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DoctorR2D2

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Hi! First of all I'd like to thank you all for accepting me, and also I'd like to acknowledge all of you as true warriors. Helping others while you're getting through all the stuff you have to live, is truly remarkable. May God bless all of you.

I hope you could help me out.
I'm a 25 y.o. male dental surgeon from Mexico. About 2 months ago I had some health issues that turned out to be a pretty big herniated disk in my lumbar spine (Specifically on L5-S1 vertebrae). Because of the size, I was adviced by my surgeon to get surgery. All good, no problems. "Just get lots of rest until surgery and everything will come up nice" I belived it since I GOT NO PAIN INVOLVED.

So I did it. Also I got an EMG about a month ago, requested by my surgeon as a routine.
The EMG said "Abnormal EMG that indicates left S1 radiculopathy"
*Note: I'll provide you the study below, I translated since it's in spanish (N = Normal; the "+" I don't know what it stands for but I was told it wasn't normal)
**Note: You'll notice the Dr left a blank space in the "nerve conduction" on the anterior tibialis muscle, that concerns me! (He couldn't pick my motor nerve conduction, did it died?)
**NOTE: The study was NOT done by a neuro or neurophysiologist, but by a physiatrist (specialist in physical and rehabilitation medicine)

At this point you all should be thinking: "this is a waste of time, what does it have to do with ALS?!"
But wait. This was only to give some background

About 3 weeks I experienced fasciculations on my left shoulder, wich was very, very unusual. At first I thought it was nothing. Then I started to experience increasing fasciculations on my left thigh (the supposedly affected one), left calf, BUT ALSO on the right tight and calf, both upper limbs and also on the back (although not as persistent and numerous as in the lower limbs). It doesn't stop!
They've began to feel a whole lot more and in greater numbers, but also I got pretty fine fasciculations that can only be visible if I or a relative stare at it with detail, cause I don't feel them, or I don't feel them quite as notoriously as the big ones (This scares me A LOT, since I've read from patients experience that they suffered from very fine twitches) Also about a week or so my right (supposedly "good one") began to feel so so weak, I knew that the "bad one" was a little bit weak, even my surgeon said it to me (he performed neuro examination on my legs and feet when he discovered the slipped disk, I wasn't even aware of suck weakness in contrast to the opposing limb), but my other one also? It feels so weak and there's a feeling that something ain't right. I feel like I'm about to lost balance and it happens quite often. When I get on my knees, my thighs feel so weak they start to tremble. Ironically my "good leg" is now much weaker than the one with the radiculopathy, when I got down the stairs it feels so weak, that it's about to give up and I'm gonna fall. My right hand also feels so so weak and clumsy.

Also: I don't have any tongue fasc. but I do notice that my voice isn't quite as normal. I feel so quiet and also like hoarsiness( I have to clear up my voice A LOT) And a very strange symptom: my left masseter muscle feels so stiff, it doesn't fasciculate but it's increadibly akward and it has began to bother me while eating.

As a healthcare profesional I'm aware of some ALS symptoms, so the persistent fasciculations (specially the fine ones) + weakness + voice issues = SCARED TO DEATH

My surgery is next week, and I got an anxiety attack after reading a case report of a patient that had an herniated disk but ALSO UNDIAGNOSED ALS!!!, so he went under surgery, and the surgery and anesthesia (the doctors in the article think) made the ALS progress unexpectedly fast!!! The article was even made TO CREATE AWARENESS THAT HERNIATED DISKS AND ALS COULD CO-EXIST. I literally cried with my mother because I have read this.

I can't have a neuro appointment, since I'm scheduled for surgery in 5 DAYS!

-Does this sound like ALS to you?
-Is that EMG helpful since they were looking for radiculopathy and not upper motor neurone disease?
-Is that EMG helpful since it was performed by the physiatrist and NOT a neuro?
-Is that EMG helpful or was it too early (more than a month since it was performed and the onset of symptoms)?

I'm thankful in advance.

I'm sorry for the poor quality of the EMG photo, you may have to zoom in a little, I'm so sorry :sad:
 

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KarenNWendyn

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Fasciculations all over the body and feelings of weakness in so many regions in a short period of time does not sound like ALS.

