Brief Answer:
Well, how does one respond to this type of QUESTION?

Detailed Answer:
I believe you have "come around" to several revelations through logical and deductive reasoning. For example, I'm glad you've discarded ALS from the differential list for all the reasons you've given. I'm glad they didn't feel the need to send you into a convulsive tizzy just for the purpose of either saying "we covered all the bases" or be able to charge you for the cost of the material and the additional nurse to make sure you didn't go into RESPIRATORY ARREST! Whew.....that's pleasant to hear that. What I'm entirely skeptical of is the doctor you tell me you went to see who says you have ?muscle hypertension? I'm sure there's something being lost in the translation but essentially what that sounds like is MUSCLE HYPERTONICITY....which certainly could be but usually if that's not due to metabolic causes such as either high or low calcium levels....which I'm sure you DON'T suffer from (yes, I will even go out on a limb here and PREDICT that your calcium levels ionized and otherwise are all normal). Anyways, if there's no metabolic discovery for muscle hypertonicity in a young man of your age and neurological status then, the only other explanation that works for the Babinski, for the hyperreflexia and everything else (which I'm truly skeptical you have any of) would be a cervicomedullary lesion which is PINCHING your spinal cord....but of course that would've been picked up long ago by every radiograph you've had so far of the head and the neck....there'd be other important changes such as distressful muscle weakness, sensory changes, muscle atrophy, bowel and bladder changes of significance.....I know you're going to think of your bladder....but don't for just a moment.

Bottom line, is I think this doctor's assessments of all of these POSITIVE findings (Finger to Nose, Babinski's- bilateral, etc. etc.)....well, let's just say I would have to be more convinced than just be told this person said it based on the 2 times we've had successful webcam contact and I've SEEN you with my own eyes.

Of course, I've never examined you but I can tell you that if that many neurologists have said no to those things....I'm sorry, I'm going to have to side with my brethren, and say this person needs to learn what REAL POSITIVE SIGNS are not just say things just so you don't feel you've wasted your money or time.....I just despise doctors, dentists, lawyers, and accountants who for some reason believe that they are ethically justified to fill peoples' heads with lies and half truths just because the person is going to think they're BAD if the best they can tell them is "Sorry, Mr. XXXXXXX from my perspective and as an expert I really don't believe there is any wrong or that I can help you with because it all checks out." Young people GENERALLY can be hyperreflexic....that's not abnormal....but CLONUS is abnormal....but not HYPERREFLEXIA in the setting of no obstruction or transection of the spinal cord or brainstem....without strokes, without tumors, etc. etc. etc.

As far as all the lab tests are concerned....I really think that most of them are proabably not going to show anything....I really don't think that myasthenia gravis should be on the table....or at least should be present CLINICALLY in a more robust and clear cut way before going for the very expensive lab test of getting Antibodies to Ach receptors. If you were in the US being covered by insurance....many of the tests we're talking about would be done for completeness sake but not because we have a HIGH LEVEL OF CLINICAL suspicion necessarily but again, to satisfy patients who seem to never think enough testing can be or is done.....that's our country's PROBLEMS WITH MENTALITY on this subject.

If I have to live with the fact knowing that you're paying for all these tests....and that includes all the calcium tests, etc. then, I have to tell you that my index of suspicion that any of those test EXCEPT Vitamin D....will come out abnormally is probably less than 2%...maybe less than 1%!

Now, the vitamin D? Different story....I would guess that virtually EVERY PERSON WALKING THE STREET in either XXXXXXX Ohio, Belgrade, London, and even XXXXXXX FLORIDA or Cancun, Mexico is either SEVERELY DEFICIENT or at least low normal. The only people who may not be low are those living in areas of the globe where's there no ozone layer left....Australia for example or even up north of the arctic circle where they are getting zapped with so many gamma rays that their Vitamin D levels are probably sufficient for 10 lifetimes although they'll probably die from melanomas and other DNA lysis syndromes decades before their time.....

I agree that COGNITIVE BEHAVIORAL THERAPY....which I think is the New Age Term for psychoanalysis would be very much to your benefit.....but even there I would stop 1 step short of going to the MAO inhibitors, SSRI's, and all the other plethora of drugs that psychiatrists have to prescribe and simply try with the simple and conservative means....no chemicals,....no junk.....I think you're intelligent, you're well grounded though a slight bit overly concerned and OVERLY ANALYTICAL on HUMAN body processes. If you'd put that much thought into the career that you've chosen....first of all....you'll very possibly free your mind up from some of this stuff that you shouldn't concern your brain with anymore....get into the gym, get into some sport....looks like you could be a swimmer.....practice your piano....good choice (I realize you're reporting some issues.....but I can tell you stories about XXXXXXX Fleischer....Google him if you don't know him and look at his story over the past few decades). I think all of that would free up your mind to get onto other things of import so you can move forward to other things you need to do in your life......

SECONDLY, you just might be able to write a book easy enough for someone like myself to understand so I can figure the heck out as to how to use MICROSOFT ACCESS! Now, that to me would be a totally productive use of your time instead of providing me business on a network like this making trying to make sure that you don't walk into some "trap" being tended to by Wolves in Doctors' Clothing.....does that make sense?

I'm glad the propranolol is somewhat helping....but as I spent about 30 minutes telling one of my elderly patients at the clinic on Friday afternoon....I would much prefer to see him and you try conservative means of controlling or improving the tremors if in fact, that's what you've got, using pure physical and mental capacitation rather than use pills....you should not be relegated to be using propranolol for the rest of your life although...I will tell you truthfully that there are some patients I have who in fact are as young as you and will probably require medication support for their tremors for life.

The difference being that I've had the opportunity to EXAMINE THOSE PATIENTS with my own hands and eyes, sit them down, give them the EYE TO EYE education on what I believe was going and what I believe they should or could do....those people probably will be on medication for the foreseeable future....BUT NOT BY FIRST INTENTION just because it gives instant or near instant gratification or because it is superior to any other method...it's not.....the human body and its biological processes which are already built in with all the sophistication and detail that no human can possibly perceive of or appreciate is the best repository of great treatments and interventions.....an individual, however, simply has to believe that they have the potential to overcome most of these sorts of ailments and the doctors have to be resourceful and patient enough to come up with the plans and keep the patients moving in the right direction although there are going to be periods of frustration, disbelief, and hardship to keep them believing that this is a far better road to travel than any other......

Well, I hope in all the above redundancy, emotional fluff, and philosophiziing there were is sufficient clarity to the belief that you are on a MUCH BETTER TRACK NOW than you were a couple of months ago, however, I would still like to see you invoke MORE CONCERTED brainpower to help solve your physical problems....but not from an analytical view...NO NO....rather from a REALIZATION (as opposed to derealization...ha!) that if you were to do something as simple as substitute one single other activity during your waking hours to pursue on a daily basis in place of thinking about your physical issues AND IF you were to slowly WEAN yourself over time to compile more and more such productive and attractive things to do and think about that most if not ALL of your physical ailments (whether real or perceived) would slowly disappear....and perhaps, even without your direct knowledge.

You may just wake up one morning and recognize that it's been so long since you even thought about or worried about X, Y, Z, that you'll just shrug your shoulders and say, "Oh well,..." And that's all the time you'll spend on that thought because there will be so many more interesting and gratifying things to help you manage the day that you'll simply make that a fleeting thought and you'll say goodbye to all these networks designed to attract truly SICK PERSONS-- not you......

And when that happens- well, That's when I WILL KNOW I'VE SUCCEEDED in my role as a healer for you!

Cheers!

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