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What Causes Muscle Twitching In Calves?
Question: I'm a 47-year-old male experiencing muscle twitches in both my calfs for the last 2 to 3 weeks. Over the last month I've increased my exercise activity and also increased my Wellbutrin dosage from 75 to 150 mg a day, per orders of my primary. I've been diagnosed with depression and anxiety and take Xanax as needed once a day .25 mg. I also have mitral valve prolapse with regurgitation and I've had muscle twitches on and off throughout my entire life which have really freaked me out . My mother had ALS for 17 years, and my father has depression and also heart problems.
I saw a neurologist 20 years ago, the same person who diagnosed my mother because I thought the muscle twitching was ALS. During the office visit he gave me a strength testing quickly determined that it was from anxiety.
I saw my primary again today because of the twitching in my calfs, when he learned of my mother he set me up for a consult with a neurologist, needless to say I'm freaking out as I can't get a neurologist to see me for another three weeks. He also discontinued the Xanax and prescribed me clonazepam. I don't feel like I have any weakness but at this point I can't tell. I can't wait three weeks to see neurologist but I don't know what else to do, any advice would be helpful.
I saw a neurologist 20 years ago, the same person who diagnosed my mother because I thought the muscle twitching was ALS. During the office visit he gave me a strength testing quickly determined that it was from anxiety.
I saw my primary again today because of the twitching in my calfs, when he learned of my mother he set me up for a consult with a neurologist, needless to say I'm freaking out as I can't get a neurologist to see me for another three weeks. He also discontinued the Xanax and prescribed me clonazepam. I don't feel like I have any weakness but at this point I can't tell. I can't wait three weeks to see neurologist but I don't know what else to do, any advice would be helpful.
Brief Answer:
Freaking Out Does Not Compute- Breathe & Read
Detailed Answer:
Good afternoon. My name is Dr. Dariush Saghafi and I'm a neurologist in the XXXXXXX OH area. I'd like to REASSURE you (to the extent one can in such an impersonal setting) that based on everything I've read I'm not at all sure why you believe you have ALS (except it seems for the fact that your PMD just called out the National Guard for very little from what I can see). Just remember, just because your doctor suddenly goes a little left of center doesn't mean you have to follow him. Make sense. Going on.
I think this ice bucket challenge is a great benefit and boost for the foundation but MAN.....everyone literally has gone "chicken little bezonkers" on me in the last 2 months. I didn't realize how many people actually twitched in this world. But they were all pretty behind the scenes UNTIL THE BUCKET CHALLENGE came along! Did you do the challenge? I did along with my whole family....except my wife...she absolutely refused....I'm planning on getting her though......oh it'll cost me dearly I'm sure...like 3 weeks sleeping outside the bedroom with my bowl of food and corner carpet.....but she WILL do the challenge! LOL....
So, please clarify this detail so I understand whether or not your mother TRULY had ALS (first of all...sounds like she passed away, is that correct?)....in the body of what you write you say that your mother HAD ALS for 17 years but then, you say that the neurologist was sure she DID NOT HAVE Familial ALS (written under MEDICATIONS above). Then, in the 2nd paragraph you said you saw a neurologist 20 years ago, the same person who diagnosed my mother because I thought the muscle twitching was ALS.
Then, you say something about your primary "finding out about your mother" and it sounds like EVEN HE FREAKED out and started pushing all sorts of panic buttons for very little reason. What did he find out about your mother?
By this point I have NO CLUE what your mother had, what anybody else thought she had, nor do I know exactly HOW SHE WAS DIAGNOSED with ALS? Was it strictly done clinically? By EMG? Muscle Biopsy?
I hope it's becoming clearer to you that I REALLY BELIEVE YOU DON'T HAVE ALS??
Now, let's move to your story. A couple of things you've said right up front which are HUGE strikes AGAINST ALS:
1. "I've had muscle twitches on and off throughout my entire life." Generally, speaking, from the time of diagnosis to the time of demise in patients with ALS is a period of about 5 years (give or take a little). Secondly, the course is progressive, relentless, and only gets worse and worse, AND WORSE no matter we do for them because there is no cure. That certainly doesn't describe any part of the last 20 years in your case, correct?
2. You are 47 years old, correct? And the most recent twitches you're concerned about started a couple of months ago, yes? So, if we assumet that the twitches you have are part of the same complex of twitches that you thought you had 20 years ago that would've made you about 25 or 27 years old? There are but a handful of people under the age of 30 who have true, path proven ALS (what is referred to as YOUNG ALS) and not one of them lived to see their 35th birthday.......LET ALONG THEIR 47th birthday.
3. The average age of onset for ALS in the U.S. in 2014 is 60-65 years. I'm sorry to inform you of such bad news....but you're anywhere from 13-18 years too early for even the average age of the disease! HA! I know what you want to say though......"But there are cases of people my age who have it....."
