Could this be ALS?

[leifvaughan1]

Hi Pals,

I am truly thankful for the opportunity to present to you. I pray for each of you for comfort and support as you battle this terrible illness.

i am a 43 year old man. Let me preface my post by saying that I have GAD, Depression and Hypochondria (I have started taking Lexapro but the side effects are terrible). My PCP says I am fine, my neurologists says "he doesn't see ALS", etc. I have read the "Read before Posting" sticky and it gave me comfort. However, I would like to ask your forgiveness as I tell you about my symptoms.

I have kind of spiraled. In July 2022, I injured my prostate riding an exercise bike (having to get out of bed to pee every 10 minutes is it's own type of hell). Then a week later I acquired a moderate case of COVID (August 6 or so) and then while I was fighting that, I gave myself a stomach ulcer (diagnosed by doctor) from taking medications on an empty stomach (stupid). The stomach ulcer took forever to heal and I was getting very anxious about it taking so long. During this time, I basically lost 28 lbs in about 2 - 2.5 months. (238lbs to 212lbs)

Due to the fact that my ulcer wasn't healing and I was getting anxious, my doctor prescribed me 10 MG of Prozac. I took that for about 10 days (I stopped because it made me itch terribly and was advised to cease). I didn't taper or anything, I just stopped cold turkey. A couple days after stopping the Prozac (September 27 or so) I started getting muscle twitches (left tricep, quadriceps, feet, hands, butt, recently in my face, lips and cheeks and eye etc). Once I noticed these twitches, I made the cardinal sin of seeing Dr. Google and found out about ALS. I scared myself to death reading about this terrible disease. Basically, I immediately went to my doctor. He looked me over did a small neurologic exam (couple tests) and said I was fine. This didn't sit right with me as he had to youtube how to do a couple of the tests (ie: Babinski).

After that exam, I immediately called and was able to get in with a local neurologist who did a much more thorough exam on me. (results posted below). Needless to say, he said I had a bit of hyperreflexia due to anxiety and my left side was slightly weaker than my right which he said was because I am right arm dominant. But at the end, he said, "I don't see ALS" He offered me the opportunity to get an EMG but I refused (EMG scares the heck out of me). I do feel the slight weakness in my left side (perceived - because I can still do everything that I always could) plus my left arm is smaller than my right.

My concern is not the twitches in my legs, face, etc but the ones in my left tricep. They are not constant by any stretch of the imagination. Mainly, if I lift my arm a certain way like across my body (like a golf swing) I can see shaking and what looks like spasming/twitching in the tricep with some of the spasming located in the elbow tendon itself. My elbow twitches 2-3 times per minute but I don't always feel them. I do get the pins and needles sensation occasionally in my pinky and ring finger but not to often (maybe once or twice a week). Today I was checking my arm and bent my elbow a certain way and watched spasm's all the way down my arm that made my pinky finger move. Does this sound like a nerve problem more than ALS? I haven't seen one post of someone complaining about their elbow tendon twitching.

Additional Symptoms that I have experienced:

-I do notice a swallowing problem from time to time but it comes and goes. I think it is globus from anxiety as my tongue, uvula, everything else seems to be in order. My throat looks a bit inflamed and is a touch tight when trying to swallow
-My left shoulder feels tight when I lift it over my head and sometimes it feels odd in my elbow when I hold items and squeeze.
-My legs used to feel really tight but have since loosened up and I haven't had to stretch them in a couple weeks.
-My hand recently started twitching so much that it would move my thumb and index finger.
-I have developed a bit of a tremor in my arm and hands. My ring fingers tremors side to side. Weird
-I can see blood vessels in my left thumb all of a sudden and I don't know why..

I have had blood work, MRI's etc and everything is normal. My Creatnine was a touch low but my doctor says that could have been from losing weight so quick due to stomach ulcer. My AST - 18 and My ALT - 21. and Billurubin was 1.0 so no issues with my liver. My Kidney's are fine as well.

Anyways, I am done with my manifesto. see below for my neurological exam.

I went to the neurologist on October 25 and had a neurological exam. Here is a summary of my neurology report:
- alert oriented x 3
- Cranial nerves 2-12 intact
- Motor 5-5 intact x 4 normal tone
- sensory: no focal deficit
- CBLLR: no dystaxi and Finger to nose intact
- DTR's 1+ to 2 symmetric (this confuses me because the neurologist said that I had hyperreflexia due to anxiety in my patella I thought 1+ was low normal)
- plantar downgoing bilaterally.. (babinski - negative)

I realize I will get my wrist slapped for posting. Does any of what I described above sound like ALS?

 

[Bestfriends14]

Like all the doctors you've seen have said and what you've read here, no, not ALS.

I wish you well. Take good care

 

[leifvaughan1]

Thank you for the reply. My anxiety get's the best of me sometimes. So, a clean neurological exam is enough to rule out ALS?

 

[affected]

Yes a clean exam rules out ALS and other neurological issues.
I would suggest you talk to your PCP about what is next.

 

[lgelb]

Many neuros won't even score DTRs, so I would not sweat the numbers.

Starting and stopping an SSRI can certainly cause twitches. Now you are on a second SSRI and you don't like the side effects of that one, either, so maybe time to ask about another class of medication. There are plenty of options for anxiety. And sometimes the underlying problem is sleep, for which there are many non-drug [recommended] approaches to improving.

The fact that you had no motor deficit is the most important thing.

For next steps, I would consider new or better counseling for the GAD and hypochondria, which are already having a significant negative effect on your life. With counseling and perhaps a medication that you better tolerate, it is likely that the physical manifestations you perceive will wane over time.

Best,
Laurie

 

[leifvaughan1]

thank you all for the reply. It does give me hope that 99.9% of people with similar symptoms to mine are perfectly fine.

2 Questions:
Do UMN and LMN symptoms start together or does one usually come first?

If someone has upper extremity onset, will babinski be positive or negative? I would think negative but the spinal cord is all connected.

 

[Bestfriends14]

In your case, it's irrelevant. There's no need for you to try to have terminally ill folks further feed your fascination with a disease you don't have .

You don't have ALS, so your time here is no longer beneficial for you.

Best of luck to you.

 

[Clearwater AL]

Leifvaughan, this is simple, sentence in second paragraph of your first post...

" I have GAD, Depression and Hypochondria." There's the root diagnosis.

You are asking questions your doctors are paid to answer... you're coming here maybe as short cut.
That's not fair to this forum and the most direct and qualified answers must come from your doctors.

Nowhere in your neurological exams has ALS been indicated. Very ALS knowledgeable members
have told you that you do not have ALS.

I wish I could make a comment about you praying for us but... we try hard to keep religion out
of this forum. We see that opening sentence so often.

There's no reason to ask anymore questions, post new symptoms... until then.

 

[ShiftKicker]

leif-

It sounds like you've accessed as much of the info and resources of this forum as is available. It's time to return to your doctor to discuss next steps and find a way to move past ALS as a focus. I will be closing this thread. Please do not start another.

Take care