Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Good Morning Dr. Saghafi, This Morning I Was Awoken With
Question: Good morning Dr. Saghafi,
This morning I was awoken with profuse night sweats this morning. This is a first time occurance for me. My sheets were soaked. Also, I continue to have tightness in my right forearm with a sense of fatigue when using my right hand. I still have precieved issues with dexterity of the right hand, in particular the right ring finger. When a new and unusual physical occurance happens, you know my questioning refers back to my original concern. Note - I have increased tightness in my right forearm and wrist area with fatigue when tying my shoe (noticed yesterday). I also fee a difference in dexterity within my right hand when tying. I have no apparent reason for forearm fatigue. Doctor, I am aware I have anxiety, but with the physical symptoms I’m currently showing, I have greater concerns. We also discussed a trip out to Parma again and I’m on board. Could we discuss the emg and other medical clinical evaluations? Would mnd cause any of the symptoms I’m discribing? This has been a long 11 weeks with twtiching and now I’m having some clear physical presentations of changes. My forearm feels tired all the way from the wrist to the elbow - apparently, the heaviness I was feeling was not directly in the right hand. Your insight is always appreciated.
This morning I was awoken with profuse night sweats this morning. This is a first time occurance for me. My sheets were soaked. Also, I continue to have tightness in my right forearm with a sense of fatigue when using my right hand. I still have precieved issues with dexterity of the right hand, in particular the right ring finger. When a new and unusual physical occurance happens, you know my questioning refers back to my original concern. Note - I have increased tightness in my right forearm and wrist area with fatigue when tying my shoe (noticed yesterday). I also fee a difference in dexterity within my right hand when tying. I have no apparent reason for forearm fatigue. Doctor, I am aware I have anxiety, but with the physical symptoms I’m currently showing, I have greater concerns. We also discussed a trip out to Parma again and I’m on board. Could we discuss the emg and other medical clinical evaluations? Would mnd cause any of the symptoms I’m discribing? This has been a long 11 weeks with twtiching and now I’m having some clear physical presentations of changes. My forearm feels tired all the way from the wrist to the elbow - apparently, the heaviness I was feeling was not directly in the right hand. Your insight is always appreciated.
Good morning Dr. Saghafi,
This morning I was awoken with profuse night sweats this morning. This is a first time occurance for me. My sheets were soaked. Also, I continue to have tightness in my right forearm with a sense of fatigue when using my right hand. I still have precieved issues with dexterity of the right hand, in particular the right ring finger. When a new and unusual physical occurance happens, you know my questioning refers back to my original concern. Note - I have increased tightness in my right forearm and wrist area with fatigue when tying my shoe (noticed yesterday). I also fee a difference in dexterity within my right hand when tying. I have no apparent reason for forearm fatigue. Doctor, I am aware I have anxiety, but with the physical symptoms I’m currently showing, I have greater concerns. We also discussed a trip out to Parma again and I’m on board. Could we discuss the emg and other medical clinical evaluations? Would mnd cause any of the symptoms I’m discribing? This has been a long 11 weeks with twtiching and now I’m having some clear physical presentations of changes. My forearm feels tired all the way from the wrist to the elbow - apparently, the heaviness I was feeling was not directly in the right hand. Your insight is always appreciated.
This morning I was awoken with profuse night sweats this morning. This is a first time occurance for me. My sheets were soaked. Also, I continue to have tightness in my right forearm with a sense of fatigue when using my right hand. I still have precieved issues with dexterity of the right hand, in particular the right ring finger. When a new and unusual physical occurance happens, you know my questioning refers back to my original concern. Note - I have increased tightness in my right forearm and wrist area with fatigue when tying my shoe (noticed yesterday). I also fee a difference in dexterity within my right hand when tying. I have no apparent reason for forearm fatigue. Doctor, I am aware I have anxiety, but with the physical symptoms I’m currently showing, I have greater concerns. We also discussed a trip out to Parma again and I’m on board. Could we discuss the emg and other medical clinical evaluations? Would mnd cause any of the symptoms I’m discribing? This has been a long 11 weeks with twtiching and now I’m having some clear physical presentations of changes. My forearm feels tired all the way from the wrist to the elbow - apparently, the heaviness I was feeling was not directly in the right hand. Your insight is always appreciated.
Follow up to Health Tap Review.
Doctor, I do have fasciculations on my shoulders and forearms. I have tightness through my right forearm and wrist. I’ve noticed fasciculations in my arms / forearms after activity. This is concerning my last statement on the change in right hand dexterity. I’ve felt fatigue in the forearm from little task like shoe tying. I presented with full body fasciculations on March 10th. Lately, they have been MORE focal in the calves, bicep and triceps of RIGHT arm than my left arm, but they exist there too. My shoulders have always shown fasciculations since presentation. I would like to emphasize that I have tightness in my right forearm and wrist area along with dexterity changes.
Thank you once again Dr. Saghafi
Doctor, I do have fasciculations on my shoulders and forearms. I have tightness through my right forearm and wrist. I’ve noticed fasciculations in my arms / forearms after activity. This is concerning my last statement on the change in right hand dexterity. I’ve felt fatigue in the forearm from little task like shoe tying. I presented with full body fasciculations on March 10th. Lately, they have been MORE focal in the calves, bicep and triceps of RIGHT arm than my left arm, but they exist there too. My shoulders have always shown fasciculations since presentation. I would like to emphasize that I have tightness in my right forearm and wrist area along with dexterity changes.
Thank you once again Dr. Saghafi
Follow up to Health Tap Review.
Doctor, I do have fasciculations on my shoulders and forearms. I have tightness through my right forearm and wrist. I’ve noticed fasciculations in my arms / forearms after activity. This is concerning my last statement on the change in right hand dexterity. I’ve felt fatigue in the forearm from little task like shoe tying. I presented with full body fasciculations on March 10th. Lately, they have been MORE focal in the calves, bicep and triceps of RIGHT arm than my left arm, but they exist there too. My shoulders have always shown fasciculations since presentation. I would like to emphasize that I have tightness in my right forearm and wrist area along with dexterity changes.
Thank you once again Dr. Saghafi
Doctor, I do have fasciculations on my shoulders and forearms. I have tightness through my right forearm and wrist. I’ve noticed fasciculations in my arms / forearms after activity. This is concerning my last statement on the change in right hand dexterity. I’ve felt fatigue in the forearm from little task like shoe tying. I presented with full body fasciculations on March 10th. Lately, they have been MORE focal in the calves, bicep and triceps of RIGHT arm than my left arm, but they exist there too. My shoulders have always shown fasciculations since presentation. I would like to emphasize that I have tightness in my right forearm and wrist area along with dexterity changes.
Thank you once again Dr. Saghafi
Brief Answer:
In preparation for visit to XXXXXXX
Detailed Answer:
Good morning Mr. Issa.
I am working on trying to get you over here as soon as possible to get both the EMG/NCV performed as well as exam you an additional time to visualize your additional areas of fasciculations.
As I explained recently to you the symptoms and progression of the fasciculations along with the sensations of tightness in the right forearm with a sense of "fatigue when using my right hand" along with complaints of loss of dexterity in the right hand compared to the left are very unusual symptoms of early presentation (11-12 weeks at this point) for any type of motor neuron disease in the face of recent neurological examinations that did not detect actual NEUROLOGICAL WEAKNESS, no muscle atrophy, no symptoms of swallowing problems, choking, no respiratory distress, no stumbling, tripping, or falling to behave this way. You'll recall that roughly 10 days ago you were complaining of weakness in the right foot when you did "pushes" against resistance your wife would put against you and you felt weaker at times....but then, other times you apparently had normal strength? Again, these sorts of things don't happen with motor neuron disease.
Certainly the complaint of 'FULL BODY FASCICULATION ON MARCH 10TH' is not something that could ever be described to motor neuron disease with your current clinical picture and only after a period of time of 11-12 weeks. Something else has to be placed HIGHER UP on the differential diagnostic scale of possibilities. Make sense?
I am also onboard with the concept you voiced last evening about having increased fasciculation activities in your shoulders, biceps, and triceps and calves, and that these are definitely visible and not just being felt by you. If you'll read some of the material I believe I sent you regarding the condition of BFS you will see that these locations are precisely the most common ones people will point to when they are identifying the places of greatest fasciculation activity.
However, again, fasciculations without XXXXXXX muscle weakness and/or atrophy PLUS a lack of UPPER MOTOR NEURON signs which would be reflective of deterioration of brain neurons (which also happens in ALS) is the equivalent of putting the cart before the horse if MOTOR NEURON DISEASE of the ALS were to be invoked as the working diagnosis. Nevertheless, I believe that an electrical study and an additional neurological examination are worthwhile doing for you and so will continue to try and schedule things to that end as quickly as possible.
The problem as you can imagine is to get timely responses from folks this week preceding the Memorial Day Weekend. Do you remain interested in being able to get sessions with Drs. Roush and Van Keuren? Or would you be satisfied with just getting the neurological examination and the ELECTRICAL STUDY? In my opinion, sessions with Drs. Roush and Van Keuren will be of great benefit to you but it would likely not be associated with any short stay housing in the CARES TOWER of the VA Hospital and in order to get maximal benefit I believe you would want to spend at least a good couple of weeks seeing them for as many sessions as possible. Of course, the entire time we are also making sure that your physical status remains stable and that there are no other medical concerns.
There are 2 things that I'd suggest doing in preparation for visiting the VA Medical Center in Cleveland:
1. Check on your status in terms of being fully connected to the VA System such that if you were to go outside your home area (VISN) that you would not have problems being admitted for treatment or consultation, etc. I don't know exactly who you would have to call to check up and verify that kind of information. I imagine the VA Center where you are has representative or patient advocates who can tell you if you are fully connected for VA treatment purposes out of State, in emergencies, etc.
2. Please bring copies of the neurology reports from the local neurologist who examined you. I'd like to read his history and examination results. Also, please bring the last report you have from your oncologist regarding your renal cell CA status and whatever the latest imaging studies are that they took for vigilance purposes ( Ultrasound, MRI, CT, etc).
3. Also, I'd like the actual CD ROM or DVD of the MRI studies done of the brain and cervical spine.
I believe that touches base with everything to bring us up to date and I look forward to either answering any other questions you have at this time in preparation for coming West again (P.S. Hope you don't find it necessary to take another Uber from Detroit! HA!) or seeing you soon.
I will keep you posted by some means on our progress as soon as people have responded to me on any of these requests I've made on your behalf. I can see you this week on Saturday in the afternoon after my regular office schedule depending on when other things seem to line up.
In preparation for visit to XXXXXXX
Detailed Answer:
Good morning Mr. Issa.
I am working on trying to get you over here as soon as possible to get both the EMG/NCV performed as well as exam you an additional time to visualize your additional areas of fasciculations.
As I explained recently to you the symptoms and progression of the fasciculations along with the sensations of tightness in the right forearm with a sense of "fatigue when using my right hand" along with complaints of loss of dexterity in the right hand compared to the left are very unusual symptoms of early presentation (11-12 weeks at this point) for any type of motor neuron disease in the face of recent neurological examinations that did not detect actual NEUROLOGICAL WEAKNESS, no muscle atrophy, no symptoms of swallowing problems, choking, no respiratory distress, no stumbling, tripping, or falling to behave this way. You'll recall that roughly 10 days ago you were complaining of weakness in the right foot when you did "pushes" against resistance your wife would put against you and you felt weaker at times....but then, other times you apparently had normal strength? Again, these sorts of things don't happen with motor neuron disease.
Certainly the complaint of 'FULL BODY FASCICULATION ON MARCH 10TH' is not something that could ever be described to motor neuron disease with your current clinical picture and only after a period of time of 11-12 weeks. Something else has to be placed HIGHER UP on the differential diagnostic scale of possibilities. Make sense?
I am also onboard with the concept you voiced last evening about having increased fasciculation activities in your shoulders, biceps, and triceps and calves, and that these are definitely visible and not just being felt by you. If you'll read some of the material I believe I sent you regarding the condition of BFS you will see that these locations are precisely the most common ones people will point to when they are identifying the places of greatest fasciculation activity.
However, again, fasciculations without XXXXXXX muscle weakness and/or atrophy PLUS a lack of UPPER MOTOR NEURON signs which would be reflective of deterioration of brain neurons (which also happens in ALS) is the equivalent of putting the cart before the horse if MOTOR NEURON DISEASE of the ALS were to be invoked as the working diagnosis. Nevertheless, I believe that an electrical study and an additional neurological examination are worthwhile doing for you and so will continue to try and schedule things to that end as quickly as possible.
