Dr. Bob :
How long has this been going on? Any muscular weakness? Any problems with speech or swallowing?
JACUSTOMER-u1dph804- : Hi Doctor. I first encountered this around October of Last year (2013). This presented as burning and tingling extremities, typically my arms and legs, coupled with tingling, consistently. This was also accompanied by very random muscle twitching throughout the body, no localised presentation, just very random, at a level of medium to significant amplitude in nature. I would also get pain in hands and feet.
JACUSTOMER-u1dph804- : This then dissipated around February and I was feeling well (ish) until around August, when all symptoms returned, compounded with what I can only describe as head rushes, tingling which seemed to ruminate from inside my head and which rushed across the back of head. I also began experiencing a very apparent and consistent burning sensation emanating from behind my left ear spreading under my left eye to the top of my lip. This persisted for weeks but has since dissipated. All the while I'm experiencing muscle twitching, randomly, on random days in random locations.
JACUSTOMER-u1dph804- : I also tend to feel feverish and generally sick from time to time, at least 2 times a week. It's also worth noting all of the above is exasperated with alcohol. Certainly not at the time but definitely the next day, in particular the aforementioned head rushes. I have no true clinical weakness, but I do have a reasonably constant pain in my right elbow, forearm and bicep as well as right Big toe, and to be honest some fleeting joint pain elsewhere from time to time. No problem chewing or swallowing Doctor.
JACUSTOMER-u1dph804- : I have less desire to go to the gym etc which is unusual for me, but I certainly can still exercise at high intensity and reasonably high weight. I also have a dynamometer for strength testing which shows no significant strength difference between left and right side. I am obviously concerned by the nasty outcomes of a Google search, yielding results such as MND/ALS. I should also mention I did have a full neurological assessment carried out in A&E which yielded no remarkable concerns. Just the usual heat/cold sensation tests, opposing force tests, vibration, gait etc.
JACUSTOMER-u1dph804- : I also get pain in both my hands from time to time at the "heel" of the hand, I guess I'm referring to the abductor muscle of the thumb. Again nothing which has became progressively worse and if anything this can come and go. It feels like a deep burning pain which is exacerbated by my pressing on it. The feeling in my bicep felt like a real deep ache at times and I would get the odd twitch. Again this comes and goes it's been several weeks since my bicep was really twitching but there is a feeling of a burning which comes and goes throughout my forearm and bicep. I would say I can tense my left forearm more than my right, however, when presented with a dumbell both are (in my opinion) then equally tensed and able to move the same loads. I have also experimented with my hand strength by fanning out my fingers and trying to oppose my pinky fingers and fore fingers etc. All of which seem to be equal on both sides. I would say my right hand can feel minutely (and this is perhaps perceived) slower than my left. Although when I tried the coin rotation test I was able to rotate a coin 23 times without dropping on both left and right hand. It does seem a bit slower when cold however. I hope this helps you advise me. Thanks for your time.
JACUSTOMER-u1dph804- : Apologies, you also mentioned speech, I would say no not really, certainly when I'm fatigued I can some times feel a bit lazy with my words however this does come and go when feeling energetic so no real consistent concern on that Dr. Although of course I do focus on my speech now that I've made the mistake of reading up on MND/ALS!
Dr. Bob :
I have encountered many cases like yours and none of them have turned out to be ALS or any MND for that matter. I don't think you should concern yourself with this quite frankly.
Dr. Bob :
Have you had nerve conduction tests done?
Dr. Bob :
This would be one additional test you could do for further reassurance. :-)
JACUSTOMER-u1dph804- : So in your opinion Dr this is not something which would be a typical description of MND or ALS? One more piece of reassurance. Is it correct that typically you cannot feel MND, in the sense that your muscles are not painful during atrophy? Also, is it correct that the twitching with ALS or MND typically occurs after muscle atrophy and is of a very high frequency/low amplitude almost invisible to the naked eye? I think just to prevent myself going insane I'll also look to get the nerve conduction study done. If this comes back normal your opinion would be I can breath easy?
Dr. Bob :
Yes. Everything you say here is accurate. Some would say the test is not necessary, and you certainly could wait and have it done later. However, a normal result would certainly take an MND off the table completely.
JACUSTOMER-u1dph804- : Okay Doctor - thanks for your expert advice. My problem is I'm an engineer and I guess we're always looking for a root cause, but I appreciate the human body is not as definitively simple as a computer! Thank you for your reassurance. Have a good evening/morning. I'm thankful for your time you have helped me here.
JACUSTOMER-u1dph804- : Dr I shall conclude this chat with an excellent service response when you confirm you need nothing else from me now?
Dr. Bob :
You're right about the body. Evolution is an amazing engineer! Research neuromuscular irritability or hyper excitability and you might find some information to satisfy, at least partially, the electrical engineer in you. :-)
JACUSTOMER-u1dph804- : Thanks Doctor!!
Dr. Bob :
You're welcome. Follow up anytime.