Associated questions on muscle twitches symptom

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Trying2Bcalm

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Hello - an advanced thank you to anyone that reads and/or comments to this post. I have read the Read before posting and found it very informative and reassuring to a great deal as I have read it many times. I will describe things going on with me but I think I have a couple of questions just outside the scope of that post.

About the first week in May 2022, I noticed twitching in my calves. Heavier in the left I think at first, quickly evened out and lately seems more so in my Right. I did manage to hold off on google for a few days and wasn't worried until I read about being accompanied by atrophy and checked. My left calf is noticeably smaller. They measure 18 3/4 on right and 18 1/4 on left. It took me weeks to associate that size difference with a grade 2 tear about 11 years ago playing softball. I had an MRI on it but will confess I didn't properly rehab it. Many ppl from my wife to the chiro to my PCP feels its entirely possible that that is what is responsible to the size difference. (the measurements have been consistent from May until now at 1/2 difference)

Along these past months, I have noticed twitches occur in shoulders, forearms, hands, thighs, feet, buttocks, lips, faintly in cheeks and rarely in torso. I have had about 2 or 3 electric shock type twitches in my tongue over this time. All of these outside of calves are a lot more rare and seem to be over fairly quickly after starting. My calves begin every time I stop moving. I began testing myself with calf raises and heel walking right away so I don't believe there was any clinical weakness (before and since seeing Neuro).

I finally got so anxious that I saw my PCP at Kaiser Permanente (basis for a question to come) on July 6th. She did not feel this was ALS or another MND but gave me a referral to a Neurologist. That night, an appointment opened up for the next day, July 7th. Dr. Jason Rosenberg, whom I believe to be just a general neurologist and not a specialist in MND/ALS but surely a qualified Neuro. He gave me the clinical exam and said he finds no signs of upper motor neuron issues/clinical weakness; but took note to say that I am still very muscular from football and if the weakness is early, he could miss it. He saw this was building my anxiety while being somewhat assuring all at the same time! He took notice of this in his notes (so I believe he was focused on me as a patient).

He got permission to squeeze me in on the schedule for an EMG/NCS for the next day; July 8th....I'm sure my anxiety levels won the lottery with getting these 3 appts. in consecutive days. I am attaching the report to this post and since I have had a hard time interrupting what these numbers on the NCS mean in plain English - please help me with any insight you can. This was done by Dr. JOSILANE MOURA MIRANDA.

She said the EMG is normal. She listed overall as Essentially Normal - - This definitely is a trigger with the word 'essentially'. The reason, as you will see on the report is that my EDB has less bulk. - causing mildly decreased amplitude but normal distal latency and normal conduction velocity. (Basis for a question to come) And through the month of August, I seem to have symptoms of Mortons Neuroma on the right foot and since its the same foot as the EDB, I'm still nervous but I have an appt. with a Podiatrist on 9/6. (any associated ALS symptom you can think of here?)

Earlier this month, I did additional bloodwork (all previous bloodwork showed my pcp no area of concern), but this time for B12 levels which was low 300s so I have started a liquid supplement 3 weeks ago or so. Not a lot of noticeable changes in the twitches (maybe slightly less overall in the calves but hard to say)

As you can imagine, I have experienced everything from constant twitching in one spot at peroneal nerve just below outside of right knee....(that even freaking hurt for a few days in a row) to phantom migrating numbness when I get up or start to walk somewhere to my brain playing tricks on me about dents in muscles, sure signs of new atrophy....anything to scare myself silly.

So! Through all this, I have tried to stay as calm as possible but its been difficult - the Read this first post really got me through a lot of nervous days and sleepless nights. I have indeed seen the doctors and gotten the tests and exams. All seems to point to no ALS or MND but.....

I have read on these forums about muscle twitches still being the first symptom, even with a clean EMG and clean neuro exam. Is this actually true and do I need to still worry and keep doing follow up EMGs?
What do you feel is more accurate relative to widespread muscle twitches; some information points to this meaning both ALS and non-ALS symptoms....I'm confused.??

What do you feel about the thinner (less bulk) EDB muscle on my right foot that created the decreased amplitude?? everything I seem to be able to find on this is that it definitely points to a MND issue and likely an ALS warning sign because of axonal involvement. please help with input here.

And finally, since this was all done at Kaiser Permanente, do you believe this to be a credible place to have all this important work done?? (I do not want to put anyone or any place in a bad light but I am asking your thoughts because I am more concerned about my health here....hopefully that's not a bad thing...)

Thank you again to anyone that can provide more or better information on my above questions/issues. I'm really trying to trust the doctors and the tests here......
God Bless to you all!
 

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I see absolutely no reason to worry about ALS. Nothing you are worried about is an actual red flag.

Stop reading. Resume living.
 
lgelb is absolutely correct, but I’ll expand on it just a bit more. Anxiety is very real and can overwhelm both your mind and body, and is often a major trigger for twitching. I’m sure you’ve read that twitching is extremely common, whether widespread or isolated, and essential nutrients such as B-12, magnesium, and others are but a few of the long list of benign causes. Also, body chemistry does not change overnight, so if it is the result of vitamin deficiencies supplements such as the one you are taking for B-12 or any other would take time.