And I understand that- but remember, these twitches that you're talking about (if it were ALS) would've begun some 20 years ago...without progression of anything except twitches which never got better or worse? IMPOSSIBLE FOR ALS.
Now, as far as the side effects of Wellbutrin are concerned...any antidepressant medication especially in the class of drugs from which Wellbutrin comes, can cause twitching throughout the body. Sounds like you have been on Wellbutrin for some time but that you just raised the dose a month ago. Coincident with this are twitches in BOTH calves at the same time over the past couple of weeks. I don't believe the increased exercise regimen has anything to do with the twitching....but clearly the increased dose of Wellbutrin I believe has a lot of potential cause to do with the twitching.
There are other substantial reasons why I don't believe you are anywhere near the threshold of having ALS...but I'm going to leave things right here and ask if YOU have any questions or comments. I hope I've been able to convince you that you need to plan for your retirement at age 65, 70, or 80 if you're a workaholic type. You need to plan for either grandchildren or great grandchildren and KEEP WORKING OUT HARD! It's great for you!
Now, if you would care to have a slightly greater amount of reassurance then, by all means send me more questions and direct them personally to my attention (DARIUSH SAGHAFI) and I will answer them. Alternatively, if you look me up at:
www.healthtap.com/drsaghafi on any Wed-Sat. from 3a-6a or Sundays from 11p-3a we can share a live, real time, webcam consultation. That way, I might get lucky and something twitching may show itself for the camera.
If I have helped you understand a bit more things about ALS and WHY YOU DO NOT have this incredibly aggressive and progressive disorder with no cure then, would you do me a huge favor and leave some written feedback as well as a STAR RATING?
In addition, if you have no further questions or comments on this thread I'd very much appreciate your CLOSING THE QUERY from your side as this will signal to the network that the case is ready for processing, archiving, and crediting appropriately.
This query required 59 min. of physician specific and directed efforts in reviewing, researching, and documenting the final draft for envoy.
Freaking Out Does Not Compute- Breathe & Read
Detailed Answer:
Good afternoon. My name is Dr. Dariush Saghafi and I'm a neurologist in the XXXXXXX OH area. I'd like to REASSURE you (to the extent one can in such an impersonal setting) that based on everything I've read I'm not at all sure why you believe you have ALS (except it seems for the fact that your PMD just called out the National Guard for very little from what I can see). Just remember, just because your doctor suddenly goes a little left of center doesn't mean you have to follow him. Make sense. Going on.
I think this ice bucket challenge is a great benefit and boost for the foundation but MAN.....everyone literally has gone "chicken little bezonkers" on me in the last 2 months. I didn't realize how many people actually twitched in this world. But they were all pretty behind the scenes UNTIL THE BUCKET CHALLENGE came along! Did you do the challenge? I did along with my whole family....except my wife...she absolutely refused....I'm planning on getting her though......oh it'll cost me dearly I'm sure...like 3 weeks sleeping outside the bedroom with my bowl of food and corner carpet.....but she WILL do the challenge! LOL....
So, please clarify this detail so I understand whether or not your mother TRULY had ALS (first of all...sounds like she passed away, is that correct?)....in the body of what you write you say that your mother HAD ALS for 17 years but then, you say that the neurologist was sure she DID NOT HAVE Familial ALS (written under MEDICATIONS above). Then, in the 2nd paragraph you said you saw a neurologist 20 years ago, the same person who diagnosed my mother because I thought the muscle twitching was ALS.
Then, you say something about your primary "finding out about your mother" and it sounds like EVEN HE FREAKED out and started pushing all sorts of panic buttons for very little reason. What did he find out about your mother?
By this point I have NO CLUE what your mother had, what anybody else thought she had, nor do I know exactly HOW SHE WAS DIAGNOSED with ALS? Was it strictly done clinically? By EMG? Muscle Biopsy?
I hope it's becoming clearer to you that I REALLY BELIEVE YOU DON'T HAVE ALS??
Now, let's move to your story. A couple of things you've said right up front which are HUGE strikes AGAINST ALS:
1. "I've had muscle twitches on and off throughout my entire life." Generally, speaking, from the time of diagnosis to the time of demise in patients with ALS is a period of about 5 years (give or take a little). Secondly, the course is progressive, relentless, and only gets worse and worse, AND WORSE no matter we do for them because there is no cure. That certainly doesn't describe any part of the last 20 years in your case, correct?
2. You are 47 years old, correct? And the most recent twitches you're concerned about started a couple of months ago, yes? So, if we assumet that the twitches you have are part of the same complex of twitches that you thought you had 20 years ago that would've made you about 25 or 27 years old? There are but a handful of people under the age of 30 who have true, path proven ALS (what is referred to as YOUNG ALS) and not one of them lived to see their 35th birthday.......LET ALONG THEIR 47th birthday.
3. The average age of onset for ALS in the U.S. in 2014 is 60-65 years. I'm sorry to inform you of such bad news....but you're anywhere from 13-18 years too early for even the average age of the disease! HA! I know what you want to say though......"But there are cases of people my age who have it....."