The problem as you can imagine is to get timely responses from folks this week preceding the Memorial Day Weekend. Do you remain interested in being able to get sessions with Drs. Roush and Van Keuren? Or would you be satisfied with just getting the neurological examination and the ELECTRICAL STUDY? In my opinion, sessions with Drs. Roush and Van Keuren will be of great benefit to you but it would likely not be associated with any short stay housing in the CARES TOWER of the VA Hospital and in order to get maximal benefit I believe you would want to spend at least a good couple of weeks seeing them for as many sessions as possible. Of course, the entire time we are also making sure that your physical status remains stable and that there are no other medical concerns.
There are 2 things that I'd suggest doing in preparation for visiting the VA Medical Center in Cleveland:
1. Check on your status in terms of being fully connected to the VA System such that if you were to go outside your home area (VISN) that you would not have problems being admitted for treatment or consultation, etc. I don't know exactly who you would have to call to check up and verify that kind of information. I imagine the VA Center where you are has representative or patient advocates who can tell you if you are fully connected for VA treatment purposes out of State, in emergencies, etc.
2. Please bring copies of the neurology reports from the local neurologist who examined you. I'd like to read his history and examination results. Also, please bring the last report you have from your oncologist regarding your renal cell CA status and whatever the latest imaging studies are that they took for vigilance purposes ( Ultrasound, MRI, CT, etc).
3. Also, I'd like the actual CD ROM or DVD of the MRI studies done of the brain and cervical spine.
I believe that touches base with everything to bring us up to date and I look forward to either answering any other questions you have at this time in preparation for coming West again (P.S. Hope you don't find it necessary to take another Uber from Detroit! HA!) or seeing you soon.
I will keep you posted by some means on our progress as soon as people have responded to me on any of these requests I've made on your behalf. I can see you this week on Saturday in the afternoon after my regular office schedule depending on when other things seem to line up.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
In preparation for visit to XXXXXXX
Detailed Answer:
Good morning Mr. Issa.
I am working on trying to get you over here as soon as possible to get both the EMG/NCV performed as well as exam you an additional time to visualize your additional areas of fasciculations.
As I explained recently to you the symptoms and progression of the fasciculations along with the sensations of tightness in the right forearm with a sense of "fatigue when using my right hand" along with complaints of loss of dexterity in the right hand compared to the left are very unusual symptoms of early presentation (11-12 weeks at this point) for any type of motor neuron disease in the face of recent neurological examinations that did not detect actual NEUROLOGICAL WEAKNESS, no muscle atrophy, no symptoms of swallowing problems, choking, no respiratory distress, no stumbling, tripping, or falling to behave this way. You'll recall that roughly 10 days ago you were complaining of weakness in the right foot when you did "pushes" against resistance your wife would put against you and you felt weaker at times....but then, other times you apparently had normal strength? Again, these sorts of things don't happen with motor neuron disease.
Certainly the complaint of 'FULL BODY FASCICULATION ON MARCH 10TH' is not something that could ever be described to motor neuron disease with your current clinical picture and only after a period of time of 11-12 weeks. Something else has to be placed HIGHER UP on the differential diagnostic scale of possibilities. Make sense?
I am also onboard with the concept you voiced last evening about having increased fasciculation activities in your shoulders, biceps, and triceps and calves, and that these are definitely visible and not just being felt by you. If you'll read some of the material I believe I sent you regarding the condition of BFS you will see that these locations are precisely the most common ones people will point to when they are identifying the places of greatest fasciculation activity.
However, again, fasciculations without XXXXXXX muscle weakness and/or atrophy PLUS a lack of UPPER MOTOR NEURON signs which would be reflective of deterioration of brain neurons (which also happens in ALS) is the equivalent of putting the cart before the horse if MOTOR NEURON DISEASE of the ALS were to be invoked as the working diagnosis. Nevertheless, I believe that an electrical study and an additional neurological examination are worthwhile doing for you and so will continue to try and schedule things to that end as quickly as possible.
The problem as you can imagine is to get timely responses from folks this week preceding the Memorial Day Weekend. Do you remain interested in being able to get sessions with Drs. Roush and Van Keuren? Or would you be satisfied with just getting the neurological examination and the ELECTRICAL STUDY? In my opinion, sessions with Drs. Roush and Van Keuren will be of great benefit to you but it would likely not be associated with any short stay housing in the CARES TOWER of the VA Hospital and in order to get maximal benefit I believe you would want to spend at least a good couple of weeks seeing them for as many sessions as possible. Of course, the entire time we are also making sure that your physical status remains stable and that there are no other medical concerns.
There are 2 things that I'd suggest doing in preparation for visiting the VA Medical Center in Cleveland:
1. Check on your status in terms of being fully connected to the VA System such that if you were to go outside your home area (VISN) that you would not have problems being admitted for treatment or consultation, etc. I don't know exactly who you would have to call to check up and verify that kind of information. I imagine the VA Center where you are has representative or patient advocates who can tell you if you are fully connected for VA treatment purposes out of State, in emergencies, etc.
2. Please bring copies of the neurology reports from the local neurologist who examined you. I'd like to read his history and examination results. Also, please bring the last report you have from your oncologist regarding your renal cell CA status and whatever the latest imaging studies are that they took for vigilance purposes ( Ultrasound, MRI, CT, etc).
3. Also, I'd like the actual CD ROM or DVD of the MRI studies done of the brain and cervical spine.
I believe that touches base with everything to bring us up to date and I look forward to either answering any other questions you have at this time in preparation for coming West again (P.S. Hope you don't find it necessary to take another Uber from Detroit! HA!) or seeing you soon.
I will keep you posted by some means on our progress as soon as people have responded to me on any of these requests I've made on your behalf. I can see you this week on Saturday in the afternoon after my regular office schedule depending on when other things seem to line up.
In preparation for visit to XXXXXXX
Detailed Answer:
Good morning Mr. Issa.
I am working on trying to get you over here as soon as possible to get both the EMG/NCV performed as well as exam you an additional time to visualize your additional areas of fasciculations.
As I explained recently to you the symptoms and progression of the fasciculations along with the sensations of tightness in the right forearm with a sense of "fatigue when using my right hand" along with complaints of loss of dexterity in the right hand compared to the left are very unusual symptoms of early presentation (11-12 weeks at this point) for any type of motor neuron disease in the face of recent neurological examinations that did not detect actual NEUROLOGICAL WEAKNESS, no muscle atrophy, no symptoms of swallowing problems, choking, no respiratory distress, no stumbling, tripping, or falling to behave this way. You'll recall that roughly 10 days ago you were complaining of weakness in the right foot when you did "pushes" against resistance your wife would put against you and you felt weaker at times....but then, other times you apparently had normal strength? Again, these sorts of things don't happen with motor neuron disease.
Certainly the complaint of 'FULL BODY FASCICULATION ON MARCH 10TH' is not something that could ever be described to motor neuron disease with your current clinical picture and only after a period of time of 11-12 weeks. Something else has to be placed HIGHER UP on the differential diagnostic scale of possibilities. Make sense?
I am also onboard with the concept you voiced last evening about having increased fasciculation activities in your shoulders, biceps, and triceps and calves, and that these are definitely visible and not just being felt by you. If you'll read some of the material I believe I sent you regarding the condition of BFS you will see that these locations are precisely the most common ones people will point to when they are identifying the places of greatest fasciculation activity.
However, again, fasciculations without XXXXXXX muscle weakness and/or atrophy PLUS a lack of UPPER MOTOR NEURON signs which would be reflective of deterioration of brain neurons (which also happens in ALS) is the equivalent of putting the cart before the horse if MOTOR NEURON DISEASE of the ALS were to be invoked as the working diagnosis. Nevertheless, I believe that an electrical study and an additional neurological examination are worthwhile doing for you and so will continue to try and schedule things to that end as quickly as possible.
The problem as you can imagine is to get timely responses from folks this week preceding the Memorial Day Weekend. Do you remain interested in being able to get sessions with Drs. Roush and Van Keuren? Or would you be satisfied with just getting the neurological examination and the ELECTRICAL STUDY? In my opinion, sessions with Drs. Roush and Van Keuren will be of great benefit to you but it would likely not be associated with any short stay housing in the CARES TOWER of the VA Hospital and in order to get maximal benefit I believe you would want to spend at least a good couple of weeks seeing them for as many sessions as possible. Of course, the entire time we are also making sure that your physical status remains stable and that there are no other medical concerns.
There are 2 things that I'd suggest doing in preparation for visiting the VA Medical Center in Cleveland:
1. Check on your status in terms of being fully connected to the VA System such that if you were to go outside your home area (VISN) that you would not have problems being admitted for treatment or consultation, etc. I don't know exactly who you would have to call to check up and verify that kind of information. I imagine the VA Center where you are has representative or patient advocates who can tell you if you are fully connected for VA treatment purposes out of State, in emergencies, etc.
2. Please bring copies of the neurology reports from the local neurologist who examined you. I'd like to read his history and examination results. Also, please bring the last report you have from your oncologist regarding your renal cell CA status and whatever the latest imaging studies are that they took for vigilance purposes ( Ultrasound, MRI, CT, etc).
3. Also, I'd like the actual CD ROM or DVD of the MRI studies done of the brain and cervical spine.
I believe that touches base with everything to bring us up to date and I look forward to either answering any other questions you have at this time in preparation for coming West again (P.S. Hope you don't find it necessary to take another Uber from Detroit! HA!) or seeing you soon.
I will keep you posted by some means on our progress as soon as people have responded to me on any of these requests I've made on your behalf. I can see you this week on Saturday in the afternoon after my regular office schedule depending on when other things seem to line up.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Doctor, I have written and pretty through message earlier, but I’m not sure that it went through... I am in agreement and understand all that you are explaining and I thank you for taking the time in doing so. Right now, my forearm is tightening and feeling fatigued from typing, so I am going to schedule one more HealthTap appointment with you tonight. I will be able to give you a rundown of my schedule there. Thank you.
Doctor, I have written and pretty through message earlier, but I’m not sure that it went through... I am in agreement and understand all that you are explaining and I thank you for taking the time in doing so. Right now, my forearm is tightening and feeling fatigued from typing, so I am going to schedule one more HealthTap appointment with you tonight. I will be able to give you a rundown of my schedule there. Thank you.
Brief Answer:
No additional commentary received...so sorry it didn't come through
Detailed Answer:
Good evening sir-
I did not receive any additional comments from you but that is OK...because in actuality I think we have plenty of information to work with in terms the evolution of symptoms that you've been having over the past several days or so...I would suggest just taking a break although I'm sure that's not foremost on your mind.
You may be happy to hear that I was able to make contact with the exact person I was hoping to get in touch with at University Hospitals of XXXXXXX who is going to confirm with me later this week whether or not he can see you on Friday May 31st at 9:45am. Not only will he perform the electrical study on you but I've asked for him to also do a 2nd consultation. He is one of the most experienced neuromuscular specialists in the Dept. of Neurology and writes books on the subject. He was one of my mentors while in training and I depend upon him when it comes to electrical studies for all my patients so you will visit with him first for a neurological examination followed by the electrical study.
Please remember that he will be CONFIRMING with me the status of that time and date. Part of solidifying the appointment means they have to verify your insurance status so let me know if they have not yet contacted you because I spoke to his secretary BOBBI who said she would make every effort to contact you (either this afternoon or tomorrow). I am sending all of your chart records to Dr. Katirji's attention so let's cross our fingers and see what happens.
If you've not heard from anyone there you may call 216.844.4854 in order to give them your insurance information so they can then, guarantee the slot.
At the same time I also heard from Dr. Roush today at the VA and she said she would be very interested in meeting with you if you came to XXXXXXX HOWEVER, she said that there is a requirement that you have a PRIMARY PHYSICIAN at the XXXXXXX VA who then, must put in a consultation request for her services before she can schedule you. I asked whether your psychiatrist on the other side could put in the consult request and she wasn't sure about that but we agreed to talk again on Friday about things and maybe we can find an answer to these questions.
This query has required 78 minutes total time in reading, researching, and synthesizing a final response for the patient.
No additional commentary received...so sorry it didn't come through
Detailed Answer:
Good evening sir-
I did not receive any additional comments from you but that is OK...because in actuality I think we have plenty of information to work with in terms the evolution of symptoms that you've been having over the past several days or so...I would suggest just taking a break although I'm sure that's not foremost on your mind.
You may be happy to hear that I was able to make contact with the exact person I was hoping to get in touch with at University Hospitals of XXXXXXX who is going to confirm with me later this week whether or not he can see you on Friday May 31st at 9:45am. Not only will he perform the electrical study on you but I've asked for him to also do a 2nd consultation. He is one of the most experienced neuromuscular specialists in the Dept. of Neurology and writes books on the subject. He was one of my mentors while in training and I depend upon him when it comes to electrical studies for all my patients so you will visit with him first for a neurological examination followed by the electrical study.
Please remember that he will be CONFIRMING with me the status of that time and date. Part of solidifying the appointment means they have to verify your insurance status so let me know if they have not yet contacted you because I spoke to his secretary BOBBI who said she would make every effort to contact you (either this afternoon or tomorrow). I am sending all of your chart records to Dr. Katirji's attention so let's cross our fingers and see what happens.
