M 18, concerned about possible ALS.

[madhurpratap20]

Hello Everyone, I'm an 18 year old living in India. Back in September 2020, I developed tingling and intense pain in both hands and feet 2 days after sudden intense workout after months of no exercise, maybe pressing my elbows on the laptop daily for hours in lockdown along with poor diet made me prone to it also. The doctor I went to was a Bone expert but he said it's pretty common to get these conditions and you seem to have mildly damaged a lot of your nerves in all limbs so don't worry about it, it'll improve on its own. The intense pain and tingling improved about 10 days after the visit but I went to the doctor twice in the same month because I developed Anxiety and thought I had MS. He said it's just your anxiety mimicking that condition and the mild tingling you have and body heat sensations are just that and gave me anxiety meds which helped with symptoms.

Around the first week of October, I started noticing that my right hand started to appear slightly wasted and my left hand followed too. The right quadricep, the right calf and even the right glute started to get smaller which was strange because that was my dominant limb and it was always bigger than left, so I went to a Neurologist. He heard my story and then checked my reflexes with a Reflex Hammer which didn't reveal anything unusual, though he didn't say it clearly. I asked what he thought it was after I said I was concerned if this is ALS and he said he thinks this is because of poor nutrition. He asked me to get an EMG and NCV of all four limbs done which he explained to my father who had accompanied me to the doctor that this would ease my anxiety. So about 8 weeks after Pain and Tingling in Limbs (that had 80% resolved by that time) and 4 weeks after I noticed wasting, I had an extensive EMG and NCV (16 muscles tested in total, 8 on each side and the calves and quadriceps were tested) and everything came back CLEAN. The graphs etc. were attached with the report and there was no spontaneous activity at rest, normal MUAPs, normal nerve velocity etc.

his relieved me of anxiety and I returned to playing Badminton in second week of November and my game improved. I started my first year at University in November and joined a gym about 10 days ago and my strength and stamina has already noticeably improved there as well. However, yesterday I noticed that the gap between my thumb and index finger had noticeably increased and my muscle has shrunk. My thenar eminence appears to be flattened and small as well. To be clear, I had noticed their size changing in October only and EMG needle was inserted in both muscles and both came back clean. So, can it still be ALS? Or is it something else like a nutritional issue, Inclusion Body Miositis or just after effects of kinda severe carpal and cubital tunnel which laster around 6 weeks and I might have missed my muscle wastins then only.

To add, I haven't had any fasciculations for 2.5 months and don't have any weakness and am able to workout

 

[lgelb]

ALS, as you will have read, is extremely unlikely given the clean EMG even in symptomatic muscles, and in all muscles tested. You seem to be giving the idea of diet some credence, so I presume it could stand some improvement. What could it hurt? A more balanced exercise regimen such as you are undertaking might help as well. A dietician can help if you need another perspective. Stay away from supplements and protein powders and eat a variety of real, less processed foods.

You can't measure your health or body by your thumbs or hands, which wax and wane for several different reasons. Give yourself time to get things underway and if you really have functional issues (as opposed to appearance), you can always ask for a followup exam for comparison. Otherwise, enjoy your good health and what you are able to do, which PALS here would give a good deal to have.

Best,
Laurie

 

[madhurpratap20]

Thank you so much Laurie for finding the time to answer, I'll wait if any functional issues come up otherwise this is just my anxiety causing trouble again. Just one small thing I'd like to ask, could you or anyone tell some conditions people were diagnosed with on this forum, when their first EMG was clean but the next one was dirty (but not resembling ALS)?

Regards

 

[lgelb]

From a very small sample, that might be spine (disk) problems, though these are typically seen on the first EMG. I see no reason to believe that you will have a second, since the one you had was obviously very thorough.