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Suggest Treatment For Twitching On The Calves And Other Parts Of Body
Question: I have been trying to get a diagnosis .... I have limited blood flow to my finger and toes along with a lot of other issues. For tem years I have been having twitches in my calfs which have gotten progressively worse and spread to other parts of my body, including the back of my head, stomach, arms. These are like fascilations. I am also getting some jerks. I have had brain, spinal cord scans, ALS testing, EEG which were negative. The fascilitation in my legs have progressed form being barely visable to looking like something is aggressively trying to break out of my legs. I have visions changes. One day I see normal and then can;t see the TV ... then it gets better again. The month I've began getting "bleeds" in my legs "bruising" for no reason. The fist was on the top of my foot so I though it was a bruise from an injury. This week I have one on my knee and upper leg and the one on my foot has returned for the third time ... also, my lower legs now hurt and I get extremely painful cramps in my feet. At times the veins bulge out in my feet and lower arms which feel uncomfortable, not painful. The tendons on the top of my feet are visable always and toes are beginning to draw upwards with one toe being "hammer toe." Occassional metalic taste in my mouth and sometimes lower jaw makes me feel like something is very wrong, like a major event is about to happen. I've had a positive ANA and have been waiting three months to get in to see a rhumatologist. I'm afraid they are waiting too long to see me and am concerned that I may loose my feet ... I'm 52 and have been in basically good health. I had jaw surgery 9 months ago. The past six months have been brutal ... may body has gone from looking like a 30 year old to looking like a 70 year old. Yikes!
Brief Answer:
Autoimmune disorders
Detailed Answer:
good evening
Thank you for writing on health care magic..
I have gone through your history and the pictures posted.
there is definitely an autoimmune process going on. your feet have classic Raynaud's phenomenon happening. Where on exposure to cold the color changes. and also your 4th toe appears swollen.
Fasciculation r specific for ALS but since they have ruled it out, at least we can be sure about it. but there is lot of muscle wasting in your feet which are exposing the tendons. Can you check for me if they have carried out nerve conduction tests as well?it looks more of neuropathy
Bruises are a bit non specific but can be related to autoimmune disorder causing platelet breakdown.
I would like to ask you a few more questions to see where we are heading:
1/ any history of oral ulcers or hair fall or other rashes
2. any history of dry eyes or dry mouth
3. any history of tingling and numbness in your toes or finger..
4. any weight loss or appetite loss?
5. how much was the ana titre and what pattern was it.
6. did they check your cpk levels as well? The ena profile and the nerve conduction studies
Do let me know these queries
Would like to see where we are heading....
regards
dr naval
Autoimmune disorders
Detailed Answer:
good evening
Thank you for writing on health care magic..
I have gone through your history and the pictures posted.
there is definitely an autoimmune process going on. your feet have classic Raynaud's phenomenon happening. Where on exposure to cold the color changes. and also your 4th toe appears swollen.
Fasciculation r specific for ALS but since they have ruled it out, at least we can be sure about it. but there is lot of muscle wasting in your feet which are exposing the tendons. Can you check for me if they have carried out nerve conduction tests as well?it looks more of neuropathy
Bruises are a bit non specific but can be related to autoimmune disorder causing platelet breakdown.
I would like to ask you a few more questions to see where we are heading:
1/ any history of oral ulcers or hair fall or other rashes
2. any history of dry eyes or dry mouth
3. any history of tingling and numbness in your toes or finger..
4. any weight loss or appetite loss?
5. how much was the ana titre and what pattern was it.
6. did they check your cpk levels as well? The ena profile and the nerve conduction studies
Do let me know these queries
Would like to see where we are heading....
regards
dr naval
Above answer was peer-reviewed by :
Dr. Raju A.T
Occasionally years ago had oral ulcer. Hair shedding a few years back but not to the point of looking bald or thin. Hoarseness everyday and recent dry mouth. Not sure about dry eyes but have a hard time wearing my contact lenses. Stopped wearing them.
Have gum recession and dentist doesn't know why. After jaw surgery the dry mouth began and I noticed more gum recession almost immediately after surgery. I'm wondering if all of this was triggered by the jaw surgery.
The ANS was 1:160 H Speckled. They did a nerve conductivity test and found no abnormalities. No cpk done.
