Symptom Advice- Could it be ALS?

[cw9613]

My symptoms started in February (well this is when I started to notice them). However, thinking back, I have had difficulty with tripping over my own feet and clumsiness for probably a year now. I work nightshift, I got off work one morning and as I was trying to sleep I noticed my left calf was twitching, I thought nothing of it, I had never experienced this before and attributed it to tired legs after a 12 hour shift. However, the twitching didn't stop. I saw my PCP a week later who ran routine blood work, all of which came back fine. Within two weeks the twitching had spread to both of my feet, my left thigh and my right bicep. I was referred to a neurophysiologist who saw me on April 3rd. He immediately dismissed my twitching for BFS or anxiety (he simply put that since I work in healthcare I probably have increased health anxiety). I have a follow up with him in October. I have truly tried to accept his clinical opinion but its hard to ignore many of my symptoms.

Since my appointment in April the twitching has spread. I still attributed this to BFS. However, in the last few weeks the fasciculations have greatly increased. They happen most frequently in my left calf, thigh and foot. The fasciculations in my right calf, thigh and foot are starting to become almost as frequent as my left. I still notice twitching in my biceps, hands, lips/face, ribs and buttocks. My left leg feels very heavy as I walk, very similar to the heaviness felt when I had a boot on my leg after breaking my foot. My left leg fatigues much quicker now than my right. Muscle stiffness has also increased, my calves feel tight, but my wrists, hands and fingers feel incredibly tight. In the last couple of weeks I have had a lot of pain and cramping. The cramping is worse in my calves and nothing seems to relieve it. Walking does make the cramping worse. The cramping is also noticed in my biceps (especially my left) and my wrists and hands. Alongside the cramping and stiffness I do notice a "burning" sensation or pain. In the last week or so I have noticed a hoarse voice (nasal and deep quality) with sore throat and neck that only occurs when I speak for more than a few minutes. I truly have never experienced this before and no matter what I do the hoarseness and neck tightness will not improve. I am constantly yawning, whether I am tired or not and feel like I am gasping for air at times.

All of this has been a whirlwind since February and I am genuinely just looking for answers and advice. I know ALS does not present the same in everyone.
Thank you!

 

[lgelb]

Have you seen your PCP lately? S/he can order a sleep study or PFTs if indicated.

We're not going to see ALS in this whirlwind preceded by a year of possible atypical clumsiness, though it understandably sounds troubling. I would be thinking about ruling out sleep disorders and sleep-disordered breathing, allergies, GERD, poor posture @ work, a mattress that needs replacing, poor nutrition/hydration, so many things.

Remember that if no one else notices any speech deficits, they aren't real.

And of course twitching uses a lot of energy and can be associated with tightness for that reason alone.

Best,
Laurie