And I understand that- but remember, these twitches that you're talking about (if it were ALS) would've begun some 20 years ago...without progression of anything except twitches which never got better or worse? IMPOSSIBLE FOR ALS.
Now, as far as the side effects of Wellbutrin are concerned...any antidepressant medication especially in the class of drugs from which Wellbutrin comes, can cause twitching throughout the body. Sounds like you have been on Wellbutrin for some time but that you just raised the dose a month ago. Coincident with this are twitches in BOTH calves at the same time over the past couple of weeks. I don't believe the increased exercise regimen has anything to do with the twitching....but clearly the increased dose of Wellbutrin I believe has a lot of potential cause to do with the twitching.
There are other substantial reasons why I don't believe you are anywhere near the threshold of having ALS...but I'm going to leave things right here and ask if YOU have any questions or comments. I hope I've been able to convince you that you need to plan for your retirement at age 65, 70, or 80 if you're a workaholic type. You need to plan for either grandchildren or great grandchildren and KEEP WORKING OUT HARD! It's great for you!
Now, if you would care to have a slightly greater amount of reassurance then, by all means send me more questions and direct them personally to my attention (DARIUSH SAGHAFI) and I will answer them. Alternatively, if you look me up at:
www.healthtap.com/drsaghafi on any Wed-Sat. from 3a-6a or Sundays from 11p-3a we can share a live, real time, webcam consultation. That way, I might get lucky and something twitching may show itself for the camera.
If I have helped you understand a bit more things about ALS and WHY YOU DO NOT have this incredibly aggressive and progressive disorder with no cure then, would you do me a huge favor and leave some written feedback as well as a STAR RATING?
In addition, if you have no further questions or comments on this thread I'd very much appreciate your CLOSING THE QUERY from your side as this will signal to the network that the case is ready for processing, archiving, and crediting appropriately.
This query required 59 min. of physician specific and directed efforts in reviewing, researching, and documenting the final draft for envoy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My mom was diagnosed witj ALS sometime around 1986, she passed in 2003. In 1994 i went to see a neurologist because i was twitching all over, especially my hands. He happened to be the same neurologist who diagnosed my mom in 1986, and just happens to be the same neurologist im going to see in Oct.
In my 1994 visit, the neirologist assired me i didnt have als based on the office visit and prescribed me anti anxiey med (which i cant remember the name of) that stopped the tremors and made me feel better. He also said my mom most likely didnt have familial ALS, which also made me feel better.
My primary didnt know about my mom having ALS until i reminded him of that today. He prescribed clonazepam, which i took a few hoirs ago but the calf tremors continue. Also have a minor bicept tremor. My back and legs are also sore most of the time, probably from my new circuit workout routine that is pretty intense, which i started in late July...Ive since backed off the workout intensity. I was hoping the clonazepam would alleviate the tremor :( .
In my 1994 visit, the neirologist assired me i didnt have als based on the office visit and prescribed me anti anxiey med (which i cant remember the name of) that stopped the tremors and made me feel better. He also said my mom most likely didnt have familial ALS, which also made me feel better.
My primary didnt know about my mom having ALS until i reminded him of that today. He prescribed clonazepam, which i took a few hoirs ago but the calf tremors continue. Also have a minor bicept tremor. My back and legs are also sore most of the time, probably from my new circuit workout routine that is pretty intense, which i started in late July...Ive since backed off the workout intensity. I was hoping the clonazepam would alleviate the tremor :( .
Brief Answer:
Much clearer but now we get into the thick of it!
Detailed Answer:
Great clarification to be sure....so let's roll right into it.....
The genetics behind ALS in terms of both its appearance in a person as well as how it is transmitted in families is complex and still an evolving area of research of discussion. The average age of onset as I said in my other message is 60-65 and only goes for about 5 years in most people. I have treated and seen people who have had it for over 20 years and in fact, their disability from it was quite benign....yes, they were wheelchair bound and rather weak in their limbs...but not paralyzed. They also did not have any significant swallowing or respiratory difficulties...quite amazing....but they are in the minority. Vast majority of ALS'ers will expire in 5 years or less from diagnosis and especially in males since it tends to be a more rapidly moving and unforgiving process compared to women.
I cannot see how the neurologist from 20 years ago was able to conclude that your mother did not have FAMILIAL ALS on the basis of clinical history except for probability and statistics. We believe that 90+% and perhaps as high as 95% of cases of ALS are sporadic. But that still leaves 5-10% which are acquired as a "genetic hand me down" from someone in the family. In your mom's case I think the neurologist would've been MORE correct if he would've told you something like, "I'm 90-95% certain your mom has sporadic ALS because I don't SEE any ALS in her family." Nobody would be able to argue with that statement since it allows for the 5-10% of cases that are genetically passed on but simply inapparent in the generation passing it along.
We good with that?