Occasional numbness in fingers over the years. My right lower leg has developed numbness over the past two weeks.
The red toes and cold feet are not from being exposed to cold. It's summer and hot but my feet are freezing cold.
No weight loss recently but anytime I eat I seem to retain water or gain instantly around the midsection. My body has changed dramatically. Last year during divorce I lost a lot but due to stress.
Eye issues with double vision and varying vision. Get bad, then better. When they get bad it lasts a few days and recovers. Eye exam show Nastagmus (jerks when look to far right or left). This has improved and isn't being seem in recent exams.
I'm under a lot of stress as a single mother supporting tow kids and I work a lot . Very high stress levels.
Bloodwork showed
Hemoglobin 11.6 L
RDW 15.3 H
Absolute Monocytes 186 L
Ferritin 6L
Rheumatoid Factor 9 normal
Sjogren's Antibodies SS-A <1.0 NEG
SS-B <1.0 NEG
Angiotensin-1-convertign Enzyme 41
RPR (monitor) w/refl titer Non-Reactive
ANA Screen, IFA POSITIVE
Speckled 1:160 H
Blood work was from over 1.5 years ago. I saw a rheumatologist at that time and he said I didn't have Lupus or arthritis and likely a false positive ANA ... seeing someone else next week. I'm not having a lot of confidence in my doctors.
I saw one neurologist for almost ten years .... he did all the neuro tests but didn't seem to be on top of finding the problem. I'm now with another neurologist who immediate did blood flow testing, also noted fat or muscle loss on top of feet. He referred me to a different rheumatologist at UAB in XXXXXXX
I need quick answers as this is progressing quickly so reaching out to you. What tests should I ask for?
Also I have muscle pain but not joint pain. Recently, I have noticed that putting a gallon of tea in the fridge hurts my forearms. My muscles get sore without any activity.
I do have some fluid (puffiness) in my knee joints. When I ate no processed foods and took fish oil the fluid went away ... it's back again. Still taking fish oil but eating some processed foods.
Whatever this is has really become aggressive with the cold feet, buldging veins, bruising (bleeding) etc lately. Any suggestion to put this in remission?
forgot to mention that after an "attack" when my toes get red, swollen and severe cramp (about a ten minute process) at the end the skin on my feet look like it has white powder on my feet ... guessing this is because no blood was getting to the skin. You can see in the photos that are labeled "ashy" ... Any guidance is greatly appreciated. What tests would you have done if this were happening to you? Any lifestyle recommendations, food to eat, vitamins or other suggestions?
Have gum recession and dentist doesn't know why. After jaw surgery the dry mouth began and I noticed more gum recession almost immediately after surgery. I'm wondering if all of this was triggered by the jaw surgery.
The ANS was 1:160 H Speckled. They did a nerve conductivity test and found no abnormalities. No cpk done.
Occasional numbness in fingers over the years. My right lower leg has developed numbness over the past two weeks.
The red toes and cold feet are not from being exposed to cold. It's summer and hot but my feet are freezing cold.
No weight loss recently but anytime I eat I seem to retain water or gain instantly around the midsection. My body has changed dramatically. Last year during divorce I lost a lot but due to stress.
Eye issues with double vision and varying vision. Get bad, then better. When they get bad it lasts a few days and recovers. Eye exam show Nastagmus (jerks when look to far right or left). This has improved and isn't being seem in recent exams.
I'm under a lot of stress as a single mother supporting tow kids and I work a lot . Very high stress levels.
Bloodwork showed
Hemoglobin 11.6 L
RDW 15.3 H
Absolute Monocytes 186 L
Ferritin 6L
Rheumatoid Factor 9 normal
Sjogren's Antibodies SS-A <1.0 NEG
SS-B <1.0 NEG
Angiotensin-1-convertign Enzyme 41
RPR (monitor) w/refl titer Non-Reactive
ANA Screen, IFA POSITIVE
Speckled 1:160 H
Blood work was from over 1.5 years ago. I saw a rheumatologist at that time and he said I didn't have Lupus or arthritis and likely a false positive ANA ... seeing someone else next week. I'm not having a lot of confidence in my doctors.