If you've not heard from anyone there you may call 216.844.4854 in order to give them your insurance information so they can then, guarantee the slot.
At the same time I also heard from Dr. Roush today at the VA and she said she would be very interested in meeting with you if you came to XXXXXXX HOWEVER, she said that there is a requirement that you have a PRIMARY PHYSICIAN at the XXXXXXX VA who then, must put in a consultation request for her services before she can schedule you. I asked whether your psychiatrist on the other side could put in the consult request and she wasn't sure about that but we agreed to talk again on Friday about things and maybe we can find an answer to these questions.
This query has required 78 minutes total time in reading, researching, and synthesizing a final response for the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
No additional commentary received...so sorry it didn't come through
Detailed Answer:
Good evening sir-
I did not receive any additional comments from you but that is OK...because in actuality I think we have plenty of information to work with in terms the evolution of symptoms that you've been having over the past several days or so...I would suggest just taking a break although I'm sure that's not foremost on your mind.
You may be happy to hear that I was able to make contact with the exact person I was hoping to get in touch with at University Hospitals of XXXXXXX who is going to confirm with me later this week whether or not he can see you on Friday May 31st at 9:45am. Not only will he perform the electrical study on you but I've asked for him to also do a 2nd consultation. He is one of the most experienced neuromuscular specialists in the Dept. of Neurology and writes books on the subject. He was one of my mentors while in training and I depend upon him when it comes to electrical studies for all my patients so you will visit with him first for a neurological examination followed by the electrical study.
Please remember that he will be CONFIRMING with me the status of that time and date. Part of solidifying the appointment means they have to verify your insurance status so let me know if they have not yet contacted you because I spoke to his secretary BOBBI who said she would make every effort to contact you (either this afternoon or tomorrow). I am sending all of your chart records to Dr. Katirji's attention so let's cross our fingers and see what happens.
If you've not heard from anyone there you may call 216.844.4854 in order to give them your insurance information so they can then, guarantee the slot.
At the same time I also heard from Dr. Roush today at the VA and she said she would be very interested in meeting with you if you came to XXXXXXX HOWEVER, she said that there is a requirement that you have a PRIMARY PHYSICIAN at the XXXXXXX VA who then, must put in a consultation request for her services before she can schedule you. I asked whether your psychiatrist on the other side could put in the consult request and she wasn't sure about that but we agreed to talk again on Friday about things and maybe we can find an answer to these questions.
This query has required 78 minutes total time in reading, researching, and synthesizing a final response for the patient.
No additional commentary received...so sorry it didn't come through
Detailed Answer:
Good evening sir-
I did not receive any additional comments from you but that is OK...because in actuality I think we have plenty of information to work with in terms the evolution of symptoms that you've been having over the past several days or so...I would suggest just taking a break although I'm sure that's not foremost on your mind.
You may be happy to hear that I was able to make contact with the exact person I was hoping to get in touch with at University Hospitals of XXXXXXX who is going to confirm with me later this week whether or not he can see you on Friday May 31st at 9:45am. Not only will he perform the electrical study on you but I've asked for him to also do a 2nd consultation. He is one of the most experienced neuromuscular specialists in the Dept. of Neurology and writes books on the subject. He was one of my mentors while in training and I depend upon him when it comes to electrical studies for all my patients so you will visit with him first for a neurological examination followed by the electrical study.
Please remember that he will be CONFIRMING with me the status of that time and date. Part of solidifying the appointment means they have to verify your insurance status so let me know if they have not yet contacted you because I spoke to his secretary BOBBI who said she would make every effort to contact you (either this afternoon or tomorrow). I am sending all of your chart records to Dr. Katirji's attention so let's cross our fingers and see what happens.
If you've not heard from anyone there you may call 216.844.4854 in order to give them your insurance information so they can then, guarantee the slot.
At the same time I also heard from Dr. Roush today at the VA and she said she would be very interested in meeting with you if you came to XXXXXXX HOWEVER, she said that there is a requirement that you have a PRIMARY PHYSICIAN at the XXXXXXX VA who then, must put in a consultation request for her services before she can schedule you. I asked whether your psychiatrist on the other side could put in the consult request and she wasn't sure about that but we agreed to talk again on Friday about things and maybe we can find an answer to these questions.
This query has required 78 minutes total time in reading, researching, and synthesizing a final response for the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Saghafi,
I received a call from the local neuro and he has set an appointment for me on 5/30. I had a feeling once he received the report from the local clinic, he would set a consult. I apologize that the date conflicts with all that you have been arranging. I am truly, truly sorry. I am very appreciative of all your effort! I’m not saying that I will not make it to XXXXXXX but for the next day - that may be rather difficult. I’d also say that depending on his findings, I may not be in the mind state to travel truthfully. I do not believe he has arranged for and emg or ncs on that day.
The PA at the clinic yesterday found what he listed as “masses” on my lower right frontal quadrant. They are pea like lesions outside the muscle wall. They are sensitive to the touch - very much. They feel like radiating muscle cramps of which I believed them to be over the last 2/3 months. I will need to have my primary care doctor review them ASAP.
I also received lab result back from last Friday. My TSH, and Lipase levels are high. My BUN/Creatinine and eGFR are low (8 & 51). I had roughly 5 days of dehydration and I was unable to hold food down prior to the test. I will send you the numbers for the TSH and Lipase if you’d like. I had a CT done and over a week ago due to painful cramping in my stomach area and there were no signs of tumors or inflammation in my pancreas (in reference to the Lipase number). I would supply you with the numbers now, but going between screens have caused the last four messages I’ve try to send you delete on this platform.
I’m sorry for giving symptom overload to you over the last few months. My anxiety had gotten the best of me for that time. I’ve come to understand that there is no direct and fast answer to my current condition. We are all hoping for the best and I’m praying every moment to have my health improve. I would like to thank you for all your effort in educating me and examining me. I did not mean to be an annoyance in any way. I’m a husband and father fearful of his health situation and I have some symptoms that cause me major concern.
I’m not sure what happens from here, as concerning my visit to the local neurologist. I plan on keeping you abreast of the findings. You are very, very respected and appreciated by me. I do not want to be a patient that is the (oh here we go again) or (now what’s next) or anything of that nature. As I sit here typing this I have twitching in my forearms, shoulders, arms. This is scary stuff.
I would appreciate if you accept this list that I write clearly of my symptoms for your records (wiping the slate of all others)
Fasciculations in both shoulders (front, outer, rear delts)
Fasciculation's in the temple areas and right jaw muscle daily
Fasics in bicep, triceps - in focal and same areas both right and left arms
Fasics appearing in forearms both sides
Occasional fasic chest (collar bone area) new.
Focal fasics on beltline.
Nonstop fasics in calves down to arch of feet.
Fasics in elbow areas.
Lesser resistance to force on right hand ring finger
Tightness in forearm with burning like sentation when in use. The tightness is also behind wrist. Areas of forearm fasciculate after use (right mostly)
Fasics in glutes when laying down and some in lower back. Occasional fasics in hamstring areas.
When I use the term fasic, they vary in type. On my quad they’ll appear and pulse 5-10 times and the glutes are the same
Some on my calves are felt and most are not but visable.
The fasics in my arms and shoulders are focal in location on each nearly in the middle of each muscle groups (bicep, triceps). They inner and outer elbow locations as well. The arms and shoulders are more constant than forearms at this time.
Slower sponge like effect when opening and closing right hand. Fingers feel heavier and have a fullness effect. Tightness and burning sensation when using fingers in the hand going down both sides of forearms.
My fasciculations have been more steady and haven’t increased due to anxious moments. 90% of the time they are the same with exception to the calves that tend to fluctuate.
Occasional cramping around the belly button, and side where the noted pea sized bumps are located. At the moment appear sore to the touch - around lower abdomen.
Again, I know I’ve shared this before, but in all fairness to you, not in this detail.
I will take a step back for now and not scratch the itch that I have. I wanted to be clear and concise with my symptoms because these have been the most consistent of all that I’ve spoken of over the last 10 or so weeks of consult.
Again, I’m not by any means ruling out XXXXXXX at this moment I almost wish I was living there to get everything taken care of. But the best plan - as I’m sure you would agree is to take the consult I have here on the 30th.
I appreciate you, and promise only to reach out with something of significance. If you’d like to have access to any of the recent labs, I will try to figure out how to send them on this platform.
I hope that you have and great remainder of the week and enjoyable holiday. Thank you so much again!
I received a call from the local neuro and he has set an appointment for me on 5/30. I had a feeling once he received the report from the local clinic, he would set a consult. I apologize that the date conflicts with all that you have been arranging. I am truly, truly sorry. I am very appreciative of all your effort! I’m not saying that I will not make it to XXXXXXX but for the next day - that may be rather difficult. I’d also say that depending on his findings, I may not be in the mind state to travel truthfully. I do not believe he has arranged for and emg or ncs on that day.
The PA at the clinic yesterday found what he listed as “masses” on my lower right frontal quadrant. They are pea like lesions outside the muscle wall. They are sensitive to the touch - very much. They feel like radiating muscle cramps of which I believed them to be over the last 2/3 months. I will need to have my primary care doctor review them ASAP.
I also received lab result back from last Friday. My TSH, and Lipase levels are high. My BUN/Creatinine and eGFR are low (8 & 51). I had roughly 5 days of dehydration and I was unable to hold food down prior to the test. I will send you the numbers for the TSH and Lipase if you’d like. I had a CT done and over a week ago due to painful cramping in my stomach area and there were no signs of tumors or inflammation in my pancreas (in reference to the Lipase number). I would supply you with the numbers now, but going between screens have caused the last four messages I’ve try to send you delete on this platform.
I’m sorry for giving symptom overload to you over the last few months. My anxiety had gotten the best of me for that time. I’ve come to understand that there is no direct and fast answer to my current condition. We are all hoping for the best and I’m praying every moment to have my health improve. I would like to thank you for all your effort in educating me and examining me. I did not mean to be an annoyance in any way. I’m a husband and father fearful of his health situation and I have some symptoms that cause me major concern.
I’m not sure what happens from here, as concerning my visit to the local neurologist. I plan on keeping you abreast of the findings. You are very, very respected and appreciated by me. I do not want to be a patient that is the (oh here we go again) or (now what’s next) or anything of that nature. As I sit here typing this I have twitching in my forearms, shoulders, arms. This is scary stuff.
I would appreciate if you accept this list that I write clearly of my symptoms for your records (wiping the slate of all others)
Fasciculations in both shoulders (front, outer, rear delts)
Fasciculation's in the temple areas and right jaw muscle daily
Fasics in bicep, triceps - in focal and same areas both right and left arms
Fasics appearing in forearms both sides
Occasional fasic chest (collar bone area) new.
Focal fasics on beltline.
Nonstop fasics in calves down to arch of feet.
Fasics in elbow areas.
Lesser resistance to force on right hand ring finger
Tightness in forearm with burning like sentation when in use. The tightness is also behind wrist. Areas of forearm fasciculate after use (right mostly)
Fasics in glutes when laying down and some in lower back. Occasional fasics in hamstring areas.
When I use the term fasic, they vary in type. On my quad they’ll appear and pulse 5-10 times and the glutes are the same
Some on my calves are felt and most are not but visable.
The fasics in my arms and shoulders are focal in location on each nearly in the middle of each muscle groups (bicep, triceps). They inner and outer elbow locations as well. The arms and shoulders are more constant than forearms at this time.
Slower sponge like effect when opening and closing right hand. Fingers feel heavier and have a fullness effect. Tightness and burning sensation when using fingers in the hand going down both sides of forearms.
My fasciculations have been more steady and haven’t increased due to anxious moments. 90% of the time they are the same with exception to the calves that tend to fluctuate.
Occasional cramping around the belly button, and side where the noted pea sized bumps are located. At the moment appear sore to the touch - around lower abdomen.
Again, I know I’ve shared this before, but in all fairness to you, not in this detail.
I will take a step back for now and not scratch the itch that I have. I wanted to be clear and concise with my symptoms because these have been the most consistent of all that I’ve spoken of over the last 10 or so weeks of consult.
Again, I’m not by any means ruling out XXXXXXX at this moment I almost wish I was living there to get everything taken care of. But the best plan - as I’m sure you would agree is to take the consult I have here on the 30th.
I appreciate you, and promise only to reach out with something of significance. If you’d like to have access to any of the recent labs, I will try to figure out how to send them on this platform.
I hope that you have and great remainder of the week and enjoyable holiday. Thank you so much again!
Dr. Saghafi,
I received a call from the local neuro and he has set an appointment for me on 5/30. I had a feeling once he received the report from the local clinic, he would set a consult. I apologize that the date conflicts with all that you have been arranging. I am truly, truly sorry. I am very appreciative of all your effort! I’m not saying that I will not make it to XXXXXXX but for the next day - that may be rather difficult. I’d also say that depending on his findings, I may not be in the mind state to travel truthfully. I do not believe he has arranged for and emg or ncs on that day.