And so, there is simply no way to tell without doing genetic testing on the person who has the disease as well as everyone else in the family what is sporadic vs. what is familial.
There is no question that from a GENETIC POINT OF VIEW you are at an increased risk of developing ALS because we know your mom had the condition. It is IMPOSSIBLE for you to have acquired anything from your dad because ALS mutations are believed to ride entirely on the X chromosome which you (and every other male on the planet) gets from his mother. So even if your father had the most fulminant and aggressive form of ALS you could not get it from him. We good there?
The fact of the matter is your presentation of twitching is inconsistent for ALS for all the reasons I explained in the last message. If you've had twitchings all your life which have never been accompanied by XXXXXXX weakness, weight loss, or the features that you witnessed in your mother of ALS of deteriorating speech, swallowing problems and choking, and eventual respiratory system and muscle failure then, you may have a condition known as Benign Fasciculation Syndrome (BFS). The twitchings that have present in the past 2 weeks are more likely than not being brought on by the Wellbutrin dose increase.
Clonazepam may simply need to be increased. I think it's a good choice of medication but on the other hand unless it's particularly bothersome for other reasons many people don't really take anything if they know they have BFS. Again, exercise likely not related.
Much clearer but now we get into the thick of it!
Detailed Answer:
Great clarification to be sure....so let's roll right into it.....
The genetics behind ALS in terms of both its appearance in a person as well as how it is transmitted in families is complex and still an evolving area of research of discussion. The average age of onset as I said in my other message is 60-65 and only goes for about 5 years in most people. I have treated and seen people who have had it for over 20 years and in fact, their disability from it was quite benign....yes, they were wheelchair bound and rather weak in their limbs...but not paralyzed. They also did not have any significant swallowing or respiratory difficulties...quite amazing....but they are in the minority. Vast majority of ALS'ers will expire in 5 years or less from diagnosis and especially in males since it tends to be a more rapidly moving and unforgiving process compared to women.
I cannot see how the neurologist from 20 years ago was able to conclude that your mother did not have FAMILIAL ALS on the basis of clinical history except for probability and statistics. We believe that 90+% and perhaps as high as 95% of cases of ALS are sporadic. But that still leaves 5-10% which are acquired as a "genetic hand me down" from someone in the family. In your mom's case I think the neurologist would've been MORE correct if he would've told you something like, "I'm 90-95% certain your mom has sporadic ALS because I don't SEE any ALS in her family." Nobody would be able to argue with that statement since it allows for the 5-10% of cases that are genetically passed on but simply inapparent in the generation passing it along.
We good with that?
And so, there is simply no way to tell without doing genetic testing on the person who has the disease as well as everyone else in the family what is sporadic vs. what is familial.
There is no question that from a GENETIC POINT OF VIEW you are at an increased risk of developing ALS because we know your mom had the condition. It is IMPOSSIBLE for you to have acquired anything from your dad because ALS mutations are believed to ride entirely on the X chromosome which you (and every other male on the planet) gets from his mother. So even if your father had the most fulminant and aggressive form of ALS you could not get it from him. We good there?
The fact of the matter is your presentation of twitching is inconsistent for ALS for all the reasons I explained in the last message. If you've had twitchings all your life which have never been accompanied by XXXXXXX weakness, weight loss, or the features that you witnessed in your mother of ALS of deteriorating speech, swallowing problems and choking, and eventual respiratory system and muscle failure then, you may have a condition known as Benign Fasciculation Syndrome (BFS). The twitchings that have present in the past 2 weeks are more likely than not being brought on by the Wellbutrin dose increase.
Clonazepam may simply need to be increased. I think it's a good choice of medication but on the other hand unless it's particularly bothersome for other reasons many people don't really take anything if they know they have BFS. Again, exercise likely not related.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks Doc, i appreciate your details and good nature. I did lose 30 lbs from XXXXXXX 2014 through XXXXXXX 2014 doing XXXXXXX Felt great and stepped up the weifht training and cardio since. I have been getting stronger in my weights, i just seem to have soreness in my legs.
Whenever i had a twitch in the past i could always rely on Xanax to stop it, and thus relieve the underlying anxiety. This time is different, the xanax and clonazepam dont seem to be allieviating the twitching, which is stepping up the anxiety. I just dont feel myself, unsteady and hyper aware of every part of my body and motion.
It doesnt help that i am an only child, my wife is an only child, and we have no children. Her father passed and she is estranged from her mother, with my father having diabetic problems that require my constant attention. To top it off, our marriage is not doing well, causing me huge amounts of internal stress, anxiety, and depression. It may sound sad, but you are the only person ive been able to share this with today. I do have a therapist, he is helping as well, i just cant deal with the thought of ALS, it is all consuming until tje twitches go away.
Whenever i had a twitch in the past i could always rely on Xanax to stop it, and thus relieve the underlying anxiety. This time is different, the xanax and clonazepam dont seem to be allieviating the twitching, which is stepping up the anxiety. I just dont feel myself, unsteady and hyper aware of every part of my body and motion.
