Calf atrophy without weakness and so confused

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maseeee

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I’m sorry to bother anybody when I know how many threads there are. I have been so concerned for several weeks now and cannot get a neuro appointment for months. Several people pointed out my calf atrophy recently and I can’t get over it. I am 32 years old. It is 3 cm smaller and it definitely is smaller than it was in the past. The odd thing is I don’t truly feel much weakness, but when I flex my calves both sides of my right calf are obviously much smaller. I’m extremely scared although I have heard weakness has to come before atrophy. I live a very sedentary lifestyle. Is it possible I never noticed the weakness, or is it that the atrophy came first? I have had fasciculations in the past but I can’t remember the last time. I continue to try to do calf raises on the right in the hopes it will even out, but I think the muscle has just atrophied and won’t come back, making me even more afraid. I did read the important info before posting but even after reading and pondering for a week I’m just really in a bad place. The atrophy was determined to be real by a primary physician in the family but again I’m waiting for a neuro appt if it’s necessary. Im just confused with atrophy and no weakness, unless I’m catching it very early. Maybe the EMG is necessary. Attached a photo of the atrophy. I just can’t function right now.
 
Attached photo removed. If you read the sticky you know we don’t allow photos
 
I apologize for this error.
 
This can be anything and nothing. Go to a primary care doc who is NOT in your family.

Best,
Laurie
 
I thought I would update, as I am still getting more worried. I know a good emg will really help but the wait is unbearable.

Short story, I went to a bad neuro who had someone do a 20-min ncs and emg with 3 needle placements in my calf and ankle and say everything was normal, but the report also said my paraspinals were normal. I don’t see how that can be said with 3 needle placements in my lower leg, but maybe someone here will tell me I’m wrong.

However, I found a much better neuro. My calf atrophy was confirmed by him without clinical weakness, but he also noticed shoulder atrophy and slight weakness on the opposite side. I know my left pinch grasp has always been a little weaker, but he noticed the smaller thenar muscles on my hand and the weaker pinch (I basically do nothing with my left hand ever though). When I try to flex that shoulder though I almost can’t and I see the muscle sorta trying to do so. I tried to work out a little, which was possible, but now that shoulder hurts. Hoping that’s a good sign. I can lift a light weight above my head, but it’s difficult.

So far, my signs are right calf atrophy without weakness, left shoulder atrophy with weakness, and left thenar weakness (no atrophy noted just “smaller” and I think that’s been for a long time). But my latest symptoms have got me spiraling as I write this.

I can’t sleep due to constant twitches. I thought it was a sleep thing, but they also happen while driving or just during the day. It seems random, sometimes a toe, a shoulder, a knee, or a finger. And I noticed that everything I do seems to be so jerky, almost ataxic. I feel like my body won’t relax no matter how tired my mind is.

Then, today I stupidly decided to try to do my own knee reflexes with a reflex hammer. My left leg I kinda got it once or twice, and every time I hit my leg with the calf atrophy it shot out harder than it ever has, and I usually don’t have strong reflexes. I just tried again, and although still asymmetrical the right leg wasn’t as brisk.

These are too many symptoms to ignore, and I’m struggling to see what else this could be. I wish I could think of anything else this could be, and I wish I could sleep. A part of my body has jerked 5 times in the past 5 minutes.

I have an emg scheduled for 11/19 with the good neuro, and I just don’t think there is anything I can do until then. I’m starting to stumble over words but keep telling myself that’s just my anxiety and lack of a good night sleep. Guess I’ll update soon.
 
Two weeks ago, you couldn't get a neuro appointment for months; since, you've evidently had two?

What did the "good neuro" actually say was the reason for ordering a second EMG? What differential diagnoses were mentioned? Did he appreciate clinical weakness in any muscle past the L thenar?

As I am sure you know, the vast majority of people with clinical muscle atrophy, particularly those living a sedentary lifestyle, do not have ALS. And twitching is ridiculously common, often spurred by anxiety and body consciousness, both of which you seem to manifest.

It does sound like you could use a good night's sleep. Bet your PCP can help with that, along with some attention to stress, diet, stretching, etc. But when you engage in hyperbole, e.g., that you "can't sleep," you only fuel that. It's a vicious cycle.

Whereas you are "struggling to see what else this could be," what you describe is not typical of ALS onset, in which, for example atrophy and weakness present in the same muscles, onset is generally on one side, and neuronal damage is seen on EMG. Try to remember that every day till your 2nd EMG, and please for your own good, stay away from the reflex hammer and other self-testing. Start with the premise that you need more/better sleep to function better, and make that your project for the next couple of weeks.

I would also make sure you have been screened for sleep disorders -- and you can video your sleep and send your doc a clip of whatever looks dodgy from the breathing or excessive movement standpoints.

Best,
Laurie
 
I would strongly suggest you read the sticky and get a good feeling of just how many other things this is more likely to be.
You can't test your own reflexes I will note.
You've found a good neuro and you have tests booked, that's great. You don't have long to wait either now, so you can do yourself a favour by following some of the great suggestions above while you wait.
Do let us know the results of all the investigations.
Until we see evidence of ALS however, we can't see anything in your descriptions that would make us leap of a huge list of likely things to there.
 
I do appreciate the replies. As I am an MD (the research side), I do believe I have more knowledge than most in terms of my own body and being able to test several of my own reflexes. That being said, I also understand the health anxiety that I have and how my medical knowledge does not help the situation.

I also understand that I am not a neuro specialist, and I will be following the neuro’s recommendations. Since the neuro confirmed weakness and atrophy in my left deltoid and supraspinatus, that is the reason for his decision for a second EMG, coupled with the fact the first EMG report noted testing on muscles that were not performed.

Thank you @affected, and I will be back only with the report of the EMG.
 
You can't test your own reflexes reliably, even if you are a researcher.
Your thread says atrophy with no weakness.
Now you say confirmed weakness.
This really highlights why we just can't say much to anyone here except work with your doctor.
People come here and say all kinds of things, then change to something else and since we can't see you ...
Definitely let us know the EMG result and remember research with bias like you have for your own case is a dangerous thing.
All the best!
 
Well if you read my previous post, I clearly say “left shoulder atrophy with weakness.” The thread began with calf atrophy and that is without weakness. I don’t understand why I’m being told I have changed my symptoms. I definitely do not want to feel the way I do or try to fit my symptoms into a diagnosis. I won’t post until my EMG results.
 
OK, I do apologise that I missed that you now have some weakness in another area.
Really, as someone in the medical field, you might understand that gathering opinions from strangers based on you descriptions by test is not going to be anywhere near as reliable as working with your doctor. Especially when those strangers are either terminally ill, or trying to care for someone in that situation.
Let us know when you have something solid to show us for sure.
 
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