21 year old female really worried

[koala7]

Hi everyone!
To everyone who reads this, thank you so much because I had not had a peace of mind for two months now. I am a 21 y old student with a bad diet and no exercise.

SYMPTOMS: My symptoms started from the beggining of June, after a weekend of lots of walking, dancing and drinking (I walked 10x more than usual). The following week my upper right leg started hurting and I couldn't walk normally and stand on it, started kind of limping. It resolved after 1,5 week. During that time, and some two weeks later I started having sensations like my legs and arms would fall asleep (sometimes they would, sometimes not) and some numbness in the area where the leg had hurt. Then my hand started failing (I couldn't grasp things and control fingers normally). Sometimes it was better sometimes worse. Right now normal. Some time after that for about three days I had great pain in arms and legs (in the area behind knees and elbows). Tingling and numbness happened a few times after that. Most recently I started having random singular muscle twitches (facciculations?) over the body which happen from time to time, for example, on the butt, lower leg, arm, etc. and once even on the chin and once on the lip.

I will write what neurologists wrote that concerns me. Neurologist 1 (when symptoms started): Areflexia on hands, weak PATs, "it seems like there is limb hypotonia". No pathological reflexes, everything else normal.

Neurologist 2, 1st visit (did the surface EMG and NC, but before I noticed facciculations): M. deltoidus dex et sin, m biceps brachii sin, m vastus medialis dex, m tibialis ant dex, m extensor digitorum brevis dex - scarce (not sure if right word, rare-ish?) intermediar pattern, some potentials are extented, poliphasic, higher amplitudes. Fibrillations at rest.
M extensor digitorum brevis sin, m tibialis ant sin - lightly scarced intermediar pattern, with singling out some higher poliphasic potentials. Rare high fibrillations at rest.
The rest of the muscles in arms and legs tested were ok.

Summary: easy to medium hard chronic neurogenic changes at C5-6 left and c5 right and easy to medium hard chronic neurogenic changes at L4-5 right and easy changes at L5 left. Neurographic and reflexological results are okay.

After MRI: dorsolateral disc protrusion left at C5-6 for 4mm, lumbal area okay
Summary: GMS a bit weak on left upper arm. I don't find signs of acute neurologic disease. Vertebrogenic symptopathologia is dominant, especially from the cervical segment. Recommended physical theraphy.

While talking to him, I expressed concerns over fibrillations, but he said something about it not being active denervation, but something from before. How does he know it? I also expressed concern about ALS and MS, but he sort of laughed it out, especially since I am young and did not show facciculations. I read so many topics on this forum and everyone says fibrillations are not good to say the least. I know that disc protrusion accounts for things going on in my left arm, but why are there fibrillations in my right leg and even worse, in my left leg, ("chronic neurogenic changes") and these poliphasic things if my lumbar region is okay.
And does my onset of facciculations change anything? They did not show on EMG. Could they be from so much stress? Is it something to worry about, should I go have a second EMG and maybe a second opinion from the first neurologist? The second one is a specialist in electrophysiological diagnostics and neuromuscular disease, primarius, professor and what not. It is not that I do not trust him, but it just doesn't make sense.

For two months now, I do not feel worse or anything if that's important to note and I forgot to note that I had scoliosis surgery 6y ago (thoracic region) . I can walk on toes, heels, stairs, I work and do normal activities. It's just that anxiety that this is just the beginning of the illness is getting the best of me so I kind of became weak, depressive and can't focus.

I already spent a fortune on all this tests, should I do more? :?::???: + On Friday I am going to go have my thyroid tested again (last test 6 months ago) and B12 and D vitamins for the first time.

Am I going crazy? :???:

 

[KarenNWendyn]

Hi. Your symptoms are not suggestive of ALS. Under-active reflexes (hyporeflexia and areflexia) do not suggest ALS but can be seen with nerve compression as in cervical radiculopathy. Numbness (paresthesias) also can be seen with nerve compression and are not a feature of ALS. Muscle twitches are non-specific. The term "fibrillation" refers to contraction of a single muscle fiber and are not generally visable or noted in EMG. Did you mean fasiculations?
I would not be worried about ALS here. Physical therapy and observation over time sound like reasonable approaches to me. Anxiety sounds like it is also a factor and can actually make your symptoms worse.
Best of luck.
Karen

 

[koala7]