It doesnt help that i am an only child, my wife is an only child, and we have no children. Her father passed and she is estranged from her mother, with my father having diabetic problems that require my constant attention. To top it off, our marriage is not doing well, causing me huge amounts of internal stress, anxiety, and depression. It may sound sad, but you are the only person ive been able to share this with today. I do have a therapist, he is helping as well, i just cant deal with the thought of ALS, it is all consuming until tje twitches go away.
Brief Answer:
I hear 'ya and I'm honored that you'd share
Detailed Answer:
Thank you for your return message. I'm very honored that you feel confident enough with me and my style (it's a bit off center sometimes) to open up like that....hopefully, it's of value to you.
I treat and have treated numbers of ALS patients in my career so far at the VA Hospital in XXXXXXX OH. I've seen so many of them go from fully productive all the way to the inevitable final phases with all the hardships that go along with it....I've seen every class of person be stricken by this disease. It's rare to see someone like your mom go for 17 years. I hope the end struggle was not too uncomfortable and she was able to stay with you right up to the end...at least with ALS the mind remains perfectly intact right up to the end in most individuals.
One possibility in your case as to why your twitches are not settling down on your usual regimen of medication is the increased dose of Wellbutrin. Do you really believe that the increase in bupropion is truly HELPING....I mean, speaking in cold hard facts....is there a measurable and objective difference in your mood that a psychiatrist or psychologist could document using a screener of some sort? If the answer is less than a hearty, "ABSOLUTELY YES" then, I'd seriously consider cutting it back if these twitches are that bothersome to you.
Seems to me that controlling the twitches is Job 1 from your perspective, am I right? And we'd clearly like to do that with as little medication as possible.
There is also the use of BOTOX for this type of problem which has its downsides since in order to stop the twitching it may be necessary to block the muscle down to the point where there could be a little weakness involved. On the other hand, you've also been increasing your exercise regimen so may have much better reserve capacity in order to compensate for that part of the equation, right?
I wish I could give you some sort of guarantee that you will never develop or acquire ALS but I cannot given the known history of your mother. You wouldn't believe me even if I told you such nonsense...you're too well versed in things.
However, I am sure that if these twitchings you're having now are a continuation of what you've been dealing with from way yonder long ago that FOR SURE you cannot be diagnosed on the current information with ALS. And in that I am sure.
Now, has the neurologist suggested an EMG study for you? I think that's definitely one way of putting some objectivity on the face of this thing. Frankly, I think it will come up negative. It may even solidify the notion of BFS....but if it were me I would put more stock in the neurological examination results and go with the fact that in the absence of any significant muscle weakness, etc. etc. that ALS is just simply cannot be defined. Make sense?
By the way, KUDOS to you on your weight loss.....keep it up.....I've got a similar story of weight loss that I started doing about 10 years ago.
I had gotten to the point where my wife looked at me one day as I was in front of the TV and asked me, "So what are you going to name it?"
I looked at her in a confused way and said, "Huh? What am I going to name what?"
She replied, "That little baby elephant you've been cooking in there for the past few years....what are you going to name it?"
Well, I looked back at her and said, "Hey, You're lookin' at a frickin SOLID 184 lb. XXXXXXX in the room....not some stupid Floppy Eared Trunkmaster....!!"
So I set out on a mission to get down in 6 months to be able to once again get into my old collegiate sport of wrestling......At 6 months (nearly to the day) that I had started losing that weight...I was down to 140.5 and I weighed in at the Edinboro Open which I've attended nearly every year since then, to wrestle at the 141 weight class. However, that was TOO LOW for me and my wife then, told me to turn off all that stupid pride and start eating again!!! LOL!
So I wrestled that tournament at 141...(got hammered by the kids although I was able to finish all my matches without throwing up anywhere) and ever since then, I've been wrestling at 149 and more recently at 157.....there's not much incentive to look like a skeleton anymore....I don't have the constitution of a 20 year old at 54....so I'm comfortable a little heavier. I still go into open tournaments and I'm an assistant varsity coach for the wrestling team at XXXXXXX XXXXXXX University here in XXXXXXX ...so I'm going to keep doing that until I either get a major injury and die (got a great life insurance policy) or get tossed on my head and paralyzed from the neck down! Sweet...(got a pretty good disability policy). So I told the wife not to worry...we're covered no matter what...
Anyways, that's a little of my story.....I think yours is very interesting and far from being done.....so let me make one more brilliant suggestion to you if you want to take a further look at these twitchings with me.
Would you consider coming on line for a video teleconference? I can see you in real time..perhaps even the twitches and we can go through some maneuvers....your wife can be my EXAMINER and I'll instruct her what to do and I'll watch so that I might be able to assess whether I think any of what you've got is at all ALS like or more likely BFS'ish?