Twitching caused by MND (which I’m very confident you do not have based on the info you provided), is a Lower Motor Neuron symptom and the EMG would have detected distinct abnormalities, along with a clinical exam showing clinical weakness. You had neither. The cases you might have come across in which someone is eventually diagnosed after initially receiving a clean EMG are almost always the result of UMN disease. This does not apply to you in the least.

You should do your best to believe your physicians and get on with life. Obsessing over words like “essentially“ because it likely showed an old injury, when the neurologist said the EMG was normal, is not doing you any good.
 
Thank you to you both for responding. I am genuinely trying take comfort that most of everything in my original post points away from ALS but I still have those posed questions (if anyone can address them) to finish off remaining, nagging thoughts and fears. I also apologize for the length of that original post, I didn't know it was that extensive but hopefully it was ok for the sake of being thorough enough in one post.

That being said; I forgot to mention 3 other symptoms and along with the original questions, can you shed light on if these raise the antenna or are nothing to worry about. Perhaps my previously attached EMG/NCS can assist with your opinions.
1. a few weeks ago, I noticed a new significant twitch on the outside of my right forearm just lower than my elbow (started after EMG)
2. a few weeks ago, I noticed that if I hold my hands straight out - palms up & eyes closed for 10 seconds, I don't make it that long before my left hand is shaking like crazy.......any worries here since my left arm was not tested on the EMG.
3. most worrisome of all is that when I lay down and especially while trying to sleep, after no more than 3 hours - I feel a vibration or spasm or fibrillation or something down the center of my torso and feel that vibration in my lower back and sometimes down to my calves.....I have no earthly idea what this is! It tends to go away after I'm sitting up or walking around for an hour. Either way, I can't sleep well so it's disturbed my sleep since April. I don't know if this is a heart chamber fibrillation (my cardiologist and nurse friend do not believe this to be true) or an excited nerve issue (man would I really have some questions) or perhaps an esophageal spasm (if so, I don't know if this is bad or not) or some other thing I no clue on.......

I would be grateful for any and all input on this things from my 2 posts. After I can address these remaining issues/questions; I am hopeful to put all this to bed. Thank you!
 
We don't diagnose on this forum. You've been told that your symptoms don't point to ALS, so asking supplemental questions about other issues you have, isn't appropriate given the nature of this forum. These questions need to be brought to your foctor. Lastly, please, you'll have to try to find solace through a friend, family member, or your community. Asking terminally ill folks or their caregivers, to provide comfort is not very appropriate either. The great news is, you really don't need to be on a forum such as this any longer.

I wish you luck in getting to the bottom of what is going on.

Take good care
 
I'll answer, and hopefully that gets you off here and back to your doctors and life.
1. no, twitching means nothing
2. shaking means nothing
3. vibrations mean nothing
Well they all mean something, but those are not what diagnose ALS. Go back and read the sticky post as we cover it all there.

All the best!
 
Thank you for the comments and I am still trying to remain calm. Today I had some blood drawn for CK test. I have the results at 326 U/L. Most of my searches on this value indicate there may be a problem. I found one medical journal from 2016 that believed typical lab levels should be raised not likely not pursued further unless a white male is over 504 UL.
Does anyone have any knowledge in this area and is this something to not be concerned with, worry about or just monitor for movement?

Thank you!
 
CK test does not diagnose ALS. Many PALS have normal levels, others have elevated.
You are not a doctor - stop researching as though you are going to be smarter than them.
 
Hello again. I have an EMG question. As you can notice by my attached EMG, it was done on both legs, right arm only, lower back and right cervical I believe. If I had signs of MND in my left arm, would this be something that is missed?

And please let me know opinions on this - whenever I use my left arm in an exercise; a full arm press outwards or upwards and a bicep curl or even just a hard flex....once I release the muscle engagement, my shoulder and bicep (as well at the end near the inside of my elbow) will start to twitch pretty strongly. Is this something to worry on, as in a sign for concern?

Thank you!
 
No, four limbs are rarely tested -- often, not even three. The signs of ALS can be seen in multiple areas tested, whether perceived as symptomatic or not.

Again, simple measures like sleep, nutrition and maybe supplemental electrolytes like K and Mg if you are not getting enough in diet (think OJ, hydration, bananas...tennis players eat bananas on changeovers for a reason...) or a drop or two of Mg lotion into "hot spots" may very much help effort-based twitching. Your primary care doc can discuss these with you as well.

You are good to go.
 
You are ignoring all the information we give you, searching for something 'new' to ask, and it is pressing too far.
If you have concerns, as said already, see your doctor.
We have nothing more to add as we have answered you and provided in depth resources.
I wish you the best.
 
Thank you so very much for your replies. Please know that I take them to heart. I am truly not "searching" for something new to ask, these things are just now noticed by me and since they are different and in a different area, I wanted to ask.
I'm familiar with effort-based shaking and such from a work load, just not vigorous twitching afterward - something very new. I also just pressed by pointer finger hard on a desk top and held it there and twitching began in the muscle area between that knuckle and the thumb knuckle. The twitching stopped when I ceased pressing hard. I feel as if something is really wrong with these type symptoms. I will have a follow up with my neurologist as you are saying.

Thank you all again.
 
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