- Joined
- Oct 7, 2019
- Messages
- 4
- Reason
- Learn about ALS
- Diagnosis
- 00/0000
- Country
- US
- State
- NY
- City
- New York
Hi, everyone. First, I'd like to start by preemptively thanking everyone for reading this. I wish the best of luck to everyone with their individual battles.
I'm a 42-yo caucasian male and up until February 2019 I was an avid cyclist in great shape, riding 100+ miles / week. I have a family history of heart disease, but to my knowledge, no other conditions. I consume 1-2 cups coffee a day and have 1-2 alcoholic beverages per week.
My problems unfolded as follows:
In mid-February I started to experience back pain after a day of moderate yard work. My back pain was concentrated in my upper right buttocks. I didn't think much of it for a few weeks, but as it persisted, I went to see a physiatrist which whom I worked with on some back pain a few years prior. He suggested PT, which I undertook. Given the location of the pain, I suspected piriformis syndrome, and went about working it aggressively. One day I used a lacrosse ball on it and I think I aggravated my sciatic nerve, giving me pain down the back of my right leg. In late March, I had an MRI of the lumbar spine which showed that a "small disc bulge flattens the ventral thecal sac at L4-5" and that "facet arthropathy is evident." The Impression was "degenerative disease and spondylosis L4-L5 resulting in mild spinal canal foranimal stenosis". My physiatrist said this was all not alarming.
In early April, I had a cortisone shot in my right piriformis muscle from a sports doc. This did nothing to alleviate my pain. Around this time, I developed some numbness in my left foot. I was advised to monitor this foot numbness. I endured with this until early May, when my phsyiatrist suggested trying a diagnostic medial branch block in my lumbar spine to address the "arthritis." This also did nothing to relieve my pain. Following the medial branch block, as I pointed to the location of pain in my upper right buttocks, the phsyiatrist suggested an SI joint injection. Around mid-May, just prior to the SI joint injection, I suddenly experienced some numbness in my left shoulder and significant pain and stiffness in my forearms on both arms and in my thumbs. Physiatrist noted this was strange and proceeded with the SI joint injection, which actually relieved 80% of the pain in my buttocks.
Late May - As I was now having arm symptoms, I went to see a spinal neurosurgeon, who had me have a cervical spine MRI and an upper and lower extremity EMG. The cervical spine MRI was generally fine but showed "mild degenerative changes w minimal broad-based central protruding disc at C5-C6 and central and bi foranimal protruding disc at C6-7 without signifcant canal or foranimal impingement." The EMG, conducted by a neurologist, came back generally fine as well other than "superficial peroneal sensory response showed diminished amplitude bilaterally. Finding is of doubtful clinical significance." I also had a brain MRI, which came back clean. The doctors said they could find no cause of my symptoms and attributed it to my hyperawareness of my body.
In mid June, I finally got around to seeing my GP, who did bloodwork, including Lyme. She indicated all was normal. Then, literally the day after seeing her, I experienced an odd sensation and some numbness in my LEFT quadricep. I had the feeling that my knee would buckle while walking, but it never did. I messaged with the neurologist who said it was likely an unrelated strain injury (even though I was hardly riding at this point). I did go see a podiatrist for the left foot numbness, and he diagnosed a neuroma and gave me a cortisone shot. That seemed to allieviate that symptom. I managed with the rest of my symptoms for a few weeks, and then in early July, went for a bike ride. Following the bike ride I began to experience fasciculations in both of my calves. This was the first time I've ever experienced this. In the next weeks, I continued with all of my symptoms - intermittent but steady pain / sensations in my arms, numb left quad and twitching calves. My calves would also cramp - not to the point of extreme pain, but discomfort.
In late July, my quad numbness was improving somewhat, but I went to see a neuromuscular neurologist at one of NYC's top hospitals as I was worried about the calf fasciculations. At this point my arm symptoms were also improving. He did a clinical exam and said he didn't know what was causing my twitching, but it wasn't ALS. He also conducted a second EMG where he stuck my in my left calf, left quad and right arm. He said everything was fine. I should note that by this point, with my various undiagnosed symptoms, I was suffering from quite a bit of anxiety and doing a fair bit of internet research.
I got through late July / early August and ramped up my cycling. My quad seemed to be getting better. However, after going on a short run in early August, my quad numbness returned and was quite bad. I once again got progressively more concerned and scheduled an appointment with a peripheral neuropathy neurologist at another top NYC hospital. She conducted a clinical exam and concluded that there was no major neurological process. She did order an EMG to reassure me that ALS was not a concern. Upon conclusion of that EMG, should called and said no ALS, but evidence of lower back arthritis. The results of that EMG are attached. In the time since then, I felt reassured for a time, but my quad has not improved. Just the other day, I noticed that when standing I cannot seem to tense it up as I do the right quad. I note that when they did the EMG, the needle was in the center of the quad, and my pain / numbness seems to be on the interior portion. I also just received the write-up of the EMG and I note that it refers to "Left gastrocnemius shows fasciculations, long duration MUAPs and reduced recruitment on submaximal effort." The conclusion was" Abnormal study. There is electrophysiological evidence of a chronic lumbosacral radiculopathy possible affecting from L4-S1 with no active denervation. There is no eletrophysiological evidence of lower motor neuron disease, conduction block, demyelination, large fiber neuropathy, right cervical radiculopathy or mononeuropathy of the right arm or left leg."
I have read all of the great advice on this form about EMGs and BFS. I still remain anxious. My question is, given this history and the latest EMG findings, is there in your opinion any chance of ALS? Should I be concerned the EMG showed the fascicultions? Could they have stuck the needle in the wrong part of my quad?