If so, I will be on tomorrow (Sunday) at 11p-3a (Eastern Time) at www.healthtap.com/drsaghafi. In fact, I'm typically online live from 3a-6a Wed-Sat's and then, Sunday night as I said. When you sign up for an account on their website you will have to specifically SEARCH FOR ME (Dariush Saghafi) otherwise, when you get online for the live consult the computer will route you to the first available consultant in your resident state.
At any rate...I wish you all the best and hope you can take something away from these conversations and settle in a little more to an understanding that your presentation of everything you've had all your life is NOT consistent with ALS...but still be recognizing and ACCEPTING of the fact that you cannot change your known risk factor of having had a 1st degree relative with ALS. Therefore, you MUST move on in your life understanding that you COULD develop ALS as your mother did. Lots of research going on in that arena though and I expect big things to be breaking in the next 10 years. Lots of cold water still being dumped on lots of heads these days so the money generated to find answers is absolutely phenomenal.....I think those are very bright stars in sky to look up at...don't you?
There's no benefit to freaking out, it only takes money from your pocket and puts in the pharmaceutical company's so don't give them the pleasure! And as you've pointed out your marriage is feeling the effects of all this SHTUFF
if you can take a few deep breaths and look at the glass as HALF FULL then, little by little, and especially with your new found sense of well being in working out, losing weight, and getting into shape, etc. maybe, just maybe you can start "filling up that glass a little bit more."
And your wife WILL SEE that and I'll bet she'll try to help if you ask her but she's probably frustrated because she wants to get involved and see you moving in the right direction with all this but you're making it tough with all the layers of SHTUFF in between.
You need to DITCH THE SHTUFF! (Say that one 3x fast--seriously try it)
And one of those UNNECESSARY layers of anxiety and fear is the one that says you have ALS. I and others clearly think you don't....not today and not yesterday and not yesteryear....use those facts to go forward!
Consider asking for an EMG/NCV study, cutting back (if not getting rid of the Wellbutrin)....let your weight lifting and cardio conditioning be your antidepressant medication.....I guarantee you'll feel better. How about getting your wife interested in a workout routine with you?
Get the recommended labs (Mg, Ca, other electrolytes, how about Vitamin D, D2, and D3? I'm a big fan of nice robust levels of Vitamin D in ANYBODY who has some type of neurological condition.)
Once again, I hope some of what I've said in this message resonated with you and is of value. If that's the case would you do me the huge favor (or as XXXXXXX Trump says, "EUGE" favor) of leaving some written feedback with a STAR RATING. The bag of peanuts for my little baby elephant will be bigger from the network if you do that! HAHA!
Also, if there are no further questions or comments on this thread please CLOSE THE QUERY on your end so that the network can process our conversations and properly archive and credit them for the future.
Finally, consider looking me up on the live webcam network according to what I've told you or alternatively DIRECT QUERY me on this network (Dariush Saghafi, MD) and I'll be happy to go over more things with you in terms of labs or EMG results should you decide to do them although it sounds like the neurologist you've already got is pretty competent. I'd follow his lead...who knows...I may even know him if he's in the XXXXXXX Academy of Neurology or have already run into him at a meeting or 2 from the past. I've been to every one of the Academy's meetings since 1999.
You know those CONVENTIONEERS MAN (Don't worry....I take my wife with me everywhere I can)! ROFLMAO.
Be cool, be safe, be well, BE SWELL!
This query required 60 minutes of physician specific time for review, research, and final draft documentation for envoy.
I hear 'ya and I'm honored that you'd share
Detailed Answer:
Thank you for your return message. I'm very honored that you feel confident enough with me and my style (it's a bit off center sometimes) to open up like that....hopefully, it's of value to you.
I treat and have treated numbers of ALS patients in my career so far at the VA Hospital in XXXXXXX OH. I've seen so many of them go from fully productive all the way to the inevitable final phases with all the hardships that go along with it....I've seen every class of person be stricken by this disease. It's rare to see someone like your mom go for 17 years. I hope the end struggle was not too uncomfortable and she was able to stay with you right up to the end...at least with ALS the mind remains perfectly intact right up to the end in most individuals.
One possibility in your case as to why your twitches are not settling down on your usual regimen of medication is the increased dose of Wellbutrin. Do you really believe that the increase in bupropion is truly HELPING....I mean, speaking in cold hard facts....is there a measurable and objective difference in your mood that a psychiatrist or psychologist could document using a screener of some sort? If the answer is less than a hearty, "ABSOLUTELY YES" then, I'd seriously consider cutting it back if these twitches are that bothersome to you.
Seems to me that controlling the twitches is Job 1 from your perspective, am I right? And we'd clearly like to do that with as little medication as possible.
There is also the use of BOTOX for this type of problem which has its downsides since in order to stop the twitching it may be necessary to block the muscle down to the point where there could be a little weakness involved. On the other hand, you've also been increasing your exercise regimen so may have much better reserve capacity in order to compensate for that part of the equation, right?