The PA at the clinic yesterday found what he listed as “masses” on my lower right frontal quadrant. They are pea like lesions outside the muscle wall. They are sensitive to the touch - very much. They feel like radiating muscle cramps of which I believed them to be over the last 2/3 months. I will need to have my primary care doctor review them ASAP.
I also received lab result back from last Friday. My TSH, and Lipase levels are high. My BUN/Creatinine and eGFR are low (8 & 51). I had roughly 5 days of dehydration and I was unable to hold food down prior to the test. I will send you the numbers for the TSH and Lipase if you’d like. I had a CT done and over a week ago due to painful cramping in my stomach area and there were no signs of tumors or inflammation in my pancreas (in reference to the Lipase number). I would supply you with the numbers now, but going between screens have caused the last four messages I’ve try to send you delete on this platform.
I’m sorry for giving symptom overload to you over the last few months. My anxiety had gotten the best of me for that time. I’ve come to understand that there is no direct and fast answer to my current condition. We are all hoping for the best and I’m praying every moment to have my health improve. I would like to thank you for all your effort in educating me and examining me. I did not mean to be an annoyance in any way. I’m a husband and father fearful of his health situation and I have some symptoms that cause me major concern.
I’m not sure what happens from here, as concerning my visit to the local neurologist. I plan on keeping you abreast of the findings. You are very, very respected and appreciated by me. I do not want to be a patient that is the (oh here we go again) or (now what’s next) or anything of that nature. As I sit here typing this I have twitching in my forearms, shoulders, arms. This is scary stuff.
I would appreciate if you accept this list that I write clearly of my symptoms for your records (wiping the slate of all others)
Fasciculations in both shoulders (front, outer, rear delts)
Fasciculation's in the temple areas and right jaw muscle daily
Fasics in bicep, triceps - in focal and same areas both right and left arms
Fasics appearing in forearms both sides
Occasional fasic chest (collar bone area) new.
Focal fasics on beltline.
Nonstop fasics in calves down to arch of feet.
Fasics in elbow areas.
Lesser resistance to force on right hand ring finger
Tightness in forearm with burning like sentation when in use. The tightness is also behind wrist. Areas of forearm fasciculate after use (right mostly)
Fasics in glutes when laying down and some in lower back. Occasional fasics in hamstring areas.
When I use the term fasic, they vary in type. On my quad they’ll appear and pulse 5-10 times and the glutes are the same
Some on my calves are felt and most are not but visable.
The fasics in my arms and shoulders are focal in location on each nearly in the middle of each muscle groups (bicep, triceps). They inner and outer elbow locations as well. The arms and shoulders are more constant than forearms at this time.
Slower sponge like effect when opening and closing right hand. Fingers feel heavier and have a fullness effect. Tightness and burning sensation when using fingers in the hand going down both sides of forearms.
My fasciculations have been more steady and haven’t increased due to anxious moments. 90% of the time they are the same with exception to the calves that tend to fluctuate.
Occasional cramping around the belly button, and side where the noted pea sized bumps are located. At the moment appear sore to the touch - around lower abdomen.
Again, I know I’ve shared this before, but in all fairness to you, not in this detail.
I will take a step back for now and not scratch the itch that I have. I wanted to be clear and concise with my symptoms because these have been the most consistent of all that I’ve spoken of over the last 10 or so weeks of consult.
Again, I’m not by any means ruling out XXXXXXX at this moment I almost wish I was living there to get everything taken care of. But the best plan - as I’m sure you would agree is to take the consult I have here on the 30th.
I appreciate you, and promise only to reach out with something of significance. If you’d like to have access to any of the recent labs, I will try to figure out how to send them on this platform.
I hope that you have and great remainder of the week and enjoyable holiday. Thank you so much again!
I received a call from the local neuro and he has set an appointment for me on 5/30. I had a feeling once he received the report from the local clinic, he would set a consult. I apologize that the date conflicts with all that you have been arranging. I am truly, truly sorry. I am very appreciative of all your effort! I’m not saying that I will not make it to XXXXXXX but for the next day - that may be rather difficult. I’d also say that depending on his findings, I may not be in the mind state to travel truthfully. I do not believe he has arranged for and emg or ncs on that day.
The PA at the clinic yesterday found what he listed as “masses” on my lower right frontal quadrant. They are pea like lesions outside the muscle wall. They are sensitive to the touch - very much. They feel like radiating muscle cramps of which I believed them to be over the last 2/3 months. I will need to have my primary care doctor review them ASAP.
I also received lab result back from last Friday. My TSH, and Lipase levels are high. My BUN/Creatinine and eGFR are low (8 & 51). I had roughly 5 days of dehydration and I was unable to hold food down prior to the test. I will send you the numbers for the TSH and Lipase if you’d like. I had a CT done and over a week ago due to painful cramping in my stomach area and there were no signs of tumors or inflammation in my pancreas (in reference to the Lipase number). I would supply you with the numbers now, but going between screens have caused the last four messages I’ve try to send you delete on this platform.
I’m sorry for giving symptom overload to you over the last few months. My anxiety had gotten the best of me for that time. I’ve come to understand that there is no direct and fast answer to my current condition. We are all hoping for the best and I’m praying every moment to have my health improve. I would like to thank you for all your effort in educating me and examining me. I did not mean to be an annoyance in any way. I’m a husband and father fearful of his health situation and I have some symptoms that cause me major concern.
I’m not sure what happens from here, as concerning my visit to the local neurologist. I plan on keeping you abreast of the findings. You are very, very respected and appreciated by me. I do not want to be a patient that is the (oh here we go again) or (now what’s next) or anything of that nature. As I sit here typing this I have twitching in my forearms, shoulders, arms. This is scary stuff.
I would appreciate if you accept this list that I write clearly of my symptoms for your records (wiping the slate of all others)
Fasciculations in both shoulders (front, outer, rear delts)
Fasciculation's in the temple areas and right jaw muscle daily
Fasics in bicep, triceps - in focal and same areas both right and left arms
Fasics appearing in forearms both sides
Occasional fasic chest (collar bone area) new.
Focal fasics on beltline.
Nonstop fasics in calves down to arch of feet.
Fasics in elbow areas.
Lesser resistance to force on right hand ring finger
Tightness in forearm with burning like sentation when in use. The tightness is also behind wrist. Areas of forearm fasciculate after use (right mostly)
Fasics in glutes when laying down and some in lower back. Occasional fasics in hamstring areas.
When I use the term fasic, they vary in type. On my quad they’ll appear and pulse 5-10 times and the glutes are the same
Some on my calves are felt and most are not but visable.
The fasics in my arms and shoulders are focal in location on each nearly in the middle of each muscle groups (bicep, triceps). They inner and outer elbow locations as well. The arms and shoulders are more constant than forearms at this time.
Slower sponge like effect when opening and closing right hand. Fingers feel heavier and have a fullness effect. Tightness and burning sensation when using fingers in the hand going down both sides of forearms.
My fasciculations have been more steady and haven’t increased due to anxious moments. 90% of the time they are the same with exception to the calves that tend to fluctuate.
Occasional cramping around the belly button, and side where the noted pea sized bumps are located. At the moment appear sore to the touch - around lower abdomen.
Again, I know I’ve shared this before, but in all fairness to you, not in this detail.
I will take a step back for now and not scratch the itch that I have. I wanted to be clear and concise with my symptoms because these have been the most consistent of all that I’ve spoken of over the last 10 or so weeks of consult.
Again, I’m not by any means ruling out XXXXXXX at this moment I almost wish I was living there to get everything taken care of. But the best plan - as I’m sure you would agree is to take the consult I have here on the 30th.
I appreciate you, and promise only to reach out with something of significance. If you’d like to have access to any of the recent labs, I will try to figure out how to send them on this platform.
I hope that you have and great remainder of the week and enjoyable holiday. Thank you so much again!
Brief Answer:
Thank you for your clarifications of symptoms
Detailed Answer:
Many thanks for putting together a list of symptoms that summarizes what is currently going on with regard to your muscle twitching. In conjunction with the video clips that I've seen and our conversations I am very confident in the fact that you do are not exhbiting any signs nor symptoms of motor neuron disease, not of the ALS type and not of any other type.
Since you've also now revealed that there are some other abnormal laboratory findings along with a complaint of flank pain and then, the "pea sized" nodules I think it would be prudent to make sure metabolically and biochemically speaking as well as anatomically speaking everything is in order. You'll recall the recent list of other tests that I recommend doing at this point. I've also still not personally seen any of the lab or imaging reports that I've either ordered or recommended. You are at your XXXXXXX to share those with me and as I've said before, all of that information could be uploaded to this network by scanning into PDF format. Alternatively, you could FAX things to my office, or your plan were to come to XXXXXXX in the future, you could certainly hand carry the results.
At this point with the current situation of some possibly thyroid problems and/or other things that need to be looked at with respect to the kidneys or GI tract I think it is perfectly reasonable to forego any EMG examination until such time as you know that there are no explanations or problems to correct because the results of the EMG are really not as helpful if there were suspicious that you were suffering from either hypo or hyperthyroidism. So again, if you wish to have clean results from the tests you are taking time and likely spending money doing then, you should do them in a logical sequence.
I am aware that University Hospitals did contact you yesterday and so I would leave further scheduling arrangements between you and they. If you decide that you would still like to get this study done despite other things still being a question mark then, by all means you can make your plans and firm up the date and time with Dr. Katirji's office to get that done. My understanding is that they were working to confirm the May 31st date and time so again, I'd ask that you stay on top of that since I don't have any control over his schedule.
If you will be coming to XXXXXXX at some point for that testing then, it would make sense for me to take a look at you beforehand. You can certainly reach out either through this platform or by calling our office at 440.842.3816 to set up an appointment. I would be remiss in reminding you that the therapy sessions I was talking about with Drs. Roush and Van Keuren remain a solid part of any treatment plan going forward no matter the diagnosis in this case. We know the psychological and physical are so intertwined with another that one cannot properly heal or maintain itself in good health without the other. They are really the Ying and XXXXXXX of Total and Perfect Human Well Being. Therefore, if a trip to XXXXXXX is in the offing I highly recommend that we try and get at least a couple of sessions for you with these excellent doctors who can offer much good information and techniques of stress/anxiety management not only for the present situation but for any other health related challenges you are bound to meet going forward, we all do!
Many thanks once again for all the kind comments regarding my services. I do hope they have in some small measure helped keep you comfortable though the distance certainly has worked to make that as difficult as possible.
Cheers! And as always, your CLOSING the query and leaving your public feedback is also graciously appreciated.
This query has required 105 minutes total time in reading, researching, and synthesizing a final response for the patient.
Thank you for your clarifications of symptoms
Detailed Answer:
Many thanks for putting together a list of symptoms that summarizes what is currently going on with regard to your muscle twitching. In conjunction with the video clips that I've seen and our conversations I am very confident in the fact that you do are not exhbiting any signs nor symptoms of motor neuron disease, not of the ALS type and not of any other type.
Since you've also now revealed that there are some other abnormal laboratory findings along with a complaint of flank pain and then, the "pea sized" nodules I think it would be prudent to make sure metabolically and biochemically speaking as well as anatomically speaking everything is in order. You'll recall the recent list of other tests that I recommend doing at this point. I've also still not personally seen any of the lab or imaging reports that I've either ordered or recommended. You are at your XXXXXXX to share those with me and as I've said before, all of that information could be uploaded to this network by scanning into PDF format. Alternatively, you could FAX things to my office, or your plan were to come to XXXXXXX in the future, you could certainly hand carry the results.
At this point with the current situation of some possibly thyroid problems and/or other things that need to be looked at with respect to the kidneys or GI tract I think it is perfectly reasonable to forego any EMG examination until such time as you know that there are no explanations or problems to correct because the results of the EMG are really not as helpful if there were suspicious that you were suffering from either hypo or hyperthyroidism. So again, if you wish to have clean results from the tests you are taking time and likely spending money doing then, you should do them in a logical sequence.
I am aware that University Hospitals did contact you yesterday and so I would leave further scheduling arrangements between you and they. If you decide that you would still like to get this study done despite other things still being a question mark then, by all means you can make your plans and firm up the date and time with Dr. Katirji's office to get that done. My understanding is that they were working to confirm the May 31st date and time so again, I'd ask that you stay on top of that since I don't have any control over his schedule.
