Need some insight. Cannot see neurologist for 7 months.

Posted by slyfryryeguy @slyfryryeguy, May 12, 2023

Full background:

I am 28 year old male and have been suffering from symptoms the last 2 months that all seem to point to ALS and I am wanting so guidance. I am just wanting some information if these symptoms point to ALS or if it’s pointing away. It started 2 months ago after having two concussions.

One I hit my frontal lobe from whiplash and blacked out brieflyand the other I slipped and blacked out and landed on my bum. I started a new job the following week and when I looked at a screen I felt a massive pain in the front of my forehead and what came with that was a numb feeling in my right foot. My primary issue was that for a few weeks, it would come and go especially if I started moving around so I didn’t think anything of it.

As days progressed, I noticed screens were now an issue, coffee caused numbness in both my feet and same with reading, I’d get a headache and foot numbness. Suddenly about beginning of April my right 4th toe started twitching and that was the main issue for a day or so. The next day the twitches started appearing everywhere in my body, primarily legs but also in my upper body in random places. The twitching also occurs often in my left arch and I’ve felt the same 4th toe a few times.

I then started to experience what I can only describe as an ache in my arch of right foot, the feeling of foot drop loss of sensation/weakness but still able to walk normally. That has now progressed to both feet, more so on right still and the left side the feeling goes away occasionally. I’m now feeling what I can describe as shin splints in my right leg primarily but a little on my left as well.

On top of that my thighs feel fatigued like I just worked them out but I haven’t recently. I just seem to be getting more and more symptoms as days progress. I spoke with a doctor and he said to try magnesium which I have but I am wanting some insight from someone here. I am so sorry for asking and I have read some of the main forums but I just need some advice as my anxiety is skyrocketed.

My twitching is still primarily in legs, and occasionally in upper limbs on both sides but I will admit the twitching is lessening. What I’m having huge issues with now is fatigue mostly in both my legs, or maybe weakness, I struggle to differentiate the two. I also still wake up every morning with numbness/lack of feeling in my feet and hands still. I do not know why I’m suddenly so tired before the day even ends even when I hardly do anything. It’s just worrisome, that my twitching seems to be lessening still very much there but now I’m getting severe fatigue. My shins especially on the right side feel like they have shin splints quite frequently. My walking also feels weird.

Current symptoms:

I’ve been twitching for the last month especially in my legs, more the the right leg, however I am getting twitching all over my body. The twitching has lessened, I am getting it less frequently. Biggest concerns are this moment is twitching but it’s lessened, however appearing in new spots like around my abdomen and in my hands a tad more. Persistent what I can only describe as shin splints mostly right side, somewhat persistent right arch ache unless I’m resting, Advil helps too I’ve noticed. I am still able to walk on my toes, heals and even did a pretty decent leg workout yesterday and did not notice any issues.

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@jenniferhunter

@slyfryryeguy Hello and welcome to Connect. I think I can help you understand what may be going on as a possibility. I'm not a doctor, but I am a spine surgery patient and I had a similar experience with symptoms to what you are describing. First, I have to say that I am shocked that your doctor told you to try taking magnesium when you are describing neurological symptoms. Did you tell this doctor about the whiplash and concussions? That is a key piece of evidence for diagnosis.

You may have done what I did after a whiplash. I told myself I was going to be OK. I had an HMO insurance plan at the time and all my primary care doctor did was write down if my neck stiffness and pain was getting better and did no further testing. It was a long time ago. You had 2 events that jarred your spine. You are reporting drop foot, difficulty walking, weakness and fatigue in your legs. Twitching muscles. I remember thinking it could be ALS, and didn't even consider that a whiplash could have injured me and caused this. I remember that my leg pain changed sides, and when I took a step, my foot slapped the floor which I could not prevent. I reported that to my doctor, but that didn't raise eyebrows, but it should have.

Laying down and having your arms and legs go numb is another huge clue to what may be wrong if you understand how the spinal cord shifts inside the spinal canal with changing body positions and the effect of gravity and what happens during a whiplash. It's like cracking a whip and snapping the spine in changing directions quickly and it stresses the discs that are holding the bones of the spine together. If there is enough damage, the discs can weaken, crack, bulge or herniate and start spilling the jelly like stuff inside. If that jelly has spilled out, it causes inflammation and initiates bone growth next to it to try to stabilize the spine. Imaging the spine in different positions of standing vs laying down or seated can show very different pictures of vertebrae that are slipping past each other instead of maintaining a neatly stacked position. There could be multiple places of laxity in the spine, a whiplash affects the neck, but there may have been damage to the spine in the lower back too. Typically with leg related symptoms, that is where doctors will look for trouble. If there is enough sliding of vertebrae, it can contact or put pressure on the spinal cord, and that is pot luck on what will be affected. The spinal cord is a big bundle of all the nerves between the brain and the body that control everything. Nerves leave at levels all along the spine, but in the neck, everything must pass through there for the entire body. Remember that the spinal cord is supposed to move inside the fluid filled spinal canal, so it may contact different places at different times and change where your symptoms are.