Dear Karen,

Thank you for the reply and reassurance. Everything you wrote seems logical and I know I am probably just making symptoms worse by anxiety. However, now I am a bit confused since the test results clearly say fibrillations, not fasciculations. Is it worrisome if the EMG showed fibrillations? Is that even possible? :|

 

[KarenNWendyn]

Ok, I just looked this up. Fibrillation potentials can be seen on an EMG and represent denervation (loss of nerve conduction) of a single muscle fiber. This can be seen with a lot of condions including nerve injury, so is really pretty non-specific. I don't think you can see or feel a muscle fibrillation on a physical exam though because they're just too tiny.
A fasiculation, on the other hand, represents contraction of a single motor unit. A fascicle represents a bundle of muscle fibrils, so you can see or feel a fasiculation on physical exam as well as note it on an EMG. Again, they're fairly non-specific.
Karen

 

[koala7]

Dear Karen,

I understand. Does nerve injury or any kind of radiculopathy have to appear on MRIs or if it is minor it just wouldn't show? In the last two days I started to develop some kind of pain in my left leg that is similar to the occasional pain in my left arm which is affected by the slipped disc in the cervical area.

And would EMG pick up reinervation even if it was made early? I read somewhere that reinervation can only be seen on an EMG after 3-6 months so I am wondering if that is true.

 

[Atsugi]

Welcome, Koala from Croatia.

A few thoughts.

I don't see why you're concerned about ALS. What ALS symptoms do you have?
You listed a lot of pain, tingling, numbness and twitches happening all over. Nix all that. Forget it. What counts is "my foot/hand stopped working for no reason. There is no feeling of weakness--it Just. Doesn't. Go. anymore and it never gets better."

At the top of this sub-forum "Do I Have ALS" there is a sticky post, stuck to the top of the sub-forum. It is titled "Read Before Posting." Take a good long look at it.

You asked a lot of questions that you really need to ask the doctors who tested you. But I note that when you were tested, he laughed off ALS. Now, it's good to read that it's "not that I don't trust him" but then you say, "it doesn't make sense." To who? It made sense to the guy who graduated medical school and a neurology residency and specializes in neuromuscular disease.

Time to visit a nonspecialist. See a family doctor. The neuro docs can do neuro, but what if your pains are something else? A GP medical doctor is trained to lead a multidisciplinary investigation and decide which specialists need to be consulted.

You mentioned stress. I won't pretend to psychoanalyze you over the internet, but that is an area you might want to look into. What are you studying? How long have you been away from home? I'm not saying "it's all in your head," but I believe the brain is just as important as any other organ, and it needs a checkup from time-to-time.

You're pretty bright so let me help you focus on the basics of ALS. ALS will destroy a motor nerve in the brain, so that nerve can no longer send a signal to its corresponding muscle. Consequently, that muscle doesn't contract anymore, forever, and ever. Typically, it starts in the hand, or maybe the foot, rarely, the tongue. Then ALS continues down the line of motor nerves, destroying them over a period of months or years, and more muscles become useless and limp. It works in serial order, usually climbing up your arm (or leg). Your limbs and finally your torso and neck become useless. It is a horrific disease, and our members deal with it all day and night for the rest of their lives, which is usually just a few years. My wife lasted 9 months from first symptom--she fell--until finally her lungs could no longer draw a breath.

I encourage you to get a second opinion, frankly, only because I think you're going to continue to be stressed over this until you do. While you're at it, don't forget to tell your GP doctor about your stress, and see if she can fix that before it eats you up.

Good luck.

 

[koala7]

Dear Mike,

I appreciate the time and effort you took to read this and write your input. Everything you wrote sound logical. What I meant by saying I trust my doctor was that I wasn't trying to be disrespectful, but was wondering if something could be up and not be visible on EMG just yet, but I guess if that was the case he would have asked me to come again in some time.

I am indeed under a lot of stress and came home from university during exam time in July to see all these doctors when my hand started failing. I will make sure to see a psychologist because I am aware my anxiety is getting in the way of normal functioning since I am constantly reading literature on neurological diseases, checking myself etc. I wouldn't say I am making things up, but I am aware it is probably making the symptoms even worse. I had some more blood work done and will see a physiatrist next week as recommended. I will make sure to post an update to this thread for people who have had unfounfed anxiety about similar symptoms and/or abnormal EMG.

I am very sorry to hear about your wife and must say that reading some of the member's stories here is truly heartbreaking.

Thanks again,
Koala7