I wish I could give you some sort of guarantee that you will never develop or acquire ALS but I cannot given the known history of your mother. You wouldn't believe me even if I told you such nonsense...you're too well versed in things.
However, I am sure that if these twitchings you're having now are a continuation of what you've been dealing with from way yonder long ago that FOR SURE you cannot be diagnosed on the current information with ALS. And in that I am sure.
Now, has the neurologist suggested an EMG study for you? I think that's definitely one way of putting some objectivity on the face of this thing. Frankly, I think it will come up negative. It may even solidify the notion of BFS....but if it were me I would put more stock in the neurological examination results and go with the fact that in the absence of any significant muscle weakness, etc. etc. that ALS is just simply cannot be defined. Make sense?
By the way, KUDOS to you on your weight loss.....keep it up.....I've got a similar story of weight loss that I started doing about 10 years ago.
I had gotten to the point where my wife looked at me one day as I was in front of the TV and asked me, "So what are you going to name it?"
I looked at her in a confused way and said, "Huh? What am I going to name what?"
She replied, "That little baby elephant you've been cooking in there for the past few years....what are you going to name it?"
Well, I looked back at her and said, "Hey, You're lookin' at a frickin SOLID 184 lb. XXXXXXX in the room....not some stupid Floppy Eared Trunkmaster....!!"
So I set out on a mission to get down in 6 months to be able to once again get into my old collegiate sport of wrestling......At 6 months (nearly to the day) that I had started losing that weight...I was down to 140.5 and I weighed in at the Edinboro Open which I've attended nearly every year since then, to wrestle at the 141 weight class. However, that was TOO LOW for me and my wife then, told me to turn off all that stupid pride and start eating again!!! LOL!
So I wrestled that tournament at 141...(got hammered by the kids although I was able to finish all my matches without throwing up anywhere) and ever since then, I've been wrestling at 149 and more recently at 157.....there's not much incentive to look like a skeleton anymore....I don't have the constitution of a 20 year old at 54....so I'm comfortable a little heavier. I still go into open tournaments and I'm an assistant varsity coach for the wrestling team at XXXXXXX XXXXXXX University here in XXXXXXX ...so I'm going to keep doing that until I either get a major injury and die (got a great life insurance policy) or get tossed on my head and paralyzed from the neck down! Sweet...(got a pretty good disability policy). So I told the wife not to worry...we're covered no matter what...
Anyways, that's a little of my story.....I think yours is very interesting and far from being done.....so let me make one more brilliant suggestion to you if you want to take a further look at these twitchings with me.
Would you consider coming on line for a video teleconference? I can see you in real time..perhaps even the twitches and we can go through some maneuvers....your wife can be my EXAMINER and I'll instruct her what to do and I'll watch so that I might be able to assess whether I think any of what you've got is at all ALS like or more likely BFS'ish?
If so, I will be on tomorrow (Sunday) at 11p-3a (Eastern Time) at www.healthtap.com/drsaghafi. In fact, I'm typically online live from 3a-6a Wed-Sat's and then, Sunday night as I said. When you sign up for an account on their website you will have to specifically SEARCH FOR ME (Dariush Saghafi) otherwise, when you get online for the live consult the computer will route you to the first available consultant in your resident state.
At any rate...I wish you all the best and hope you can take something away from these conversations and settle in a little more to an understanding that your presentation of everything you've had all your life is NOT consistent with ALS...but still be recognizing and ACCEPTING of the fact that you cannot change your known risk factor of having had a 1st degree relative with ALS. Therefore, you MUST move on in your life understanding that you COULD develop ALS as your mother did. Lots of research going on in that arena though and I expect big things to be breaking in the next 10 years. Lots of cold water still being dumped on lots of heads these days so the money generated to find answers is absolutely phenomenal.....I think those are very bright stars in sky to look up at...don't you?
There's no benefit to freaking out, it only takes money from your pocket and puts in the pharmaceutical company's so don't give them the pleasure! And as you've pointed out your marriage is feeling the effects of all this SHTUFF
if you can take a few deep breaths and look at the glass as HALF FULL then, little by little, and especially with your new found sense of well being in working out, losing weight, and getting into shape, etc. maybe, just maybe you can start "filling up that glass a little bit more."
And your wife WILL SEE that and I'll bet she'll try to help if you ask her but she's probably frustrated because she wants to get involved and see you moving in the right direction with all this but you're making it tough with all the layers of SHTUFF in between.
You need to DITCH THE SHTUFF! (Say that one 3x fast--seriously try it)
And one of those UNNECESSARY layers of anxiety and fear is the one that says you have ALS. I and others clearly think you don't....not today and not yesterday and not yesteryear....use those facts to go forward!
Consider asking for an EMG/NCV study, cutting back (if not getting rid of the Wellbutrin)....let your weight lifting and cardio conditioning be your antidepressant medication.....I guarantee you'll feel better. How about getting your wife interested in a workout routine with you?