If you will be coming to XXXXXXX at some point for that testing then, it would make sense for me to take a look at you beforehand. You can certainly reach out either through this platform or by calling our office at 440.842.3816 to set up an appointment. I would be remiss in reminding you that the therapy sessions I was talking about with Drs. Roush and Van Keuren remain a solid part of any treatment plan going forward no matter the diagnosis in this case. We know the psychological and physical are so intertwined with another that one cannot properly heal or maintain itself in good health without the other. They are really the Ying and XXXXXXX of Total and Perfect Human Well Being. Therefore, if a trip to XXXXXXX is in the offing I highly recommend that we try and get at least a couple of sessions for you with these excellent doctors who can offer much good information and techniques of stress/anxiety management not only for the present situation but for any other health related challenges you are bound to meet going forward, we all do!
Many thanks once again for all the kind comments regarding my services. I do hope they have in some small measure helped keep you comfortable though the distance certainly has worked to make that as difficult as possible.
Cheers! And as always, your CLOSING the query and leaving your public feedback is also graciously appreciated.
This query has required 105 minutes total time in reading, researching, and synthesizing a final response for the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Thank you for your clarifications of symptoms
Detailed Answer:
Many thanks for putting together a list of symptoms that summarizes what is currently going on with regard to your muscle twitching. In conjunction with the video clips that I've seen and our conversations I am very confident in the fact that you do are not exhbiting any signs nor symptoms of motor neuron disease, not of the ALS type and not of any other type.
Since you've also now revealed that there are some other abnormal laboratory findings along with a complaint of flank pain and then, the "pea sized" nodules I think it would be prudent to make sure metabolically and biochemically speaking as well as anatomically speaking everything is in order. You'll recall the recent list of other tests that I recommend doing at this point. I've also still not personally seen any of the lab or imaging reports that I've either ordered or recommended. You are at your XXXXXXX to share those with me and as I've said before, all of that information could be uploaded to this network by scanning into PDF format. Alternatively, you could FAX things to my office, or your plan were to come to XXXXXXX in the future, you could certainly hand carry the results.
At this point with the current situation of some possibly thyroid problems and/or other things that need to be looked at with respect to the kidneys or GI tract I think it is perfectly reasonable to forego any EMG examination until such time as you know that there are no explanations or problems to correct because the results of the EMG are really not as helpful if there were suspicious that you were suffering from either hypo or hyperthyroidism. So again, if you wish to have clean results from the tests you are taking time and likely spending money doing then, you should do them in a logical sequence.
I am aware that University Hospitals did contact you yesterday and so I would leave further scheduling arrangements between you and they. If you decide that you would still like to get this study done despite other things still being a question mark then, by all means you can make your plans and firm up the date and time with Dr. Katirji's office to get that done. My understanding is that they were working to confirm the May 31st date and time so again, I'd ask that you stay on top of that since I don't have any control over his schedule.
If you will be coming to XXXXXXX at some point for that testing then, it would make sense for me to take a look at you beforehand. You can certainly reach out either through this platform or by calling our office at 440.842.3816 to set up an appointment. I would be remiss in reminding you that the therapy sessions I was talking about with Drs. Roush and Van Keuren remain a solid part of any treatment plan going forward no matter the diagnosis in this case. We know the psychological and physical are so intertwined with another that one cannot properly heal or maintain itself in good health without the other. They are really the Ying and XXXXXXX of Total and Perfect Human Well Being. Therefore, if a trip to XXXXXXX is in the offing I highly recommend that we try and get at least a couple of sessions for you with these excellent doctors who can offer much good information and techniques of stress/anxiety management not only for the present situation but for any other health related challenges you are bound to meet going forward, we all do!
Many thanks once again for all the kind comments regarding my services. I do hope they have in some small measure helped keep you comfortable though the distance certainly has worked to make that as difficult as possible.
Cheers! And as always, your CLOSING the query and leaving your public feedback is also graciously appreciated.
This query has required 105 minutes total time in reading, researching, and synthesizing a final response for the patient.
Thank you for your clarifications of symptoms
Detailed Answer:
Many thanks for putting together a list of symptoms that summarizes what is currently going on with regard to your muscle twitching. In conjunction with the video clips that I've seen and our conversations I am very confident in the fact that you do are not exhbiting any signs nor symptoms of motor neuron disease, not of the ALS type and not of any other type.
Since you've also now revealed that there are some other abnormal laboratory findings along with a complaint of flank pain and then, the "pea sized" nodules I think it would be prudent to make sure metabolically and biochemically speaking as well as anatomically speaking everything is in order. You'll recall the recent list of other tests that I recommend doing at this point. I've also still not personally seen any of the lab or imaging reports that I've either ordered or recommended. You are at your XXXXXXX to share those with me and as I've said before, all of that information could be uploaded to this network by scanning into PDF format. Alternatively, you could FAX things to my office, or your plan were to come to XXXXXXX in the future, you could certainly hand carry the results.
At this point with the current situation of some possibly thyroid problems and/or other things that need to be looked at with respect to the kidneys or GI tract I think it is perfectly reasonable to forego any EMG examination until such time as you know that there are no explanations or problems to correct because the results of the EMG are really not as helpful if there were suspicious that you were suffering from either hypo or hyperthyroidism. So again, if you wish to have clean results from the tests you are taking time and likely spending money doing then, you should do them in a logical sequence.
I am aware that University Hospitals did contact you yesterday and so I would leave further scheduling arrangements between you and they. If you decide that you would still like to get this study done despite other things still being a question mark then, by all means you can make your plans and firm up the date and time with Dr. Katirji's office to get that done. My understanding is that they were working to confirm the May 31st date and time so again, I'd ask that you stay on top of that since I don't have any control over his schedule.
If you will be coming to XXXXXXX at some point for that testing then, it would make sense for me to take a look at you beforehand. You can certainly reach out either through this platform or by calling our office at 440.842.3816 to set up an appointment. I would be remiss in reminding you that the therapy sessions I was talking about with Drs. Roush and Van Keuren remain a solid part of any treatment plan going forward no matter the diagnosis in this case. We know the psychological and physical are so intertwined with another that one cannot properly heal or maintain itself in good health without the other. They are really the Ying and XXXXXXX of Total and Perfect Human Well Being. Therefore, if a trip to XXXXXXX is in the offing I highly recommend that we try and get at least a couple of sessions for you with these excellent doctors who can offer much good information and techniques of stress/anxiety management not only for the present situation but for any other health related challenges you are bound to meet going forward, we all do!
Many thanks once again for all the kind comments regarding my services. I do hope they have in some small measure helped keep you comfortable though the distance certainly has worked to make that as difficult as possible.
Cheers! And as always, your CLOSING the query and leaving your public feedback is also graciously appreciated.
This query has required 105 minutes total time in reading, researching, and synthesizing a final response for the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. Saghafi,
I just wanted to keep you updated. I can clearly feel the weekends in my right arm now. The sense of tiredness is apparent of using it. It feels like it’s been through some sort of physical exercise. That kind of weakness. Lifting objects seem to call on my muscle to fasciculate more In the areas of my arms and shoulder. I’m getting fascis in my arms more often, so it seems the intensity is getting there. The other day white tying my shoe, my right hand had the feeling of having done a strenuous exercise. I’ll be in touch with you concerning my findings on Thursday. I’d like to stress these are physical symptoms that I feel now beyond the “it may be” statements from before. As of now, an emg is scheduled on the 10th of XXXXXXX I’ve also had another negative lime test. No results back yet on my Lipase and thyroid.
Thank you and take care. Enjoy your weekend
I just wanted to keep you updated. I can clearly feel the weekends in my right arm now. The sense of tiredness is apparent of using it. It feels like it’s been through some sort of physical exercise. That kind of weakness. Lifting objects seem to call on my muscle to fasciculate more In the areas of my arms and shoulder. I’m getting fascis in my arms more often, so it seems the intensity is getting there. The other day white tying my shoe, my right hand had the feeling of having done a strenuous exercise. I’ll be in touch with you concerning my findings on Thursday. I’d like to stress these are physical symptoms that I feel now beyond the “it may be” statements from before. As of now, an emg is scheduled on the 10th of XXXXXXX I’ve also had another negative lime test. No results back yet on my Lipase and thyroid.
Thank you and take care. Enjoy your weekend
Hello Dr. Saghafi,
I just wanted to keep you updated. I can clearly feel the weekends in my right arm now. The sense of tiredness is apparent of using it. It feels like it’s been through some sort of physical exercise. That kind of weakness. Lifting objects seem to call on my muscle to fasciculate more In the areas of my arms and shoulder. I’m getting fascis in my arms more often, so it seems the intensity is getting there. The other day white tying my shoe, my right hand had the feeling of having done a strenuous exercise. I’ll be in touch with you concerning my findings on Thursday. I’d like to stress these are physical symptoms that I feel now beyond the “it may be” statements from before. As of now, an emg is scheduled on the 10th of XXXXXXX I’ve also had another negative lime test. No results back yet on my Lipase and thyroid.
Thank you and take care. Enjoy your weekend
I just wanted to keep you updated. I can clearly feel the weekends in my right arm now. The sense of tiredness is apparent of using it. It feels like it’s been through some sort of physical exercise. That kind of weakness. Lifting objects seem to call on my muscle to fasciculate more In the areas of my arms and shoulder. I’m getting fascis in my arms more often, so it seems the intensity is getting there. The other day white tying my shoe, my right hand had the feeling of having done a strenuous exercise. I’ll be in touch with you concerning my findings on Thursday. I’d like to stress these are physical symptoms that I feel now beyond the “it may be” statements from before. As of now, an emg is scheduled on the 10th of XXXXXXX I’ve also had another negative lime test. No results back yet on my Lipase and thyroid.
Thank you and take care. Enjoy your weekend
Brief Answer:
Happy that Lyme testing was negative
Detailed Answer:
Thanks for the update on your right arm. A neurological examination would help to localize the muscle group that is asymmetrically weak with the left side. So, is the EMG/NCV for XXXXXXX 10th with your local neurologist or with Dr. Katirji? Last I had heard at University Hospitals there was a tentative date of May 31st.
Lipase testing is for the purpose of detecting problems with the pancreas. Amylase is usually obtained as well which can help underscore the pancreas as normal in the event the lipase is also normal. Just as a reminder I've not seen the actual reported results for the lab tests we ordered or the MRI of the brain and c-spine I ordered from April. Feel free to attach as PDF files to this thread or send by FAX to the office. And part of the reports I'd also be interested in seeing would be your oncologist's last recorded visit and testing results having to do with your partially nephrectomized kidney.
Have a nice Memorial Day with your family as well.
Happy that Lyme testing was negative
Detailed Answer:
Thanks for the update on your right arm. A neurological examination would help to localize the muscle group that is asymmetrically weak with the left side. So, is the EMG/NCV for XXXXXXX 10th with your local neurologist or with Dr. Katirji? Last I had heard at University Hospitals there was a tentative date of May 31st.
Lipase testing is for the purpose of detecting problems with the pancreas. Amylase is usually obtained as well which can help underscore the pancreas as normal in the event the lipase is also normal. Just as a reminder I've not seen the actual reported results for the lab tests we ordered or the MRI of the brain and c-spine I ordered from April. Feel free to attach as PDF files to this thread or send by FAX to the office. And part of the reports I'd also be interested in seeing would be your oncologist's last recorded visit and testing results having to do with your partially nephrectomized kidney.
Have a nice Memorial Day with your family as well.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Happy that Lyme testing was negative
Detailed Answer:
Thanks for the update on your right arm. A neurological examination would help to localize the muscle group that is asymmetrically weak with the left side. So, is the EMG/NCV for XXXXXXX 10th with your local neurologist or with Dr. Katirji? Last I had heard at University Hospitals there was a tentative date of May 31st.
Lipase testing is for the purpose of detecting problems with the pancreas. Amylase is usually obtained as well which can help underscore the pancreas as normal in the event the lipase is also normal. Just as a reminder I've not seen the actual reported results for the lab tests we ordered or the MRI of the brain and c-spine I ordered from April. Feel free to attach as PDF files to this thread or send by FAX to the office. And part of the reports I'd also be interested in seeing would be your oncologist's last recorded visit and testing results having to do with your partially nephrectomized kidney.
Have a nice Memorial Day with your family as well.
Happy that Lyme testing was negative
Detailed Answer:
Thanks for the update on your right arm. A neurological examination would help to localize the muscle group that is asymmetrically weak with the left side. So, is the EMG/NCV for XXXXXXX 10th with your local neurologist or with Dr. Katirji? Last I had heard at University Hospitals there was a tentative date of May 31st.
Lipase testing is for the purpose of detecting problems with the pancreas. Amylase is usually obtained as well which can help underscore the pancreas as normal in the event the lipase is also normal. Just as a reminder I've not seen the actual reported results for the lab tests we ordered or the MRI of the brain and c-spine I ordered from April. Feel free to attach as PDF files to this thread or send by FAX to the office. And part of the reports I'd also be interested in seeing would be your oncologist's last recorded visit and testing results having to do with your partially nephrectomized kidney.
