Questions about symptoms

[MichelleBea]

I had an EMG on just one side. The electric part was on all four limbs, but the needle part was on just one arm and leg. It was clean.

The new symptoms I have experienced for about a week and a half now, have been cramping in my right forearm and spasms that will come every once in awhile (about two or three every hour.) I also have a tight feeling in my hand and spasms in my hand, stiffness/discomfort in a few fingers, mostly my thumb and joint and muscle fatigue and twitching in shoulder/bicep area, all on the same arm. Also, just a shaky feeling in right arm when doing simple things and it gets tired easily.

I didn't have an EMG on right side yet.

I've gotten all levels from potassium, thyroid to calcium tested, etc. MRI's of head. Lots of bloodwork done and also a spinal tap. Everything was ok.

Does this sound more like early symptoms or something else? Thank you.

 

[Nikki J]

What were your original symptoms that led to the EMG etc?do you still have them? How long ago did they start and when were the tests? What did your physician say? How old are you?
We can answer better with more info though appreciate the brevity!

What you have so far said does not sound anything like my experience of ALS but obviously you have omitted quite a bit of history

 

[Dusty7]

So, all symptoms are in right arm?

What were the NCS results? Clean?

Blood tests, MRIs were all clean?

What makes you think this is ALS?

 

[MichelleBea]

Thank you for your response. I am 25 years old. They did the EMG, just out of precaution and that was done two weeks ago.

The original symptoms I had were in my right arm a little over two months ago, they just weren't as noticeable as now. I thought it might have just been from nerve irritation, due to all the blood work I had done along with a few IV's I had gotten in that arm. The MRI was done in March. The Spinal tap was done in May. The other blood tests I have had done, were done within the last month or so.

When I saw the neurologist, he said my strength was fine and my reflexes were normal. This was about a month ago and I won't be seeing him again for a few weeks, to go over new symptoms.

 

[MichelleBea]

Hi Dusty. Yes, right now all the symptoms I am experiencing are in the right arm, with the exception of a few twitches on both legs (about two or three everyday, so not very often). I believe that when I searched the symptoms I was feeling and found ALS, that is what brought me to the idea of it being just that. The NCS was clean and MRI was clean.

 

[Atsugi]

You might have any number of things, but ALS is not in the cards.
Clean EMG points to no ALS.
Cramping and spasms are the opposite of paralysis. Paralysis means limp and useless.
Tight feeling and stiffness are not indicative of ALS.
25 years old is way too young for ALS.
Strength is fine so you don’t have ALS.
Reflexes normal is good.
Twitches are so common they don’t diagnose anything.

 

[MichelleBea]

Thank you for your response Atsugi. One quick question, does it matter which side they do the EMG on? Like in my case, they did the left side and it was all good, but I am feeling this on my right and just days after my first EMG.

I have heard it doesn't matter where they do the EMG, I just wasn't sure. Thank you.

 

[Dusty7]

All symptoms in right arm sound more like a pinched nerve or muscle strain, which could resolve on its own.
A few twitches here and there are normal; most humans have those from time to time.
My first EMG was mostly left side--dirty.
They then did the right side--dirty in the same muscles.
Trust the EMG doc. They know what they are doing. Way more years of medical school than you and me... combined. If he had seen ANYTHING to be concerned about, he would have expanded the EMG or ordered a new one.

Nothing sounds like ALS. Congratulations! Go forth and be happy.

 

[MichelleBea]

Thank you Dusty. I appreciate your response.

 

[MichelleBea]

Hi again..I have one more question. Today I saw another neuro just to get another opinion with my new symptoms, he openly admitted he wasn't specialized in ALS, but he knew enough about it. When I asked about the constant twitches/weakness/fatigue I was having in mainly my right arm, some chest and shoulder area, he said stress would not be a cause and started going off about denervation, etc. I was kind of puzzled about this, since I had never heard that before from other neuros.

He conducted a strength test and checked my tongue and everything was fine.

When he did the reflexes, he was quick to say I had hyper reflexes on my legs, but that was normal for younger people. I was never told I had hyper reflexes by the other two neuros I saw (which one I saw just about a week ago). He wants to conduct an EMG on my right arm, just to see if there is any carpal tunnel, etc., even though I had told him I got one done just a few weeks before and the electric part was clean on right arm.

He then proceeded to say it was too early to know if I had ALS or not. I had another neuro told me, that with enough symptoms, you could get an EMG and it would tell you if you had it or not, which is why I had it done on left side.

I don't want to sound like I don't take what neuros say seriously, but even after my appointment today, I was left going..what the heck..?

Thanks for your time.

 

[Atsugi]

A man with two watches is never sure what time it is.

Michelle, as I read your latest post, I saw clearly in your new doctor a "starting over" attitude. Many (most?) specialists have it. They trust themselves so much to the exclusion of other doctors, that they ignore what others have found, and start over the whole process anew. Every neuro has spent their entire lives being smarter than the rest of the class.

I also saw in his response about "stress would not be a cause" that he was leaping out of his own specialty into psychiatry. There is a truism in medicine that you get the diagnosis you look for. If you see neuro doctors, your diagnosis will be neuro. This is why I use a really experienced PCP to help tell me which specialists I should see.

The gold standard test is the EMG. The nature of the disease is that a person has nerve damage long before you know it. That is, the EMG finds problems long before you have symptoms. Your nerves start being "dirty" sometimes a year before symptoms appear.

While I'm not a doctor, I have gotten opinions from several, and I've researched this matter a bit and come to the conclusion that a clean EMG means no ALS. As one ALS researcher put it, "I've never seen a case where a clean EMG later turned into ALS."

The fact that neither of the neuros you saw didn't tell you about your hyper reflexes is not unusual. Frankly, doctors (my wife was a doctor) look for a hundred things, and don't tell you hardly anything that they notice, unless you really need to know. They really don't want to give information to the patient that alarms them needlessly.

Then there's your age. The ALSA website says: "Most people who develop ALS are between the ages of 40 and 70, with an average age of 55 at the time of diagnosis. However, cases of the disease do occur in persons in their twenties and thirties. Generally though, ALS occurs in greater percentages as men and women grow older."

Given all your experiences as you've related them here, I'd say you have something, but it isn't ALS. I humbly refer you to re-read my post #6, above.

 

[MichelleBea]

Thank you Atsugi. That definitely makes me feel a bit calmer about this. Good information.

 

[Dusty7]

I agree with Mike totally. As to your neuro dismissing anxiety and saying it must be neuro... well, when you're a hammer everything looks like a nail.

 

[MaxEidswick]

>A man with two watches is never sure what time it is.

showing your age Mike, now all sync with internet ...