I’m assuming you had a MRI of your spine that confirmed the disc herniation? If it’s a big disc, it can sometimes cause problems in both legs and at more than one spinal level.

Your EMG and nerve conduction results are consistent with nerve root compression from the disc.

Stress about the situation and upcoming surgery can trigger fasciculations elsewhere.

I don’t see enough here to worry about ALS.
 

DoctorR2D2

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Hi Karen, thanks for your quick response.
Yes, I had a lumbar spine MRI, that's when I got diagnosed with the disc. But the herniation is headed towards the left side, not central or right.
In the neuroradiologist report it even says "Disc extrusion towards the left side"

My biggest concern is the EMG, cause as I've mentioned it was requested looking for the radiculopathy not looking for upper motor neuron disease, also it was done not by a neuro.
But I don't know for ex. when I ask a patient for an x-ray, maybe I was looking for an infection and when I look at it, I encounter an unrelated tumor that's asymptomatic. Does anyone know if this apply for EMG? would ALS showed up in that EMG?

I'm pretty scared because of the disc herniation + ALS thing, I thought it wasn't possible, and I'm maybe being undiagnosed.
 

Nikki J

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Like your example of an incidental finding on a xray a person doing an emg for one indication would still see another pathology if it were there. The technique is the same and they see ( or hear) whatever is there.
 

DoctorR2D2

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Thank you, Nikki.

I see. Just another question, (hoping it's not bothersome) the muscles evaluated as noted above were: anterior tibialis, first toe extensor, twin muscle (gastrocnemious), and lumbar para vertebral. Are this muscles the ones to evaluate lowers limb? My weakness on the right leg is mostly on the thigh, not the calf.
But if my anatomy is still sharp, all those muscles are on the calf. So I don't know...besides the twitching and weakness started later

Thank you in advance. Bless you.
 

lgelb

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An EMG would not be "too early" for later weakness, since much visible-to-EMG destruction has been done by the time weakness shows up. Similarly, the EMG hallmark is showing motor neuron destruction in muscles that are asymptomatic.

Best,
Laurie
 

DoctorR2D2

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Thank you Laurie
I indeed have read that, but I wasn't very sure if that would apply to my case, since this EMG wasn't requested looking for ALS, but rather the radiculopathy, hence the whole purpose of this post; the posibility of an early UMND beign misdiagnosed as radiculopathy.

But I guess that UMND would have a different pattern on the EMG? I don't know :(

All the best to you too. Blessings.
 

lgelb

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Sorry, I thought Nikki had answered your question. The EMG is indeed read like a film -- any abnormalities are flagged and any clear or potential pathological pattern is identified.

In short, the indication for the test doesn't matter.
 

Bestfriends14

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Hi there,

From what you described as symptoms, they are not the symptoms of someone with ALS. UMN or LMN signs have not been evident in your exams, but what has been are the issues outlined in the summary of your EMG report along with clinical findings. Going back and forth with members on this forum can create anxiety as opposed to helping get rid of it. You should be happy that you do not have such a debilitating disease as ALS, thank the members who have already answered your questions, and move on with what is a healthy life. This is a blessing that I hope you can grateful for.

Good luck to you and take good care.
 

DoctorR2D2

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Thanks a lot, both of you. I agree @Bestfriendstilltheend, and I'm truly grateful for those things.
I'm grateful for your patience and time.

My prayers are with all you people. I'll be donating to the forum and ALS organization as fast as I'm out of the hospital.
 

Lkaibel

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Similarly, the EMG hallmark is showing motor neuron destruction in muscles that are asymptomatic.
Laurie
I never quote, but this is just too accurate not to do just that. My husband’s asymptomatic torso was off the chart for chronic and active denervation and short wave abnormalities. He had more EMG findings in his asymptomatic pectorals than in his symptomatic left leg.

ALS is like this thing you can smell sometimes. Not smelling it in your story at all.
 

DoctorR2D2

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Thanks for taking time in reading my story, Lenore.
I'm so sorry about your husband.

Since you can read that the all my left muscles have "positive waves" and one has "fibrilations", it concerned me since I read a lot here and there, about being a pretty bad sign for ALS.

I hope your smelling is not wrong with my case.

My best wishes to you and all your beloved ones.
 
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