Have a nice Memorial Day with your family as well.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Saghafi
Unfortunately, I have tongue fasciculations and my wife has seen them as well. I’m already having difficulty swallowing. I’m not the normal case I guess. I was trying to do neck bridges and I cannot do them as I did before. I have twtiching in the muscle under my chin now. I do not understand how rapid things are happening. I have a different odd taste in my mouth for the past few days as well. I have to drink water to get vegetables down.
Unfortunately, I have tongue fasciculations and my wife has seen them as well. I’m already having difficulty swallowing. I’m not the normal case I guess. I was trying to do neck bridges and I cannot do them as I did before. I have twtiching in the muscle under my chin now. I do not understand how rapid things are happening. I have a different odd taste in my mouth for the past few days as well. I have to drink water to get vegetables down.
Dr. Saghafi
Unfortunately, I have tongue fasciculations and my wife has seen them as well. I’m already having difficulty swallowing. I’m not the normal case I guess. I was trying to do neck bridges and I cannot do them as I did before. I have twtiching in the muscle under my chin now. I do not understand how rapid things are happening. I have a different odd taste in my mouth for the past few days as well. I have to drink water to get vegetables down.
Unfortunately, I have tongue fasciculations and my wife has seen them as well. I’m already having difficulty swallowing. I’m not the normal case I guess. I was trying to do neck bridges and I cannot do them as I did before. I have twtiching in the muscle under my chin now. I do not understand how rapid things are happening. I have a different odd taste in my mouth for the past few days as well. I have to drink water to get vegetables down.
Brief Answer:
Rapidity of these symptoms very uncharacteristic for MND...nevertheless
Detailed Answer:
Good morning sir:
Sorry, to hear that you are now being bothered by symptoms that are striking in the "neck up" region. I have read the constellation of symptoms through several times and reread our notes from before looking at the timeline and distribution of your symptoms including your last summary from a week ago when you put together everything that was going on with respect to twitches, fasciculations, and motor weakness as to localizations, intensity, and ways you and your wife have been keeping tabs on progression.
You did recently write something about your thyroid numbers as coming back out of the norm but I've not heard or seen the results of those tests. I can tell you that a condition of either HYPER or HYPOTHYROIDISM can better explain the symptoms you're describing (as well as their rapid progression) more concisely and reasonably (including the change in taste you mention for the first time) compared to any of the motor neuron diseases such as either ALS, PMA, or PLS. I'm saving time using abbreviations because I know you've studied all of these entities. I will not bore you either with a lot of FACTS as to each one of these TYPICALLY starts, evolves, or progresses....because again, we've discussed these details not just in this forum but in person, and multiple times on the telephone.
The fact is I believe another good neurological examination is well worth your while +/- the electrical study which you say is scheduled for XXXXXXX 10th. You did not specify for me whether that test was being performed in CT or whether you had scheduled it with Dr. Katirji, my assumption is that you scheduled it locally which I believe is quite reasonable and will yield very adequate results if being done by an expert technician and read by a neuromuscular expert or at least a NEUROLOGIST who has examined you and knows what to look for in the study.
I continue to maintain that the NEUROLOGICAL EXAMINATION and history or the past 12-13 weeks remain the cornerstones for accurate diagnosis in your case. Also, very importantly we need judicious and relevant labs and other diagnostic testing of items that are relevant to rule out systemic or metabolic disease (such as a DYSTHYROID state) or renal/pancreas issues that can at the very least cause the fasciculations that you've been having. I continue to advocate AGAINST any type of "everything INCLUDING the kitchen sink approach!"....I'm sure you're in agreement. Let the results of the examination guide the next steps to diagnostic or lab testing. This type of problem cannot be diagnosed on the basis of labs and images or invasive testing and that includes biopsies. You need all your good tissue samples...on deck and ready to work....UNLESS specifically, warranted.
I'm hopeful that your local neurologist will be able to see you prior to the XXXXXXX study so that additional information can be added to the previous data and combined with the electrical results to come to a better semblance of what is going on. Of course, I'm happy to make time for you as well if that would be of use though the distance and cost of returning to XXXXXXX for only a neurological examination hardly seems convenient nor financially frugal....nevertheless, it is an option that is available to you.
Please let me know if that is of interest to you since next week in the evenings I am tied up every night. If we did meet it would need to be either on Tuesday or Wed. morning or it could also be Saturday early morning. We could also do a Sunday morning (8a) if desired.
This query has required 180 minutes total time in reading, researching, and synthesizing a final response for the patient.
Rapidity of these symptoms very uncharacteristic for MND...nevertheless
Detailed Answer:
Good morning sir:
Sorry, to hear that you are now being bothered by symptoms that are striking in the "neck up" region. I have read the constellation of symptoms through several times and reread our notes from before looking at the timeline and distribution of your symptoms including your last summary from a week ago when you put together everything that was going on with respect to twitches, fasciculations, and motor weakness as to localizations, intensity, and ways you and your wife have been keeping tabs on progression.
You did recently write something about your thyroid numbers as coming back out of the norm but I've not heard or seen the results of those tests. I can tell you that a condition of either HYPER or HYPOTHYROIDISM can better explain the symptoms you're describing (as well as their rapid progression) more concisely and reasonably (including the change in taste you mention for the first time) compared to any of the motor neuron diseases such as either ALS, PMA, or PLS. I'm saving time using abbreviations because I know you've studied all of these entities. I will not bore you either with a lot of FACTS as to each one of these TYPICALLY starts, evolves, or progresses....because again, we've discussed these details not just in this forum but in person, and multiple times on the telephone.
The fact is I believe another good neurological examination is well worth your while +/- the electrical study which you say is scheduled for XXXXXXX 10th. You did not specify for me whether that test was being performed in CT or whether you had scheduled it with Dr. Katirji, my assumption is that you scheduled it locally which I believe is quite reasonable and will yield very adequate results if being done by an expert technician and read by a neuromuscular expert or at least a NEUROLOGIST who has examined you and knows what to look for in the study.
I continue to maintain that the NEUROLOGICAL EXAMINATION and history or the past 12-13 weeks remain the cornerstones for accurate diagnosis in your case. Also, very importantly we need judicious and relevant labs and other diagnostic testing of items that are relevant to rule out systemic or metabolic disease (such as a DYSTHYROID state) or renal/pancreas issues that can at the very least cause the fasciculations that you've been having. I continue to advocate AGAINST any type of "everything INCLUDING the kitchen sink approach!"....I'm sure you're in agreement. Let the results of the examination guide the next steps to diagnostic or lab testing. This type of problem cannot be diagnosed on the basis of labs and images or invasive testing and that includes biopsies. You need all your good tissue samples...on deck and ready to work....UNLESS specifically, warranted.
I'm hopeful that your local neurologist will be able to see you prior to the XXXXXXX study so that additional information can be added to the previous data and combined with the electrical results to come to a better semblance of what is going on. Of course, I'm happy to make time for you as well if that would be of use though the distance and cost of returning to XXXXXXX for only a neurological examination hardly seems convenient nor financially frugal....nevertheless, it is an option that is available to you.
Please let me know if that is of interest to you since next week in the evenings I am tied up every night. If we did meet it would need to be either on Tuesday or Wed. morning or it could also be Saturday early morning. We could also do a Sunday morning (8a) if desired.
This query has required 180 minutes total time in reading, researching, and synthesizing a final response for the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Rapidity of these symptoms very uncharacteristic for MND...nevertheless
Detailed Answer:
Good morning sir:
Sorry, to hear that you are now being bothered by symptoms that are striking in the "neck up" region. I have read the constellation of symptoms through several times and reread our notes from before looking at the timeline and distribution of your symptoms including your last summary from a week ago when you put together everything that was going on with respect to twitches, fasciculations, and motor weakness as to localizations, intensity, and ways you and your wife have been keeping tabs on progression.
You did recently write something about your thyroid numbers as coming back out of the norm but I've not heard or seen the results of those tests. I can tell you that a condition of either HYPER or HYPOTHYROIDISM can better explain the symptoms you're describing (as well as their rapid progression) more concisely and reasonably (including the change in taste you mention for the first time) compared to any of the motor neuron diseases such as either ALS, PMA, or PLS. I'm saving time using abbreviations because I know you've studied all of these entities. I will not bore you either with a lot of FACTS as to each one of these TYPICALLY starts, evolves, or progresses....because again, we've discussed these details not just in this forum but in person, and multiple times on the telephone.
The fact is I believe another good neurological examination is well worth your while +/- the electrical study which you say is scheduled for XXXXXXX 10th. You did not specify for me whether that test was being performed in CT or whether you had scheduled it with Dr. Katirji, my assumption is that you scheduled it locally which I believe is quite reasonable and will yield very adequate results if being done by an expert technician and read by a neuromuscular expert or at least a NEUROLOGIST who has examined you and knows what to look for in the study.
I continue to maintain that the NEUROLOGICAL EXAMINATION and history or the past 12-13 weeks remain the cornerstones for accurate diagnosis in your case. Also, very importantly we need judicious and relevant labs and other diagnostic testing of items that are relevant to rule out systemic or metabolic disease (such as a DYSTHYROID state) or renal/pancreas issues that can at the very least cause the fasciculations that you've been having. I continue to advocate AGAINST any type of "everything INCLUDING the kitchen sink approach!"....I'm sure you're in agreement. Let the results of the examination guide the next steps to diagnostic or lab testing. This type of problem cannot be diagnosed on the basis of labs and images or invasive testing and that includes biopsies. You need all your good tissue samples...on deck and ready to work....UNLESS specifically, warranted.
I'm hopeful that your local neurologist will be able to see you prior to the XXXXXXX study so that additional information can be added to the previous data and combined with the electrical results to come to a better semblance of what is going on. Of course, I'm happy to make time for you as well if that would be of use though the distance and cost of returning to XXXXXXX for only a neurological examination hardly seems convenient nor financially frugal....nevertheless, it is an option that is available to you.
Please let me know if that is of interest to you since next week in the evenings I am tied up every night. If we did meet it would need to be either on Tuesday or Wed. morning or it could also be Saturday early morning. We could also do a Sunday morning (8a) if desired.
This query has required 180 minutes total time in reading, researching, and synthesizing a final response for the patient.
Rapidity of these symptoms very uncharacteristic for MND...nevertheless
Detailed Answer:
Good morning sir:
Sorry, to hear that you are now being bothered by symptoms that are striking in the "neck up" region. I have read the constellation of symptoms through several times and reread our notes from before looking at the timeline and distribution of your symptoms including your last summary from a week ago when you put together everything that was going on with respect to twitches, fasciculations, and motor weakness as to localizations, intensity, and ways you and your wife have been keeping tabs on progression.
You did recently write something about your thyroid numbers as coming back out of the norm but I've not heard or seen the results of those tests. I can tell you that a condition of either HYPER or HYPOTHYROIDISM can better explain the symptoms you're describing (as well as their rapid progression) more concisely and reasonably (including the change in taste you mention for the first time) compared to any of the motor neuron diseases such as either ALS, PMA, or PLS. I'm saving time using abbreviations because I know you've studied all of these entities. I will not bore you either with a lot of FACTS as to each one of these TYPICALLY starts, evolves, or progresses....because again, we've discussed these details not just in this forum but in person, and multiple times on the telephone.
The fact is I believe another good neurological examination is well worth your while +/- the electrical study which you say is scheduled for XXXXXXX 10th. You did not specify for me whether that test was being performed in CT or whether you had scheduled it with Dr. Katirji, my assumption is that you scheduled it locally which I believe is quite reasonable and will yield very adequate results if being done by an expert technician and read by a neuromuscular expert or at least a NEUROLOGIST who has examined you and knows what to look for in the study.
I continue to maintain that the NEUROLOGICAL EXAMINATION and history or the past 12-13 weeks remain the cornerstones for accurate diagnosis in your case. Also, very importantly we need judicious and relevant labs and other diagnostic testing of items that are relevant to rule out systemic or metabolic disease (such as a DYSTHYROID state) or renal/pancreas issues that can at the very least cause the fasciculations that you've been having. I continue to advocate AGAINST any type of "everything INCLUDING the kitchen sink approach!"....I'm sure you're in agreement. Let the results of the examination guide the next steps to diagnostic or lab testing. This type of problem cannot be diagnosed on the basis of labs and images or invasive testing and that includes biopsies. You need all your good tissue samples...on deck and ready to work....UNLESS specifically, warranted.
I'm hopeful that your local neurologist will be able to see you prior to the XXXXXXX study so that additional information can be added to the previous data and combined with the electrical results to come to a better semblance of what is going on. Of course, I'm happy to make time for you as well if that would be of use though the distance and cost of returning to XXXXXXX for only a neurological examination hardly seems convenient nor financially frugal....nevertheless, it is an option that is available to you.
Please let me know if that is of interest to you since next week in the evenings I am tied up every night. If we did meet it would need to be either on Tuesday or Wed. morning or it could also be Saturday early morning. We could also do a Sunday morning (8a) if desired.
