Seeking Clarity After Stressful Period

StoneLeopard

Well-known member
Sigh. Never thought I would freak out and post on here, but my anxiety is sky-high and I want some clarity. I'll try to keep it as short as possible.About February 2010 I went through probably the most stressful period of my life. Shortly thereafter I began having a lot of symptoms ... twitching everywhere, muscle soreness, exercise intolerance/muscle burning upon the slightest activity, sore/popping/snapping joints, muscle pain, jolts, tremor, etc. I made my first trip to my neurologist. This guy is Columbia/Johns Hopkins educated and is an ALS specialist, so that's good. Anyway, he did a clinical exam and said muscle strength was 100% OK. He ordered an EMG. He discussed the results with me and said I possibly have a pinched nerve in my spine (which is also what the doc doing the EMG said), but that none of my findings were consistent with ALS. I never got a copy of that EMG study; just took his word for it. The EMG was done in June 2010.For the next year and a half, my symptoms greatly subsided. I almost forgot about the twitches - I wouldn't get them for days, or if I did, maybe just one or two a day. The jolts and tremors were gone. I could exercise a lot - ride my bike for hours, etc., no problem. Maybe only a slight muscle burn/intolerance, but generally the symptoms were MUCH improved.Fast forward to the past few weeks, and all my symptoms have come rushing back. I won't list them because they're the same as before (see above). So in my anxiety mode I ran over to the neurologist's office to get a copy of my records from last year to see if my EMG really was clean. It was not, or at least I don't think it was. Here's the language that I think is important:--"His EMG and nerve conduction studies showed that motor nerve conductions of the tested nerves were normal and sensory nerve conductions were also normal."--"The EMG examination showed that he had positive sharp waves in lumbar paraspinals at the lower level. This is just at a single level. Otherwise there was no spontaneous activity seen by needle examination. Slight chronic denervation and reinnervation changes were reported to be seen in tibialis anterior [shins], vastus lateralis [outer thigh], and gastrocnemius [calves] muscles. Similary, there were few polyphasic potentials that were seen in biceps brachii, triceps brachii, and deltoid on the left side. He did not have myopathic units and this study was reported to be compatible with possible cervical and radicular disease."--"His blood work was unremarkable except for CK which was elevated to 265."--"His motor testing importantly was normal in the cranial nerve distribution, neck flexion and extension, and in both upper and lower extremities."--"His deep tendon reflexes were brisk but nonpathologic."ASSESSMENT:"The patient has complaints of muscle pain and soreness and possibly decreased exercise endurance whose nerve conductions and EMGs have not shown any myopathic features but mild chronic neurogenic changes in some upper and lower extremity muscles. He has mildly elevated CK but despite the symptomatology and the lab findings his muscle strength is completely normal. He has asked me about the possibility of ALS and I have told him that given his clinical features most notable of which are normal muscle strength and lack of definite upper motor neuron signs would not favor this diagnosis. There are no confirmatory tests for this condition. I have reassured him and told him that patients with ALS or motor neuron disease typically start with muscle weakness and in his case we do not detect any muscle weakness at this point and he has had the symptoms of muscle soreness for over a year [I don't recall saying that...?]. I have rec ommended an MRI of the cervical spine to evaluate for spondylitic changes because chronic changes were seen in cervical myotomes [the muscles connected to the cervical nerves] by EMG examination. I have told him to follow up in 3-6 months bec ause I would like to monitor his symptoms and clinical examination. Muscle biopsy remains a consideration."Could ALL of the "bad stuff" - denervation/reinnervation, polyphasic potentials, and positive sharp waves be caused by compressed nerves?????? Help.
 
Nickston,Based on what you've said, it doesn't sound like you've developed weakness or UMN signs. Is this correct? If so, then it doesn't sound like there's any reason to be worried. After 1.5 years, if this were pathological, it would have done some serious damage by now. If your emg results were concerning, the ALS specialist would have picked up on it. So, IMO, trust what he said to you and that your symptoms wax and wane. Doesn't sound like an ALS story to me. Hang in there buddy. I know how much damage anxiety can do. -Matt
 
Thanks for the response. Regarding UMN signs ... I do get tightness in my right calf when I exercise - it's a burning, tight, lactic-acidy, swollen feeling like the kind you get after an intense workout (without the workout). But no spasticity that I am aware of. As far as brisk reflexes, as you saw the doctor did mention brisk deep tendon reflexes but said they were not pathological ... not sure how he differentiates between pathological and non pathological. I think Babinski's sign was negative.
 
