Question: I have recently had fasciculations while at rest that have had me very very concerned about ALS. Went to a neurologist who said the twitches were due to my running (exercise) and that he had no concerns. He said he would give me an EMG but it would be a waste of time because he knew the results would be normal. So I said okay and left. My reflexes , balance and strength were all good.

Now I have noticed that I cannot fully flex my left calf to the extent that I can my right. The calf is not weak when I go for jogs, etc. but the muscle doesn't feel like it gets as hard when I flex it. I tried to measure the calves and they appear to be about the same size. The one that I can't fully flex may be a quarter inch smaller. My questions is- does this sound like the beginning of atrophy? Again, the muscle is not weak, but I am concerned the muscle is beginning to atrophy. Does weakness come before or after atrophy? I should add that when I stand I can lean forward and the left calf seems to fully flex; however it still does not feel totally as big as the right one. I know the the body is not perfectly symmetrical, but my arms are the opposite. My left arm is actually quite a bit bigger than my right and always has been. Please let me know if given that full strength is there this seems more like my normal physiology, or possible atrophy? Please also advise on your thoughts as to how likely ALS is in me based off of the info provided?

Thank you, doctor. So the muscle wasting would be noticeable without having to take precise measurements (even at the beginning?) and weaknesss would certainly be accompanying the wasting? If these are the case I do feel better as my strength is fine when I run miles and I can lift the same weight using either calf muscle.

Anxiety aside, how likely is ALS in me Doctor? Is it almost 100% that I do not have this disease? I was very comfortable with moving on before I made the mistake of trying to find wasting on my body. The neurologist I went to just seemed very sure I was fine. I appreciate your insight very much and will rate nicely.

I understand you can't say for 100% without having studied me, but would you say you're 99.9% sure that ALS is not my diagnosis? I have looked up your name online and can see that you are very well respected. Likewise I respect your words and would appreciate your answer on this before I go. Thanks you again!

Okay thank you for being forthright doctor. I am then going to take this to say that except for my own personal peace of mind, going back for an EMG is not medically necessary and I can accept that I don't have ALS? This also aligns with what the neurologist I saw said, so you would then be supporting his statement. Please just confirm this if you can before I go and rate highly!! You are a great help