This query has required 180 minutes total time in reading, researching, and synthesizing a final response for the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. Saghafi,
The Thyriod level came back normal. My primary care doctor just got the results today. Tomorrow I have an appointment with the local neuro in Norwich, CT. I know my symptoms list is of everything under the sun and there’s been no rhyme nor reason to how the symptoms are occurring and the pace of which. Today I had a jaw clinching incident (2). I was laying on my side to rest and had them. I don’t believe I was sleeping at either incident - I was relaxed. Once I have the new printer ink I will send you the info you’re been patiently awaiting. I received a call from Dr Katirji’s office today, and I informed them that I will be visiting the neuro here. I’m very thankful for their call. I don’t believe I’ll have an emg tomorrow, but I’m sure I will have one once he spots the tongue fasciculations. I have a slightly pitted area which it is occurring. Occasionally on the same side of the tongue also. Sudden onset. It’s very uncomfortable and disheartening for me. Thank you for your time. A second opinion in OH is NOT out of the picture.
The Thyriod level came back normal. My primary care doctor just got the results today. Tomorrow I have an appointment with the local neuro in Norwich, CT. I know my symptoms list is of everything under the sun and there’s been no rhyme nor reason to how the symptoms are occurring and the pace of which. Today I had a jaw clinching incident (2). I was laying on my side to rest and had them. I don’t believe I was sleeping at either incident - I was relaxed. Once I have the new printer ink I will send you the info you’re been patiently awaiting. I received a call from Dr Katirji’s office today, and I informed them that I will be visiting the neuro here. I’m very thankful for their call. I don’t believe I’ll have an emg tomorrow, but I’m sure I will have one once he spots the tongue fasciculations. I have a slightly pitted area which it is occurring. Occasionally on the same side of the tongue also. Sudden onset. It’s very uncomfortable and disheartening for me. Thank you for your time. A second opinion in OH is NOT out of the picture.
Hello Dr. Saghafi,
The Thyriod level came back normal. My primary care doctor just got the results today. Tomorrow I have an appointment with the local neuro in Norwich, CT. I know my symptoms list is of everything under the sun and there’s been no rhyme nor reason to how the symptoms are occurring and the pace of which. Today I had a jaw clinching incident (2). I was laying on my side to rest and had them. I don’t believe I was sleeping at either incident - I was relaxed. Once I have the new printer ink I will send you the info you’re been patiently awaiting. I received a call from Dr Katirji’s office today, and I informed them that I will be visiting the neuro here. I’m very thankful for their call. I don’t believe I’ll have an emg tomorrow, but I’m sure I will have one once he spots the tongue fasciculations. I have a slightly pitted area which it is occurring. Occasionally on the same side of the tongue also. Sudden onset. It’s very uncomfortable and disheartening for me. Thank you for your time. A second opinion in OH is NOT out of the picture.
The Thyriod level came back normal. My primary care doctor just got the results today. Tomorrow I have an appointment with the local neuro in Norwich, CT. I know my symptoms list is of everything under the sun and there’s been no rhyme nor reason to how the symptoms are occurring and the pace of which. Today I had a jaw clinching incident (2). I was laying on my side to rest and had them. I don’t believe I was sleeping at either incident - I was relaxed. Once I have the new printer ink I will send you the info you’re been patiently awaiting. I received a call from Dr Katirji’s office today, and I informed them that I will be visiting the neuro here. I’m very thankful for their call. I don’t believe I’ll have an emg tomorrow, but I’m sure I will have one once he spots the tongue fasciculations. I have a slightly pitted area which it is occurring. Occasionally on the same side of the tongue also. Sudden onset. It’s very uncomfortable and disheartening for me. Thank you for your time. A second opinion in OH is NOT out of the picture.
Brief Answer:
Glad that you will be examined once again soon
Detailed Answer:
I think it's great news that your THYROID came back normal.
I'm going to guess that you're only "half" happy for that news. BUT in my opinion (and after reading several messages you've written in the last couple of days), I intend on standing by my gut impression that whatever is going on in your case is unrelated to any form of MOTOR NEURON DISEASE based upon the rapidity of progression of your symptoms, the distribution and order of appearance of them, and the fact that you do NOT suffer from any discernible muscle atrophy anywhere in your body.
Therefore, in my estimation although I entirely and fully acknowledge that SOMETHING other than stress COULD be going on- my diagnostic differential remains tilted AWAY from any type of organic or fatal neurodegenerative process and maintain that if there is an organic process afoot it is being manifest by widespread peripheral nerve irritation by metabolic processes of some type.
I am once again extremely honored that you choose to continue seeking my advice and await to hear about a colleague's opinion on what's been going on and how best to approach its management. I am happy to offer you a re-examination if you think it helpful and will await to hear further news of how symptoms continue to evolve.
This query has required 210 minutes total time in reading, researching, and synthesizing a final response for the patient.
Glad that you will be examined once again soon
Detailed Answer:
I think it's great news that your THYROID came back normal.
I'm going to guess that you're only "half" happy for that news. BUT in my opinion (and after reading several messages you've written in the last couple of days), I intend on standing by my gut impression that whatever is going on in your case is unrelated to any form of MOTOR NEURON DISEASE based upon the rapidity of progression of your symptoms, the distribution and order of appearance of them, and the fact that you do NOT suffer from any discernible muscle atrophy anywhere in your body.
Therefore, in my estimation although I entirely and fully acknowledge that SOMETHING other than stress COULD be going on- my diagnostic differential remains tilted AWAY from any type of organic or fatal neurodegenerative process and maintain that if there is an organic process afoot it is being manifest by widespread peripheral nerve irritation by metabolic processes of some type.
I am once again extremely honored that you choose to continue seeking my advice and await to hear about a colleague's opinion on what's been going on and how best to approach its management. I am happy to offer you a re-examination if you think it helpful and will await to hear further news of how symptoms continue to evolve.
This query has required 210 minutes total time in reading, researching, and synthesizing a final response for the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Glad that you will be examined once again soon
Detailed Answer:
I think it's great news that your THYROID came back normal.
I'm going to guess that you're only "half" happy for that news. BUT in my opinion (and after reading several messages you've written in the last couple of days), I intend on standing by my gut impression that whatever is going on in your case is unrelated to any form of MOTOR NEURON DISEASE based upon the rapidity of progression of your symptoms, the distribution and order of appearance of them, and the fact that you do NOT suffer from any discernible muscle atrophy anywhere in your body.
Therefore, in my estimation although I entirely and fully acknowledge that SOMETHING other than stress COULD be going on- my diagnostic differential remains tilted AWAY from any type of organic or fatal neurodegenerative process and maintain that if there is an organic process afoot it is being manifest by widespread peripheral nerve irritation by metabolic processes of some type.
I am once again extremely honored that you choose to continue seeking my advice and await to hear about a colleague's opinion on what's been going on and how best to approach its management. I am happy to offer you a re-examination if you think it helpful and will await to hear further news of how symptoms continue to evolve.
This query has required 210 minutes total time in reading, researching, and synthesizing a final response for the patient.
Glad that you will be examined once again soon
Detailed Answer:
I think it's great news that your THYROID came back normal.
I'm going to guess that you're only "half" happy for that news. BUT in my opinion (and after reading several messages you've written in the last couple of days), I intend on standing by my gut impression that whatever is going on in your case is unrelated to any form of MOTOR NEURON DISEASE based upon the rapidity of progression of your symptoms, the distribution and order of appearance of them, and the fact that you do NOT suffer from any discernible muscle atrophy anywhere in your body.
Therefore, in my estimation although I entirely and fully acknowledge that SOMETHING other than stress COULD be going on- my diagnostic differential remains tilted AWAY from any type of organic or fatal neurodegenerative process and maintain that if there is an organic process afoot it is being manifest by widespread peripheral nerve irritation by metabolic processes of some type.
I am once again extremely honored that you choose to continue seeking my advice and await to hear about a colleague's opinion on what's been going on and how best to approach its management. I am happy to offer you a re-examination if you think it helpful and will await to hear further news of how symptoms continue to evolve.
This query has required 210 minutes total time in reading, researching, and synthesizing a final response for the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I’m sorry Dr. Saghafi,
I have weakness in both arms now and fasciculations throughout them after using them. They feel fatigued and exhausted after showering. My tongue continues to fasciculate. My shoulders are exhausted and it’s getting tiring to type this out. I’m shocked
I have weakness in both arms now and fasciculations throughout them after using them. They feel fatigued and exhausted after showering. My tongue continues to fasciculate. My shoulders are exhausted and it’s getting tiring to type this out. I’m shocked
I’m sorry Dr. Saghafi,
I have weakness in both arms now and fasciculations throughout them after using them. They feel fatigued and exhausted after showering. My tongue continues to fasciculate. My shoulders are exhausted and it’s getting tiring to type this out. I’m shocked
I have weakness in both arms now and fasciculations throughout them after using them. They feel fatigued and exhausted after showering. My tongue continues to fasciculate. My shoulders are exhausted and it’s getting tiring to type this out. I’m shocked
Brief Answer:
Today is your appointment with your local neurologist?
Detailed Answer:
I am also unable to really explain the rapidity and widespread distribution that has occurred in such a short amount of time.
Isn't today the day of your appointment with your local neurologist? Keep me in the loop please and let me know if there's anything that I can offer in terms of help.
And continue to be vigilant of the symptoms, what makes them better, what makes them worse, if anything seems to be related in terms of psychological stressors or thoughts. Remember that neurological weakness and perceptual weakness are often 2 separate things. Let's see what the doc comes up with when he sees you today.
Cheers kind sir!
Today is your appointment with your local neurologist?
Detailed Answer:
I am also unable to really explain the rapidity and widespread distribution that has occurred in such a short amount of time.
Isn't today the day of your appointment with your local neurologist? Keep me in the loop please and let me know if there's anything that I can offer in terms of help.
And continue to be vigilant of the symptoms, what makes them better, what makes them worse, if anything seems to be related in terms of psychological stressors or thoughts. Remember that neurological weakness and perceptual weakness are often 2 separate things. Let's see what the doc comes up with when he sees you today.
Cheers kind sir!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Today is your appointment with your local neurologist?
Detailed Answer:
I am also unable to really explain the rapidity and widespread distribution that has occurred in such a short amount of time.
Isn't today the day of your appointment with your local neurologist? Keep me in the loop please and let me know if there's anything that I can offer in terms of help.
And continue to be vigilant of the symptoms, what makes them better, what makes them worse, if anything seems to be related in terms of psychological stressors or thoughts. Remember that neurological weakness and perceptual weakness are often 2 separate things. Let's see what the doc comes up with when he sees you today.
Cheers kind sir!
Today is your appointment with your local neurologist?
Detailed Answer:
I am also unable to really explain the rapidity and widespread distribution that has occurred in such a short amount of time.
Isn't today the day of your appointment with your local neurologist? Keep me in the loop please and let me know if there's anything that I can offer in terms of help.
And continue to be vigilant of the symptoms, what makes them better, what makes them worse, if anything seems to be related in terms of psychological stressors or thoughts. Remember that neurological weakness and perceptual weakness are often 2 separate things. Let's see what the doc comes up with when he sees you today.
Cheers kind sir!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Doctor,
I’m being sent to the ALS clinic XXXXXXX 24th. My right arm gets tired really fast now. The tongue is apparent. The doctor didn’t afford me a real workup less than a minute. I thought it was unfair. Didn’t look into my weakness that I’d explained. I showed him the (tried) what I was feeling. He kept saying it was mental. Nobody understands that I’m feeling real weakness, because my push and pull seem fine. That’s not the solution. I still have strength. It’s the endurance end of things. For example, my forearms shouldn’t be weak typing this to you. It’s the inside area of my right elbow / forearm. I know, unusual presentation I guess. Thank you for all of your help Doctor saghafi. You’ve been extremely helpful and insightful.
I’m being sent to the ALS clinic XXXXXXX 24th. My right arm gets tired really fast now. The tongue is apparent. The doctor didn’t afford me a real workup less than a minute. I thought it was unfair. Didn’t look into my weakness that I’d explained. I showed him the (tried) what I was feeling. He kept saying it was mental. Nobody understands that I’m feeling real weakness, because my push and pull seem fine. That’s not the solution. I still have strength. It’s the endurance end of things. For example, my forearms shouldn’t be weak typing this to you. It’s the inside area of my right elbow / forearm. I know, unusual presentation I guess. Thank you for all of your help Doctor saghafi. You’ve been extremely helpful and insightful.
