade science here in Weslaco! Teachers are awesome!!
    Good to hear you're practicing now. You will be glad you did. I use both dwell and blink, but individually, not that combination setting. I like dwell when inside the Series 5 software, but blink when using normal Windows apps. I use the zoom a fair amount on the desktop. My dwell time is 1100 now. I started at 1500. And when first learning I only used blink so I could study things without the dwell selecting stuff. But as I got faster it's too much blinking.
    No pain in my hands. But when I turn my arm to pull pants up, I get a cramp in my lower arm. My thumb and finger don't works as pliers.

    I don't know if I'm slowly progressing. Some days I discover that I can't do something that I can do. But I have involvement in all areas. I can still talk, walk, and write. But my balance is a problem. I use a scooter at work and a rolling walker at home and for shopping.

    My daughter got me the neatest thing at The Container Store. It's a package of wide robber bands. There were two of each of 4 different sized bands. I use them on the milk carton screw off lid, my facial cleaner, the laundry soap lid, peanut butter lid, etc. The pack cost $4.
    Yes, the hand atrophy in the thenars (FDI and APB, especially) looks like it is very common. My atrophy just recently started, though Mayo found denervation in the FDI and Opponens Pollicis back in August. I now use the notch between the thumb abd index finger as a "wrench" as the thumb and index finger no longer work as a "pliers". I have also started to have pain in the wrist area. I don't know if that's related to the atrophy or if that's from the denervation they found up at C6-C7. Do you have wrist pain? Occassional, sharp, stabbing pain that would make me drop whatever i am trying to grasp. I don't trust that hand any more. I was all lower body until my left hand started to go. Still, I am progressing rather slowly, so I try to live as fully as I can as who knows what next month will look like.
    My wife is a teacher just like yourself. I'm hoping that your progression is slow enough that a cure is found or at least better treatment!! I will pray for you.
    Hello ... Thanks for asking? It took so long to finish the entire process, yesterday was my last apt, where the neuro stuck needles in me. The result so far is that I do not have a MND let alone ALS. Twitches are still persistent, and the one on my forehead is a mystery to my doctor. She gave me muscles relaxers to see if this helps but wants to follow up with me in a month? But EMG was clean, no noise or fibrillations, just flat lines in all four limbs. DOn't knoiw why they didnt save me the trouble and do that first, but I feel very blessed and thankful right now that I did not get bad news. How are you doing?
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