I finally wanted to note that I've been seeing a psychiatrist (for the first time in my life) about anxiety and potential somatic disorder. He doesn't think I display elements of this. Please let me know your thoughts.
I'm a 42-yo caucasian male and up until February 2019 I was an avid cyclist in great shape, riding 100+ miles / week. I have a family history of heart disease, but to my knowledge, no other conditions. I consume 1-2 cups coffee a day and have 1-2 alcoholic beverages per week.
My problems unfolded as follows:
In mid-February I started to experience back pain after a day of moderate yard work. My back pain was concentrated in my upper right buttocks. I didn't think much of it for a few weeks, but as it persisted, I went to see a physiatrist which whom I worked with on some back pain a few years prior. He suggested PT, which I undertook. Given the location of the pain, I suspected piriformis syndrome, and went about working it aggressively. One day I used a lacrosse ball on it and I think I aggravated my sciatic nerve, giving me pain down the back of my right leg. In late March, I had an MRI of the lumbar spine which showed that a "small disc bulge flattens the ventral thecal sac at L4-5" and that "facet arthropathy is evident." The Impression was "degenerative disease and spondylosis L4-L5 resulting in mild spinal canal foranimal stenosis". My physiatrist said this was all not alarming.
In early April, I had a cortisone shot in my right piriformis muscle from a sports doc. This did nothing to alleviate my pain. Around this time, I developed some numbness in my left foot. I was advised to monitor this foot numbness. I endured with this until early May, when my phsyiatrist suggested trying a diagnostic medial branch block in my lumbar spine to address the "arthritis." This also did nothing to relieve my pain. Following the medial branch block, as I pointed to the location of pain in my upper right buttocks, the phsyiatrist suggested an SI joint injection. Around mid-May, just prior to the SI joint injection, I suddenly experienced some numbness in my left shoulder and significant pain and stiffness in my forearms on both arms and in my thumbs. Physiatrist noted this was strange and proceeded with the SI joint injection, which actually relieved 80% of the pain in my buttocks.
Late May - As I was now having arm symptoms, I went to see a spinal neurosurgeon, who had me have a cervical spine MRI and an upper and lower extremity EMG. The cervical spine MRI was generally fine but showed "mild degenerative changes w minimal broad-based central protruding disc at C5-C6 and central and bi foranimal protruding disc at C6-7 without signifcant canal or foranimal impingement." The EMG, conducted by a neurologist, came back generally fine as well other than "superficial peroneal sensory response showed diminished amplitude bilaterally. Finding is of doubtful clinical significance." I also had a brain MRI, which came back clean. The doctors said they could find no cause of my symptoms and attributed it to my hyperawareness of my body.
In mid June, I finally got around to seeing my GP, who did bloodwork, including Lyme. She indicated all was normal. Then, literally the day after seeing her, I experienced an odd sensation and some numbness in my LEFT quadricep. I had the feeling that my knee would buckle while walking, but it never did. I messaged with the neurologist who said it was likely an unrelated strain injury (even though I was hardly riding at this point). I did go see a podiatrist for the left foot numbness, and he diagnosed a neuroma and gave me a cortisone shot. That seemed to allieviate that symptom. I managed with the rest of my symptoms for a few weeks, and then in early July, went for a bike ride. Following the bike ride I began to experience fasciculations in both of my calves. This was the first time I've ever experienced this. In the next weeks, I continued with all of my symptoms - intermittent but steady pain / sensations in my arms, numb left quad and twitching calves. My calves would also cramp - not to the point of extreme pain, but discomfort.
In late July, my quad numbness was improving somewhat, but I went to see a neuromuscular neurologist at one of NYC's top hospitals as I was worried about the calf fasciculations. At this point my arm symptoms were also improving. He did a clinical exam and said he didn't know what was causing my twitching, but it wasn't ALS. He also conducted a second EMG where he stuck my in my left calf, left quad and right arm. He said everything was fine. I should note that by this point, with my various undiagnosed symptoms, I was suffering from quite a bit of anxiety and doing a fair bit of internet research.
I got through late July / early August and ramped up my cycling. My quad seemed to be getting better. However, after going on a short run in early August, my quad numbness returned and was quite bad. I once again got progressively more concerned and scheduled an appointment with a peripheral neuropathy neurologist at another top NYC hospital. She conducted a clinical exam and concluded that there was no major neurological process. She did order an EMG to reassure me that ALS was not a concern. Upon conclusion of that EMG, should called and said no ALS, but evidence of lower back arthritis. The results of that EMG are attached. In the time since then, I felt reassured for a time, but my quad has not improved. Just the other day, I noticed that when standing I cannot seem to tense it up as I do the right quad. I note that when they did the EMG, the needle was in the center of the quad, and my pain / numbness seems to be on the interior portion. I also just received the write-up of the EMG and I note that it refers to "Left gastrocnemius shows fasciculations, long duration MUAPs and reduced recruitment on submaximal effort." The conclusion was" Abnormal study. There is electrophysiological evidence of a chronic lumbosacral radiculopathy possible affecting from L4-S1 with no active denervation. There is no eletrophysiological evidence of lower motor neuron disease, conduction block, demyelination, large fiber neuropathy, right cervical radiculopathy or mononeuropathy of the right arm or left leg."
I have read all of the great advice on this form about EMGs and BFS. I still remain anxious. My question is, given this history and the latest EMG findings, is there in your opinion any chance of ALS? Should I be concerned the EMG showed the fascicultions? Could they have stuck the needle in the wrong part of my quad?
I finally wanted to note that I've been seeing a psychiatrist (for the first time in my life) about anxiety and potential somatic disorder. He doesn't think I display elements of this. Please let me know your thoughts.
