nickston
New member
- Joined
- Nov 21, 2011
- Messages
- 4
- Reason
- Learn about ALS
- Country
- US
- State
- Texas
- City
- Somewhere
Sigh. Never thought I would freak out and post on here, but my anxiety is sky-high and I need some clarity. I'll try to keep it as short as possible.
About February 2010 I went through probably the most stressful period of my life. Shortly thereafter I began having a lot of symptoms ... twitching everywhere, muscle soreness, exercise intolerance/muscle burning upon the slightest activity, sore/popping/snapping joints, muscle pain, jolts, tremor, etc. I made my first trip to my neurologist. This guy is Columbia/Johns Hopkins educated and is an ALS specialist, so that's good. Anyway, he did a clinical exam and said muscle strength was 100% OK. He ordered an EMG. He discussed the results with me and said I possibly have a pinched nerve in my spine (which is also what the doc doing the EMG said), but that none of my findings were consistent with ALS. I never got a copy of that EMG study; just took his word for it. The EMG was done in June 2010.
For the next year and a half, my symptoms greatly subsided. I almost forgot about the twitches - I wouldn't get them for days, or if I did, maybe just one or two a day. The jolts and tremors were gone. I could exercise a lot - ride my bike for hours, etc., no problem. Maybe only a slight muscle burn/intolerance, but generally the symptoms were MUCH improved.
Fast forward to the past few weeks, and all my symptoms have come rushing back. I won't list them because they're the same as before (see above). So in my anxiety mode I ran over to the neurologist's office to get a copy of my records from last year to see if my EMG really was clean. It was not, or at least I don't think it was. Here's the language that I think is important:
--"His EMG and nerve conduction studies showed that motor nerve conductions of the tested nerves were normal and sensory nerve conductions were also normal."
--"The EMG examination showed that he had positive sharp waves in lumbar paraspinals at the lower level. This is just at a single level. Otherwise there was no spontaneous activity seen by needle examination. Slight chronic denervation and reinnervation changes were reported to be seen in tibialis anterior [shins], vastus lateralis [outer thigh], and gastrocnemius [calves] muscles. Similary, there were few polyphasic potentials that were seen in biceps brachii, triceps brachii, and deltoid on the left side. He did not have myopathic units and this study was reported to be compatible with possible cervical and radicular disease."
--"His blood work was unremarkable except for CK which was elevated to 265."
--"His motor testing importantly was normal in the cranial nerve distribution, neck flexion and extension, and in both upper and lower extremities."
--"His deep tendon reflexes were brisk but nonpathologic."
ASSESSMENT:
"The patient has complaints of muscle pain and soreness and possibly decreased exercise endurance whose nerve conductions and EMGs have not shown any myopathic features but mild chronic neurogenic changes in some upper and lower extremity muscles. He has mildly elevated CK but despite the symptomatology and the lab findings his muscle strength is completely normal. He has asked me about the possibility of ALS and I have told him that given his clinical features most notable of which are normal muscle strength and lack of definite upper motor neuron signs would not favor this diagnosis. There are no confirmatory tests for this condition. I have reassured him and told him that patients with ALS or motor neuron disease typically start with muscle weakness and in his case we do not detect any muscle weakness at this point and he has had the symptoms of muscle soreness for over a year [I don't recall saying that...?]. I have rec ommended an MRI of the cervical spine to evaluate for spondylitic changes because chronic changes were seen in cervical myotomes [the muscles connected to the cervical nerves] by EMG examination. I have told him to follow up in 3-6 months bec ause I would like to monitor his symptoms and clinical examination. Muscle biopsy remains a consideration."
Could ALL of the "bad stuff" - denervation/reinnervation, polyphasic potentials, and positive sharp waves be caused by compressed nerves? Help. Thank you.
About February 2010 I went through probably the most stressful period of my life. Shortly thereafter I began having a lot of symptoms ... twitching everywhere, muscle soreness, exercise intolerance/muscle burning upon the slightest activity, sore/popping/snapping joints, muscle pain, jolts, tremor, etc. I made my first trip to my neurologist. This guy is Columbia/Johns Hopkins educated and is an ALS specialist, so that's good. Anyway, he did a clinical exam and said muscle strength was 100% OK. He ordered an EMG. He discussed the results with me and said I possibly have a pinched nerve in my spine (which is also what the doc doing the EMG said), but that none of my findings were consistent with ALS. I never got a copy of that EMG study; just took his word for it. The EMG was done in June 2010.
For the next year and a half, my symptoms greatly subsided. I almost forgot about the twitches - I wouldn't get them for days, or if I did, maybe just one or two a day. The jolts and tremors were gone. I could exercise a lot - ride my bike for hours, etc., no problem. Maybe only a slight muscle burn/intolerance, but generally the symptoms were MUCH improved.
Fast forward to the past few weeks, and all my symptoms have come rushing back. I won't list them because they're the same as before (see above). So in my anxiety mode I ran over to the neurologist's office to get a copy of my records from last year to see if my EMG really was clean. It was not, or at least I don't think it was. Here's the language that I think is important:
--"His EMG and nerve conduction studies showed that motor nerve conductions of the tested nerves were normal and sensory nerve conductions were also normal."
--"The EMG examination showed that he had positive sharp waves in lumbar paraspinals at the lower level. This is just at a single level. Otherwise there was no spontaneous activity seen by needle examination. Slight chronic denervation and reinnervation changes were reported to be seen in tibialis anterior [shins], vastus lateralis [outer thigh], and gastrocnemius [calves] muscles. Similary, there were few polyphasic potentials that were seen in biceps brachii, triceps brachii, and deltoid on the left side. He did not have myopathic units and this study was reported to be compatible with possible cervical and radicular disease."
--"His blood work was unremarkable except for CK which was elevated to 265."
--"His motor testing importantly was normal in the cranial nerve distribution, neck flexion and extension, and in both upper and lower extremities."
--"His deep tendon reflexes were brisk but nonpathologic."
ASSESSMENT:
"The patient has complaints of muscle pain and soreness and possibly decreased exercise endurance whose nerve conductions and EMGs have not shown any myopathic features but mild chronic neurogenic changes in some upper and lower extremity muscles. He has mildly elevated CK but despite the symptomatology and the lab findings his muscle strength is completely normal. He has asked me about the possibility of ALS and I have told him that given his clinical features most notable of which are normal muscle strength and lack of definite upper motor neuron signs would not favor this diagnosis. There are no confirmatory tests for this condition. I have reassured him and told him that patients with ALS or motor neuron disease typically start with muscle weakness and in his case we do not detect any muscle weakness at this point and he has had the symptoms of muscle soreness for over a year [I don't recall saying that...?]. I have rec ommended an MRI of the cervical spine to evaluate for spondylitic changes because chronic changes were seen in cervical myotomes [the muscles connected to the cervical nerves] by EMG examination. I have told him to follow up in 3-6 months bec ause I would like to monitor his symptoms and clinical examination. Muscle biopsy remains a consideration."
Could ALL of the "bad stuff" - denervation/reinnervation, polyphasic potentials, and positive sharp waves be caused by compressed nerves? Help. Thank you.
