Could this be ALS? 29 M

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NickP3

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Learn about ALS
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Syracuse
Hello,

My heart goes out to everybody affected by this disease.

I am a 29 year old male experiencing symptoms that I fear could be ALS. Here is a rough timeline:

12/2023 - I was an avid weight lifter. I began to feel tingling and weakness in my entire left arm, one night after leaving the gym. I was still able to move it, but it had a numb feeling and the grip strength felt weak. About 48 hours later, similar symptoms appear in my right hand/ arm. There’s also been some pain in my neck, upper back, and various spots in my arms and hands.

Roughly a week to 10 days after that, my legs went from having calf pain, to wobbly, to numbness/tingling, to some minor twitching. People I know are saying my walking hasn’t changed, but it feels imbalanced. However, I’m yet to fall, even catching myself as normal when I slip on black ice outside. There’s some minor twitching occurring in my arms also. These symptoms have persisted, and my hands aren’t working like they were before. However, I’m still able to walk/run and grab things, it just seems to be fine motor movements in hands that give me trouble. I also wake up every morning with numb/cold upper extremities.

I sought medical care in the ER. Had MRI/CT scans of my brain and spine, came back normal. Blood work was normal. I saw my PCP as I began to suspect ALS or I had an injury, they said I may have something called Thoracic Outlet Syndrome, and the PT I was prescribed to agreed. Blood pressure was tested in various positions of arm, BP dropped when arm was raised. Thoracic Outlet Syndrome is not common and is not well understood, but my PT firmly believes I have it, and she said to me directly once “you don’t have ALS”. However, PT doesn’t seem to be improving the symptoms (at least not to me). Worth noting my PCP said ALS was “not on his radar”.

1/2024 - I had an EMG Of both upper and lower extremities, done at an outpatient spine clinic. Both studies came back normal, and the Dr there said I had no evidence of Nueromuscular disease. She discussed with me the rarity of ALS, and that a 29 year old does not “fit the profile”.

I have an appointment with a vascular surgeon in March and with a neurologist on Feb 19. I don’t know what to expect at the neuro appointment.

Question is, does this sound anything like onset of ALS? I have been wondering this for weeks, but nobody I have seen so far seems to think so, despite these symptoms. Also worth noting I am being treated for anxiety as well. Currently taking SSRI.

Thank you very much!

-Nick
 
Most TOS responds to PT. Why not give it a chance? Often it takes a couple of months for PT to really reach full effect or to cause appreciable improvement. The compression didn't build up overnight and the treatment won't work that fast, either.

Typically surgery is not necessary with TOS.

If there is no improvement in 3 months, I would seek a second ortho opinion.

Even before you acknowledged the normal EMG, I saw no reason to think of ALS.
 
Thank you for the replies. I guess my biggest concern was the weakness, but that is a TOS symptom.

I will be giving that a chance and doing everything I can to get better. Thanks again.
 
Hello again,

Sorry to post again, but the symptoms are really concerning. Seems like my hands still aren’t back to “normal”. It’s like I can’t move them as smoothly and they aren’t as strong, and sometimes will tremor. My arms also seem to be weaker, particularly shoulders and biceps. I also have twitches in my arms and thighs, but they aren’t constant. I’m also having weird pains in all those same spots, along with inside my elbow.

I know EMG was normal, strength tests are 5/5 everywhere except my hands were “WFL”. I can’t tell if all of this is nerve related, or blood flow related or both.

I was also bit by a deer tick about 3 months ago, but I tested negative for Lyme.

Don’t mean to be a broken record, but the symptoms are constant and I feel like the doctors aren’t really engaging with me. Does any of this resemble early ALS at all?
 
It has been less than a week since you agreed that you should give PT a proper chance. My advice remains the same.

No, this does not sound like early ALS at all. If your docs are not engaging, send a portal message, await results, if none, find new docs.
 
Thanks again, I have been keeping up with my PT. It’s the weakness in the arms/hands and one leg that concerns me, especially since it came on so fast. What else could cause it? I’m so confused. Like I said I’m still able to do things it just doesn’t “feel right”.
 
I can’t stop researching my symptoms, I read a post on here and my symptoms were very similar to someone suspected with upper motor neuron symptoms. My balance isn’t right, it feels like I will tip over when walking and I keep getting altered sensation in my legs and feet, tingling I think? My neck and upper back are stiff, I have twitches, weakened grip in hands, arm sensation changes and weakness. Fatigue. EMG normal, Lyme negative. Cervical MRI negative. I don’t know what else this could be and it feels like it’s getting worse. It’s like I’m just waiting for the day I can’t grab anything or I will start falling frequently.
 
Re-read "EMG normal." If ALS were causing all this, it wouldn't be.

I would also check in with a good internist who can run labs to look at possible postviral syndromes and other systemic illnesses.

Waiting for a bad outcome that there's no evidence for is a pretty wasteful way to spend your time.
 
So is it safe to assume that a normal EMG in the hands, arms, legs and feet completely exclude ALS? even though it was weeks ago now?
 
Hey Nick, you keep asking whether you have signs of ALS in different ways and you keep getting the same answer- no. If you are not reassured by the answers and information you've received here, you'll have to go back to your doctor to ask them. My recommendation is to stop researching online, as you are not doing yourself any favours.

I will be closing this thread, please do not start another.
 
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