Get the recommended labs (Mg, Ca, other electrolytes, how about Vitamin D, D2, and D3? I'm a big fan of nice robust levels of Vitamin D in ANYBODY who has some type of neurological condition.)
Once again, I hope some of what I've said in this message resonated with you and is of value. If that's the case would you do me the huge favor (or as XXXXXXX Trump says, "EUGE" favor) of leaving some written feedback with a STAR RATING. The bag of peanuts for my little baby elephant will be bigger from the network if you do that! HAHA!
Also, if there are no further questions or comments on this thread please CLOSE THE QUERY on your end so that the network can process our conversations and properly archive and credit them for the future.
Finally, consider looking me up on the live webcam network according to what I've told you or alternatively DIRECT QUERY me on this network (Dariush Saghafi, MD) and I'll be happy to go over more things with you in terms of labs or EMG results should you decide to do them although it sounds like the neurologist you've already got is pretty competent. I'd follow his lead...who knows...I may even know him if he's in the XXXXXXX Academy of Neurology or have already run into him at a meeting or 2 from the past. I've been to every one of the Academy's meetings since 1999.
You know those CONVENTIONEERS MAN (Don't worry....I take my wife with me everywhere I can)! ROFLMAO.
Be cool, be safe, be well, BE SWELL!
This query required 60 minutes of physician specific time for review, research, and final draft documentation for envoy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi doc, thanks again for the info and support :) I played golf today, minimal tremors. I also had a long falk with my golf buddy, who is much like me and also very supportive, which made me feel better. I tool a clonazepam this morning, ive also been cutting back on wellbutrin back to 75 mg day.
I know that when my neurologist told me my mom did not have familial it was to make me feel better (he said 90% of ALS was sporadic, with most familial in Asia, plus no orher history in her family of ALS). Anyway, i rationalized that as truth and hung on to it ever simce. Our neurologist is dr Hazradji, in Holyoke/Springfield, MA.
Ill most likely take you up on your offer to connect on Healthtap. Ill also share the lab results with you.
Thanks again for your reassurance, honesty, and compassion. Its so hard to access any specialist without going to the ER, i think new model is a great start at changing healthcare accessibility.
I know that when my neurologist told me my mom did not have familial it was to make me feel better (he said 90% of ALS was sporadic, with most familial in Asia, plus no orher history in her family of ALS). Anyway, i rationalized that as truth and hung on to it ever simce. Our neurologist is dr Hazradji, in Holyoke/Springfield, MA.
Ill most likely take you up on your offer to connect on Healthtap. Ill also share the lab results with you.
Thanks again for your reassurance, honesty, and compassion. Its so hard to access any specialist without going to the ER, i think new model is a great start at changing healthcare accessibility.
Brief Answer:
Glad you're feeling better
Detailed Answer:
So good that you're feeling better. I will be on tonight from 11p-3a ET and will be happy to talk to you at greater length about things. Perhaps, things in terms of the twitches are improving now that you've cut Wellbutrin back. Remember, it takes a solid week for medication to really wash out of the system and for your body to start reacting once again to what it now SEES as the lower dose. When that happens I will bet that the twitches will return to their baseline behavior.
Weather is nice in this part of the country so I'm assuming it's the same out there...maybe another round or 2 of golf for you today? I have a gig to play at later this afternoon out at a Festival with a group I frequently play with after I go catch a good roll with my wrestling buddies down at XXXXXXX State University.
Ciao!
Oh, please don't forget to provide that all important WRITTEN FEEDBACK and STAR RATING for our interactions to this point and CLOSE THE QUERY on your end so the system can process, archive, and credit what we've done to date.
Look forward to speaking with you again (perhaps seeing you) soon.
www.healthtap.com/drsaghafi for video conferencing: Wed-Sat. 3a-6a, Sun. 11p-3a (ET)
Glad you're feeling better
Detailed Answer:
So good that you're feeling better. I will be on tonight from 11p-3a ET and will be happy to talk to you at greater length about things. Perhaps, things in terms of the twitches are improving now that you've cut Wellbutrin back. Remember, it takes a solid week for medication to really wash out of the system and for your body to start reacting once again to what it now SEES as the lower dose. When that happens I will bet that the twitches will return to their baseline behavior.
Weather is nice in this part of the country so I'm assuming it's the same out there...maybe another round or 2 of golf for you today? I have a gig to play at later this afternoon out at a Festival with a group I frequently play with after I go catch a good roll with my wrestling buddies down at XXXXXXX State University.
Ciao!
Oh, please don't forget to provide that all important WRITTEN FEEDBACK and STAR RATING for our interactions to this point and CLOSE THE QUERY on your end so the system can process, archive, and credit what we've done to date.
Look forward to speaking with you again (perhaps seeing you) soon.
www.healthtap.com/drsaghafi for video conferencing: Wed-Sat. 3a-6a, Sun. 11p-3a (ET)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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