Follow-up to my concern for Bulbar Onset post in Feb

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IdoneDeClare

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Since my post was locked, I wanted to come back simply to say..thank you for being candid and clear. Please always know that kindness is in honesty, not always in presentation.

I had a quivering tongue extended and at rest, and I DO have health anxiety. I googled (anyone worried about ALS or anything else? NEVER google. Dr. Google is not your friend. Ever. Omg)

I ended up having to wait until 4/3 for a neuro exam and the majority of the movement had ceased by then. My tongue, in my mouth and at rest, resembles every other tongue (not perfectly still, but slight movement/quiver that all tongues seem to have..yes..my family let me look in their mouths)
I had my visit, I had all reflexes tested, the neuro went "ALS symptoms don't go away, so I think we're good there. Also, you have migraines.. and probably carpal tunnel, come back we'll do an EMG on both hands and elbows"

Came back 5/5. EMG performed. No motor nerve damage, obvious sensory nerve damage completely in line with mild carpal and cubital tunnel.
THEN GUESS WHAT?! I went to an ortho spine doc (my back, she's a spicy disaster) and he went "hmmm" during a reflex check on my ankle. You can't say "hmmm" around someone with health anxiety. That's like waving a red cloak in front of an angry bull. "HMM?!" I said. "oh, you just have three beats of clonus in your right ankle. Normal is two or less. So it could be nothing..or it could be a neurological disorder. You're hyperreflexive a bit in your knee"
Guess what I did? Because I'm an idiot who cannot take her own advice? I googled. OMG CLONUS AND HYPERREFLEXIVE IS ALS! I FREAKING KNEW IT!
Per the Ortho, I should see a neuro. Instead, I sent a message to the neuro who had seen me all of a month prior and went "OMG!" and he, bless his heart, basically went, "...dumb. No. I did the reflex test. Yours are fine. Some people are hyperreflexive. Your strength tests are all normal, no muscle wasting, normal gait and no loss of sensation anywhere. It's not a neuro degenerative issue. You're fine"

...so my advice is? When the folks here are sometimes brusque, or seem like they're telling you to chill out and THINK for a moment? They mean it. They mean it from a place of kindness, and probably exasperation. They understand you're panicking, but they really do want to give you the assurance you're looking for even if you don't want to see it.

And if you're anything like me, you'll still panic a little and look at every little weird twinge as some "but they missed it!" moment. ("my head feels like it's shaky in the morning!" "Why do my toes feel prickly on my left foot if I sit too long!" "sometimes I fumble things if someone hands it to me!") and like me? You will have to be okay, even if you don't want to be. I even googled "can an EMG mistake ALS for Carpal Tunnel?" and that's the one time even Google was like "...girl, no. Stop it. Look at your life. Look at your choices."

I am working on it. I hope you can too <3

To the wonderful people of this forum who have gone through this journey as patients or caregivers, I cannot begin to imagine the strength it takes to spend the time ultimately trying to help other people see through their worst fears that have or are your reality. You have my sincerest gratitude and believe me when I say this with all the love I have..I truly hope to never have to have your help again!

I also want people to consider just how rare ALS really is, per reported statistics. Then if you, like me, happy to be a fat person? Consider the large scale studies that indicate how you have a further near 50% lower chance than the already low chance (in one NIH study, it showed an obese woman's chance as around .00006 to MAYBE .0007% of study participants in that cohort as obtaining a diagnosis)
Not saying it's IMPOSSIBLE? Just..it really is improbable

So sometimes..remember your math is important!
 
*sigh* Well..heck. I give myself good advice and all...

I suddenly have tons of muscle twitches in my left foot and calf, along with cramping in the calf. I had some twitches in my right side last night. I have had some feelable twinges in my tongue, but not general quivering or twitching. I have a test of my lower extremities scheduled for June 9, now..

And I am wondering. Is surface EMG accurate? They do surface emg and ncs at the same time at this office, and not needle emg. If it comes back okay as a surface emg, is it..okay to assume it's actually okay?

I admit, again, to health anxiety and this has been a not fun night and morning. I went from some pins and needles, to a twitch here and there, to lots of twitches over all of 5 days.

Man, I hate being crazy..but I also hate that something like these sensations can mean I may have a terminal diagnosis
 
Hello and sorry you find yourself back here and posting concerns. We do urge people to read the Read Before Posting thread and really take in what it says. It addresses all the common questions (even the "Is it too soon for EMG?"). If you have further questions about your own symptoms, please speak with your medical care providers. We can't really help you with returning worries about ALS when you have been cleared.

It sounds like you definitely have some awareness about your anxiety, so you do need to find someone qualified to help you with that. An ALS forum is likely quite unhealthy for you to keep returning to and can not help you with this aspect of your health and wellbeing.

Please take care.
 
In this instance, my question is more whether surface emg would be okay compared to needle emg in diagnosis.

I don't tend to disbelieve the doc once I have evidence in hand, I just.. Idk. This sudden onset of twitching all over my foot and calf is alarming.
 
So..i have fasciculations more in the left leg than the right, but I DO have them right sided. Foot (primarily the arch) and calf. Rarely above the knee.

My PT (bless her heart) did a strength snd reflex test and I am not hyperreflexive, which matches the neuro on 4/3. My left leg (raising myself into my tiptoes one leg at a time IS harder, than my right, but my knee and ankle on that side are injured. I CAN, it's just hard. Would that be considered clinical weakness?

My question is, absent clinical weakness, does ALS lead with sudden onset fasciculations of the feet/calves (and in my butt cheek a couple of times?)? These started a week ago, mostly went away for a day, then came back!