Hello Doctor,
I’m being sent to the ALS clinic XXXXXXX 24th. My right arm gets tired really fast now. The tongue is apparent. The doctor didn’t afford me a real workup less than a minute. I thought it was unfair. Didn’t look into my weakness that I’d explained. I showed him the (tried) what I was feeling. He kept saying it was mental. Nobody understands that I’m feeling real weakness, because my push and pull seem fine. That’s not the solution. I still have strength. It’s the endurance end of things. For example, my forearms shouldn’t be weak typing this to you. It’s the inside area of my right elbow / forearm. I know, unusual presentation I guess. Thank you for all of your help Doctor saghafi. You’ve been extremely helpful and insightful.
I’m being sent to the ALS clinic XXXXXXX 24th. My right arm gets tired really fast now. The tongue is apparent. The doctor didn’t afford me a real workup less than a minute. I thought it was unfair. Didn’t look into my weakness that I’d explained. I showed him the (tried) what I was feeling. He kept saying it was mental. Nobody understands that I’m feeling real weakness, because my push and pull seem fine. That’s not the solution. I still have strength. It’s the endurance end of things. For example, my forearms shouldn’t be weak typing this to you. It’s the inside area of my right elbow / forearm. I know, unusual presentation I guess. Thank you for all of your help Doctor saghafi. You’ve been extremely helpful and insightful.
Brief Answer:
And therefore, the NEUROLOGIST's conclusion was "Mental?"
Detailed Answer:
So the same neurologist who saw you the first time concluded that it was "mental?" Did he acknowledge the fasciculations you demonstrated to me on the videos? Those are definitely present. I don't about your tongue because you've never sent any videos on that one or seen it on a teleconference session.
And he did not do any sort neurological strength testing? How about the EMG that was set up for XXXXXXX 24th? Any other labs get performed?
The only way I believe one can legitimately distinguish between perceptual weakness in a muscle and neurological weakness is by performing certain task testing.
And therefore, the NEUROLOGIST's conclusion was "Mental?"
Detailed Answer:
So the same neurologist who saw you the first time concluded that it was "mental?" Did he acknowledge the fasciculations you demonstrated to me on the videos? Those are definitely present. I don't about your tongue because you've never sent any videos on that one or seen it on a teleconference session.
And he did not do any sort neurological strength testing? How about the EMG that was set up for XXXXXXX 24th? Any other labs get performed?
The only way I believe one can legitimately distinguish between perceptual weakness in a muscle and neurological weakness is by performing certain task testing.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
And therefore, the NEUROLOGIST's conclusion was "Mental?"
Detailed Answer:
So the same neurologist who saw you the first time concluded that it was "mental?" Did he acknowledge the fasciculations you demonstrated to me on the videos? Those are definitely present. I don't about your tongue because you've never sent any videos on that one or seen it on a teleconference session.
And he did not do any sort neurological strength testing? How about the EMG that was set up for XXXXXXX 24th? Any other labs get performed?
The only way I believe one can legitimately distinguish between perceptual weakness in a muscle and neurological weakness is by performing certain task testing.
And therefore, the NEUROLOGIST's conclusion was "Mental?"
Detailed Answer:
So the same neurologist who saw you the first time concluded that it was "mental?" Did he acknowledge the fasciculations you demonstrated to me on the videos? Those are definitely present. I don't about your tongue because you've never sent any videos on that one or seen it on a teleconference session.
And he did not do any sort neurological strength testing? How about the EMG that was set up for XXXXXXX 24th? Any other labs get performed?
The only way I believe one can legitimately distinguish between perceptual weakness in a muscle and neurological weakness is by performing certain task testing.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
He was focused mainly on my anxiety the moment he came in the room. At one point he asked me if I wanted ALS? He then pulled on my arms, tried to push them down, vaguely tested my finger with a quick squeeze and stated someone with ALS wouldn’t have my strength. I am naturally strong though.
He was focused mainly on my anxiety the moment he came in the room. At one point he asked me if I wanted ALS? He then pulled on my arms, tried to push them down, vaguely tested my finger with a quick squeeze and stated someone with ALS wouldn’t have my strength. I am naturally strong though.
Brief Answer:
Do you have the most recent reports on your renal cell CA checkup
Detailed Answer:
I understand that you didn't feel that his examination was complete enough to help you understand why things have progressed. If I could offer any consolation on that count it would be that perhaps, he was able to glean much more from the brief observations and Push/pulls he did than you realize. Although, to be honest, if the muscle strength examination did not last at least 5 FULL MINUTES of maneuvers and comparisons as well as observation of the fasciculations you have (including tongue) then, I agree with you that it was less complete than what I would've performed on any of my patients returning with additional concerns.....I'm sure you'll vouch for that.....BUT....perhaps, he did LOOK FOR but did not see what he was looking for.....and you just didn't realize it?
As always, I am available to at least visualize your tongue fasics in a video as we've done before since those can be misinterpreted by patients. It actually takes some experience and technique to really appreciate tongue fasciculations.
And again, if could offer any consolation in what's been happening.....always keep in mind that MUSCLE FASCICULATIONS due to MOTOR NEURON DISEASE always represents a fairly advanced stage of the disease process. This has only been about 14 weeks now from the time when you've expressed noticeable concern, correct? Maybe 15 weeks? That is exceedingly fast for ALS to show up with this many fasiculations to include the head, torso, etc. WITHOUT observable MUSCLE WASTING AND ATROPHY.
In other words things are really presenting in almost a reverse order of what we expect...even if we wish to go ahead and suppose for a moment that the weakness/tiredness you are feeling in your forearms were actually due to MND of some type. Before getting any sort of fasics ELSEWHERE in the body....we'd really expect to see progression of weakness in the forearm to the point of muscle mass loss, followed by fasics, followed by real measurable neurological weakness. Again, everything is just very dispersed and not following the very clinicoanatomic patterns that really need to be adhered to for motor neuron disease of the ALS type (or of any type).....otherwise, it's entirely inexplicable.
Anyhow do let me know if you'd like to make any additional plans for us to meet and could I impose upon you to consider closing this thread on this last day of the month which would help credit this question to my workload and if necessary you may always start another thread. Many thanks for your consideration. These questions on Healthcarmagic are really designed for a maximum of 4 responses to each question before most they are typically closed out. Cheers and keep me informed....you have the office number..... 440.842.3816
This query has required 260 minutes total time in reading, researching, and synthesizing a final response for the patient.
Do you have the most recent reports on your renal cell CA checkup
Detailed Answer:
I understand that you didn't feel that his examination was complete enough to help you understand why things have progressed. If I could offer any consolation on that count it would be that perhaps, he was able to glean much more from the brief observations and Push/pulls he did than you realize. Although, to be honest, if the muscle strength examination did not last at least 5 FULL MINUTES of maneuvers and comparisons as well as observation of the fasciculations you have (including tongue) then, I agree with you that it was less complete than what I would've performed on any of my patients returning with additional concerns.....I'm sure you'll vouch for that.....BUT....perhaps, he did LOOK FOR but did not see what he was looking for.....and you just didn't realize it?
As always, I am available to at least visualize your tongue fasics in a video as we've done before since those can be misinterpreted by patients. It actually takes some experience and technique to really appreciate tongue fasciculations.
And again, if could offer any consolation in what's been happening.....always keep in mind that MUSCLE FASCICULATIONS due to MOTOR NEURON DISEASE always represents a fairly advanced stage of the disease process. This has only been about 14 weeks now from the time when you've expressed noticeable concern, correct? Maybe 15 weeks? That is exceedingly fast for ALS to show up with this many fasiculations to include the head, torso, etc. WITHOUT observable MUSCLE WASTING AND ATROPHY.
In other words things are really presenting in almost a reverse order of what we expect...even if we wish to go ahead and suppose for a moment that the weakness/tiredness you are feeling in your forearms were actually due to MND of some type. Before getting any sort of fasics ELSEWHERE in the body....we'd really expect to see progression of weakness in the forearm to the point of muscle mass loss, followed by fasics, followed by real measurable neurological weakness. Again, everything is just very dispersed and not following the very clinicoanatomic patterns that really need to be adhered to for motor neuron disease of the ALS type (or of any type).....otherwise, it's entirely inexplicable.
Anyhow do let me know if you'd like to make any additional plans for us to meet and could I impose upon you to consider closing this thread on this last day of the month which would help credit this question to my workload and if necessary you may always start another thread. Many thanks for your consideration. These questions on Healthcarmagic are really designed for a maximum of 4 responses to each question before most they are typically closed out. Cheers and keep me informed....you have the office number..... 440.842.3816
This query has required 260 minutes total time in reading, researching, and synthesizing a final response for the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Do you have the most recent reports on your renal cell CA checkup
Detailed Answer:
I understand that you didn't feel that his examination was complete enough to help you understand why things have progressed. If I could offer any consolation on that count it would be that perhaps, he was able to glean much more from the brief observations and Push/pulls he did than you realize. Although, to be honest, if the muscle strength examination did not last at least 5 FULL MINUTES of maneuvers and comparisons as well as observation of the fasciculations you have (including tongue) then, I agree with you that it was less complete than what I would've performed on any of my patients returning with additional concerns.....I'm sure you'll vouch for that.....BUT....perhaps, he did LOOK FOR but did not see what he was looking for.....and you just didn't realize it?
As always, I am available to at least visualize your tongue fasics in a video as we've done before since those can be misinterpreted by patients. It actually takes some experience and technique to really appreciate tongue fasciculations.
And again, if could offer any consolation in what's been happening.....always keep in mind that MUSCLE FASCICULATIONS due to MOTOR NEURON DISEASE always represents a fairly advanced stage of the disease process. This has only been about 14 weeks now from the time when you've expressed noticeable concern, correct? Maybe 15 weeks? That is exceedingly fast for ALS to show up with this many fasiculations to include the head, torso, etc. WITHOUT observable MUSCLE WASTING AND ATROPHY.
In other words things are really presenting in almost a reverse order of what we expect...even if we wish to go ahead and suppose for a moment that the weakness/tiredness you are feeling in your forearms were actually due to MND of some type. Before getting any sort of fasics ELSEWHERE in the body....we'd really expect to see progression of weakness in the forearm to the point of muscle mass loss, followed by fasics, followed by real measurable neurological weakness. Again, everything is just very dispersed and not following the very clinicoanatomic patterns that really need to be adhered to for motor neuron disease of the ALS type (or of any type).....otherwise, it's entirely inexplicable.
Anyhow do let me know if you'd like to make any additional plans for us to meet and could I impose upon you to consider closing this thread on this last day of the month which would help credit this question to my workload and if necessary you may always start another thread. Many thanks for your consideration. These questions on Healthcarmagic are really designed for a maximum of 4 responses to each question before most they are typically closed out. Cheers and keep me informed....you have the office number..... 440.842.3816
This query has required 260 minutes total time in reading, researching, and synthesizing a final response for the patient.
Do you have the most recent reports on your renal cell CA checkup
Detailed Answer:
I understand that you didn't feel that his examination was complete enough to help you understand why things have progressed. If I could offer any consolation on that count it would be that perhaps, he was able to glean much more from the brief observations and Push/pulls he did than you realize. Although, to be honest, if the muscle strength examination did not last at least 5 FULL MINUTES of maneuvers and comparisons as well as observation of the fasciculations you have (including tongue) then, I agree with you that it was less complete than what I would've performed on any of my patients returning with additional concerns.....I'm sure you'll vouch for that.....BUT....perhaps, he did LOOK FOR but did not see what he was looking for.....and you just didn't realize it?
As always, I am available to at least visualize your tongue fasics in a video as we've done before since those can be misinterpreted by patients. It actually takes some experience and technique to really appreciate tongue fasciculations.
And again, if could offer any consolation in what's been happening.....always keep in mind that MUSCLE FASCICULATIONS due to MOTOR NEURON DISEASE always represents a fairly advanced stage of the disease process. This has only been about 14 weeks now from the time when you've expressed noticeable concern, correct? Maybe 15 weeks? That is exceedingly fast for ALS to show up with this many fasiculations to include the head, torso, etc. WITHOUT observable MUSCLE WASTING AND ATROPHY.
In other words things are really presenting in almost a reverse order of what we expect...even if we wish to go ahead and suppose for a moment that the weakness/tiredness you are feeling in your forearms were actually due to MND of some type. Before getting any sort of fasics ELSEWHERE in the body....we'd really expect to see progression of weakness in the forearm to the point of muscle mass loss, followed by fasics, followed by real measurable neurological weakness. Again, everything is just very dispersed and not following the very clinicoanatomic patterns that really need to be adhered to for motor neuron disease of the ALS type (or of any type).....otherwise, it's entirely inexplicable.
Anyhow do let me know if you'd like to make any additional plans for us to meet and could I impose upon you to consider closing this thread on this last day of the month which would help credit this question to my workload and if necessary you may always start another thread. Many thanks for your consideration. These questions on Healthcarmagic are really designed for a maximum of 4 responses to each question before most they are typically closed out. Cheers and keep me informed....you have the office number..... 440.842.3816
This query has required 260 minutes total time in reading, researching, and synthesizing a final response for the patient.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