Yeah, a lot of us have had brisk reflexes noted in the clinical, I did. I bet they were bilateral and not associated with weakness which makes them not concerning. Has anything changed since your first assessment in terms of your symptoms? With no weakness, I think you can feel reassured. Sounds like you have something going on but there are probably many many things it could be that are not pathological."He did not have myopathic units and this study was reported to be compatible with possible cervical and radicular disease."Look up Radcular Neuropathy. Sounds WAY more logical than anything like ALS. -Matt
 
Nickston,Hi and thanks for checking back in. First of all, you have an ALS specialist from John Hopkins checking you out originally and he is thinking radiculopathy. That is a great thing.Secondly. if you had a clean EMG in June2010 and then continued for 1.5years and just NOW have a dirty EMG, then I would be slightly suspect. HOWEVER, your EMG did show some abnormal activity. BUT, (big BUT) if this was related in ANY WAY to ALS, then there is NO WAY that you would have been able to continue to perform at the level you are at. In the 1.5 years, SOME KIND of weakness would have shown by now if it was ALS. You doctor judged your EMG to show some form of radiculopathy. No way would ALS stay dormant for 1.5 years if that was indeed what was happening to your lower motor neurons. And to answer your question, yes EMG changes would show up with a pinched nerve of some kind. Note in the report that he didn't find any myopathic units (MUPS). Which point away from ALS when there are sharp waves present. No fibs present either.Maybe your symptoms are flaring up because of the change in the season, cold weather, etc. Reschedule with the same neuro for a check-up. I think you won't be surprised if he continues to tell you that ALS is not being considered.
 
Matt,I haven't had any changes/weakness that I can tell. I do have the exercise intolerance ... as many people around here do, I have self-tested endlessly, particularly calf-raises, since my right calf is exercise intolerant. It gets tired more quickly compared to my left calf, but I don't think it's a lack of power or strength - it's a matter of endurance. I will definitely look up radicular neuropathy. I can't tell you all how much your replies mean, although I'm guessing I don't have to since you have all been there!Thanks,NickstonPS - I was by some Godly miracle able to schedule an appt for tomorrow with my neurologist - apparently someone cancelled. I will keep you guys informed. Thanks to all, and if anyone else has anything to add, PLEASE chime in!!!
 
That's great Nickston. Keep us updated. Based on your story (1.5 years and no weakness, plus an ALS specialist suggesting some sort of radiculopathy), I'm sure you'll get some reassurance tomorrow. Remember, your fears are all in your head right now. So try to watch a movie tonight or do something to take your mind off it and leave it to the experts tomorrow. -Matt
 
Just visited the neuro. He did a clinical exam and said with a laugh that I don't have ALS. Of course I feel better but there's that nagging doubt. I seriously need some Prozac. :D) any recommendations out there for meds to treat anxiety? I've struggled with this demon for years.Thanks for the help, guys.
 
Edit: nagging doubt because spinal MRI showed no radiculopathy. But the neuro said my emg abnormalities were very minor. he couldn't really say what caused them...?
 
You see! There are tons of reasons why an EMG could show some "abnormalities" (back problems for instance), so keep smiling :D)
 
Woo hoo Nickston!!!! So happy for you!!! Most of us struggle with nagging doubts, which is fueled by our health anxiety nothing else.Lexapro is a good choice to combat anxiety. I've used it in the past and it really works well, but takes several weeks to fully take effect. Xanax is good short term, but is highly addictive so you have to be careful how much you take.Mitra
 
A slightly irregular EMG is actually pretty common and throughout even a healthy person's life they will have some deinnervation/reinnervation from time to time. If you had something horrible there wouldn't be a shadow of a doubt on the EMG and yes you would be presenting with severe weakness and pathological reflexes. How was your vitamin levels? Did you get potassium, magnesium, calcium, and vitamin D checked? These all play a role in your muscles.
 

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