And yes.. I have an emg scheduled for my lower back causing leg pain anyway, and that's on 6/9. I can ask him about that.
 
Then please do that; your questions are for your doc. However, once you've had your EMG, please report back.
 
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Of course. I keep hoping this is somehow the result of an angry nerve, but I admit that the feeling of muscle twitches all over my legs and feet keeps stoking a terror that it am not going to be that lucky.

I don't know if muscle twitches that seem to only get started after I get up and move around (then they started at rest) would follow a pattern typical for als fasciculation, and that's why I was asking.
 
The answer is no. Twitching is very common, even when you can't identify a cause.
 
I appreciate that answer. This sudden onset of twitching mostly in my legs (I have had a one off in my arm, my side, my tongue again) has been..not great.

I am trying to remain hopeful that the EMG will come back fine, as I have no weakness or other issues. My mental illness means Ive catastrophized and assume it won't. The twitching will disappear for hours and I forget...then boom. Back it comes and I spiral.

Thank you all for your candor and kindness
 
I was going to ask if I could ast a stupid question, but then I realized I can better than nearly anyone.
Still twitching in calves/feet/backs of thighs.. now sometimes an arm here, or a thumb there. No weakness. No foot drop. No atrophy that I can tell.
Now y'all aren't mathemagicians, but this started 6 days after a clear upper extremity EMG/Nerve conduction study. Am I wrong for thinking the odds aren't SUPER high that I would have a clear EMG and then SIX DAYS later suddenly develop symptom onset?

And I won't lie, I have a question about swallowing issues. I have reflux and a sliding hiatal hernia (ugh). I ALSO have tons of postnasal drip. Now and then, if my food is especially dry, or tiny, it feels like a piece gets stuck on the very back of my tongue and I have to reach in and sort of peel it up off my tongue to get it to go down. Is THAT considered dysphagia in this instance?

Yes, I acknowledge I have health anxiety. My unusual presentation is that I am not hoping someone WILL diagnose me with an illness.. I don't beat down doors hoping to be proven right. I get checked to get physical evidence I am NOT struggling with said illness.
Is it possible to have elevated CPK and twitches and it not be ALS? I suppose anything is possible. My GP, who I love, said with the 12 days of leg twitching (which varies in intensity...sometimes it's super mild and happens once every five to 10 minutes..sometimes it lights up if I've done a lot of activity), that she wanted to do labs and it includes that one. My iron was checked, B12 was fine, but CPK takes 3-4 days to get back and I remember reading somewhere that just by the nature of being fat mine might be elevated..

This forum is not my therapist, no, and I don't want you to be. I don't need you to pat my hand and tell me I'm cool. I can't ask my neurologist because he's not great at answering messages (he's a neurologist..he's busy) so I guess I'm asking people who have gone through it themselves or with loved ones if these things sound similar or ...feasible?

Not for nothing, my most fervent prayer is to get a normal CPK and normal EMG on June 9 and then not have to bother you lovely and incredibly patient people ever again. I KNOW ALS is rare. I know being obese, the odds are even drastically lower.

So I guess it just occurred to me to ask if there is a real statistical likelihood that an EMG of upper extremeties would be clear and 6 days later lower extremity symptoms could start AND THEN start involving uppers two or three days later.

Absurdly emotionally fragile yet still hopefully yours,
Idone deClare
 
You are correct about the odds.

Lots of people get bits of food on the tongue or teeth. Drinking before and during eating can help.

Even if your CPK is abnormal, that isn't a red flag.

I think you know the answer to your last question -- that "real statistical likelihood" resembles the possibility that the sun will rise in the west tomorrow.

There are counselors that can really help with health anxiety. Please seek one out for the sake of your overall health. Hypervigilance can lead to a host of actual physical health problems like fragmented sleep and high blood pressure.
 
I appreciate the answer. I mostly have feelable muscle twitches in my feet and legs when lying down, so that sets me off at night.

I kept getting up on my toes and heels (despite a problematic left ankle, I'm not smart), so now my calves ache behind my knees and I want "oh no! Now muscle aches! Twitching and aches! The end!"

I am very much trying to hold to motor nerves being completely normal in the NCS/EMG in my arms on 5/5, and these twitches starting in my left foot then spreading to right foot/calves/thighs all of 8 or 9 days later making it VERY unlikely to be als. I cannot imagine normal arm tests and then suddenly having leg onset that quickly. ...especially since this comes with low back pain that started after having to bend backwards for an xray two days prior. The twitching is also sometimes in my thumb, my biceps...

Really it's all just twitching (well..and now calf pain...) And back pain. A logical brain could accept that this probably has something to do with my back..but not me.

I swear, you all deserve medals for dealing with all of us. If my emg comes back clear on the 9th, I'm donating to your forum to help keep it running just because..well..you all more than deserve it.

Continuing to keep my fingers crossed, despite crying emo 42 year old woman meltdowns about being gone by Christmas (yes really...)
 
When you're on the verge of a meltdown and you keep having twitching in your legs and feet and start wondering if maybe that's atrophy and start sobbing at random thibking that all the emg in 13 days will do is confirm your worst fear...and then wonder if the episodes of despair are pseudobulbar affect...

Jesus be a fence. 13 days until my EMG for all of this and I am an absolute mess of terror with each twitch I feel (and don't feel but see...) On the arches of my feet as I sit.

I have a cramp in the arches of my foot and the top of my calf behind my knee and they make me go "oh see..twitching and cramps. Def als"
 
I am sorry you are like this. Get help for your anxiety which is clearly out of control. Sadly we can not be your support system at this point. Let us know when you have results. Closing thread.
 
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