I saw one neurologist for almost ten years .... he did all the neuro tests but didn't seem to be on top of finding the problem. I'm now with another neurologist who immediate did blood flow testing, also noted fat or muscle loss on top of feet. He referred me to a different rheumatologist at UAB in XXXXXXX
I need quick answers as this is progressing quickly so reaching out to you. What tests should I ask for?
Also I have muscle pain but not joint pain. Recently, I have noticed that putting a gallon of tea in the fridge hurts my forearms. My muscles get sore without any activity.
I do have some fluid (puffiness) in my knee joints. When I ate no processed foods and took fish oil the fluid went away ... it's back again. Still taking fish oil but eating some processed foods.
Whatever this is has really become aggressive with the cold feet, buldging veins, bruising (bleeding) etc lately. Any suggestion to put this in remission?
forgot to mention that after an "attack" when my toes get red, swollen and severe cramp (about a ten minute process) at the end the skin on my feet look like it has white powder on my feet ... guessing this is because no blood was getting to the skin. You can see in the photos that are labeled "ashy" ... Any guidance is greatly appreciated. What tests would you have done if this were happening to you? Any lifestyle recommendations, food to eat, vitamins or other suggestions?
Brief Answer:
? Sjogrens syndrome
Detailed Answer:
good evening
thank you for your reply
well, I really feel this is an autoimmune process going on. I would go in favour of a sjogrens syndrome considering dry mouth and gum recession which can be a part of the disease. inability to wear lenses is due to dry eyes as they don't produce enough lubrication. I see that they have tested you for it already with ssa and ssb but they are only positive in 50 percent cases.. Lot of times you have to treat with clinical suspicions.
your feet are having Raynaud's phenomenon as they have a characteristic colour change and since you say the Doppler has been looked at which is normal. that is another indicator of autoimmune disease
At this stage considering there is quite muscle wasting at your feet , I would like to do a few tests:
1. ENA profile to see which other antibodies under the subset of ANA are positive
2. I would like to repeat nerve conduction studies once more as I feel some nerve is getting inflamed near your feet which is causing so much wasting(mononeuritis multiplex).
3/ since your ssa and ssb are negative, a minor salivary gland biopsy would be helpful to why you are having dry mouth and gum recession.
4. get your muscle enzymes done..Cpk ldh aldolase.
5/ lastly just to rule out a rare disease I would like to do your XXXXXXX as well
for treatment at present you can consult your gp regarding starting you on nifedipine which will improve the feet circulation.
till you wait to see rheumatologist you can get these tests done. maybe seek another opinion with a neurologist for repeating ncv of just the Lower limbs.
I totally agree with you on what you are feeling and intervening early would be helpful.
do let me know for more queries
regards
dr naval
? Sjogrens syndrome
Detailed Answer:
good evening
thank you for your reply
well, I really feel this is an autoimmune process going on. I would go in favour of a sjogrens syndrome considering dry mouth and gum recession which can be a part of the disease. inability to wear lenses is due to dry eyes as they don't produce enough lubrication. I see that they have tested you for it already with ssa and ssb but they are only positive in 50 percent cases.. Lot of times you have to treat with clinical suspicions.
your feet are having Raynaud's phenomenon as they have a characteristic colour change and since you say the Doppler has been looked at which is normal. that is another indicator of autoimmune disease
At this stage considering there is quite muscle wasting at your feet , I would like to do a few tests:
1. ENA profile to see which other antibodies under the subset of ANA are positive
2. I would like to repeat nerve conduction studies once more as I feel some nerve is getting inflamed near your feet which is causing so much wasting(mononeuritis multiplex).
3/ since your ssa and ssb are negative, a minor salivary gland biopsy would be helpful to why you are having dry mouth and gum recession.
4. get your muscle enzymes done..Cpk ldh aldolase.
5/ lastly just to rule out a rare disease I would like to do your XXXXXXX as well
for treatment at present you can consult your gp regarding starting you on nifedipine which will improve the feet circulation.
till you wait to see rheumatologist you can get these tests done. maybe seek another opinion with a neurologist for repeating ncv of just the Lower limbs.
I totally agree with you on what you are feeling and intervening early would be helpful.
do let me know for more queries
regards
dr naval
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Answered by
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