Two Neurologist Trips. Questions about experience

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ConcernedJ27

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Hello all,
I am a 29 year old male and I have been observing these forums and I don't want to make the mistake many people do and post in here without doing research and visiting neuro etc. I admire everyone who responds to these posts for their helpful nature and commitment to the community.

My symptoms started last June with severe RT Calf atrophy and weakness. Emg in Oct report:

"NCV Findings:
• All nerve conduction studies (as indicated in the following
tables) were within normal limits.
• All F Wave latencies were within normal limits.

EMG Findings:
• Needle evaluation of the Right Med Gastroc muscle showed Incr
Ins Act, 2+ Fibs, 2+ Psw, motor unit amplitude, motor unit
duration, and recruitment.
• The Right gluteus maximus musclesshowed motor unit amplitude,
motor unit duration, and recruitment.
• The Right gastroc muscle and the Right biceps femoris (long
head)showed Incr Ins Act, 1+ Fibs, 1+ Psw, motor unit amplitude,
motor unit duration, and recruitment.
• All remaining muscles (as indicated in the following table)
showed no evidence of electrical instability."

My neurologist (Nov visit) believes the crux of my symptoms are S1 nerve root irritation, shown as lumbar disk problem on MRI + clinical exam went well. I returned in 3 month, last friday (Feb), and again my clinical exam went well but not improvement in my Rt calf. He reported active disease is possible but he prefers incomplete reinnervation. A few other things I'm dealing with are constant diffuse muscle tremors. I'm not talking about a twitch. I mean it happens all day and keeps me up at night. Then problems in my hands. Notably the feeling of hand fatigue. My left hand now begins to tingle in thumb, palm, and fingertip (no pain ever), and intentional tremors in thenar muscles when bending my thumb. It looks like the muscles have signal interruption when I test the muscles and tremor. Generally, the strength feels okay.

I am not looking for a diagnosis. Just help. I know almost everyone in here has dealt with the anxiety of waiting and I'd like input on how to deal with it. Any thought on my above mentioned symptoms or mental health tips are very much welcomed.
 
Please clarify there should be modifiers for motor units amplitude duration and recruitment. Were they normal or what?

I also have no idea what you mean by it looks like muscles have signal interruption when you test them
 
Hi Nikki,
Thank you for your reply. I copied the EMG findings report from my doctor notes. I don't really understand them so instead I just took a screen shot of the chart, now attached below. They were abnormal results according to my neuro.

And as far as the signal interruption, I did a bad job describing. An example of the tremor is when I press my thumb into the side of my index finger, my thenar muscle starts jumping up and down. Almost like as if there was a spotty signal.
-Jordan
 

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Not sure if you read this one Jordan, it will answer your concerns

You cannot test yourself, and that example of a test you are doing and the result you are deciding is the result, proves it beyond a doubt.

To deal with the anxiety, see your doctor as this is a treatable condition.
Also can suggest: stop researching online, take up yoga, tai chi, meditation, start volunteering with people less fortunate, light exercise and take up cooking fresh foods, are all excellent strategies. You won't ever get this time back no matter the diagnosis, so make use of the time.
 
EMG shows symptoms of what could be many different conditions. Once they ID the abnormal results, it is time to start figuring out the cause. If this is radiculopathy, expect MRI w/Contrast to verify/identify where the cause is. L5/S1 is a very common source of lower extremity symptoms. Look up images on dermatomes for sensory nerves, and myotomes for motor nerves to ID what sections of the spine affect which parts of your body they affect.

They may suggest surgery to correct this.

Medscape has a fairly comprehensive section on ALS.
 
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