Here is where understanding spine injuries gets tricky and 5 surgeons missed my diagnosis in that they could not relate my symptoms to my imaging of my neck. I had pain all over my body, twitching and it changed positions, uneven gait when walking, difficulty emptying my bladder, weakness in arms and legs, loss of coordination of my arms, headaches that were usually worse on one side. Pain in the bottom of my feet that made it difficult to press the accelerator and drive which would start tingling and pain in my foot. If a nerve is compressed where it exits the spinal cord between the vertebrae bones, it is very predictable where pain and nerve symptoms will be felt. If spinal cord compression is present, it can cause pain anywhere in the body and pain that can change locations. That is what confused every spine surgeon before I came to Mayo. I found medical literature that described a case like mine because I was reading literature authored by a Mayo neurosurgeon, and I looked up a term I didn't understand which was "funicular pain". That is pain all over the body caused by spinal cord compression in the neck. I wasted 2 years seeing surgeons who wouldn't help me because they didn't understand this, and there was not a lot of literature about this "rare presentation of symptoms" 6 years ago when I had my surgery.
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@slyfryryeguy

If I may be direct here, I think that waiting 7 months to see a neurologist is a waste of time. Then you'll wait again for testing or imaging and just drag out the diagnosis. It is better to see a spine specialist first. The spine surgeon probably has a preferred neurologist that they like to work with anyway. I saw 5 different surgeons over a 2 year time and got nowhere, only to be dismissed because they didn't understand my case and there was neurology testing too. When I got to Mayo, they repeated the neurology testing again because the need to confirm the results.

Find the very best spine surgeon that you can. If you can go to Mayo first, you will probably save a lot of time and find a surgeon who can figure all this out. The wait to get into Mayo (if accepted) is probably around 3 months, but they would have to answer that. Urgent cases get priority. I wish I had come to Mayo first, but I didn't know how difficult this was to figure out. I was also running up against surgeons who didn't want to risk their reputation on something that they thought was difficult with unpredictable results. No one wants that on their record. It was much easier to say that they thought I could have an inflammatory disease like MS and I was told that by a top level surgeon who said that a cervical fusion may not help most of my symptoms and he didn't want to put me through it... how "kind' of him to say that, but he was wrong. This surgeon did an epidural spinal injection as a diagnostic test and that temporarily took away ALL my pain symptoms, and then they gradually came back. He didn't understand the results, so he ignored the test. Apparently it was supposed to only help my arm pain, and leave the rest as evidence there was an additional problem and weed me out as patient. This is a possible predictor that funicular pain is present if it resolves all the pain temporarily. There is no diagnostic test to confirm it, except that decompression spine surgery fixes the problem, and in my case, that was true and surgery fixed everything.

Surgeons can be very selective about what cases they will accept for many reasons. Some reasons are honest opinions of not wanting to harm a patent, and some are selfish reasons that are more about their own fears of failure. I don't wish to bash doctors, and the best ones do put the patients needs first. That is why you want a surgeon who enjoys the challenge of a difficult case. My surgeon at Mayo wants the challenging cases. You will have to advocate for yourself and you need one who understands funicular pain. I found myself in the position of finding my correct diagnosis myself and then none of my doctors at that medical center would help me inform the surgeon who examined me. No one would point out his mistake and I was left without help. That is when I applied to Mayo, and I sent in a copy of the medical literature that I found asking if my case was similar to this paper and I sent it with a letter explaining that I found it because of his paper where I found the term "funicular pain". That gives control to the doctor who can evaluate it and decide, and my concern was heard.

After my whiplash, the drop foot did resolve in a couple months, but returned again later when I had bone spurs and a ruptured disc pressing into my spinal cord. I was working with a physical therapist at the time and she would realign my spine which improved my symptoms and the drop foot until muscle spasms brought it back because it shifted my vertebrae. It was about 20 years for my spine condition to progress to surgery after the injury. Each case is different, and the degree of injury can be different.

Here are some links. There are 2 stories about my surgeon at Mayo, and one of them is mine, and the medical literature that I found that described my condition of "funicular pain."

Sharing Mayo Clinic: Spinal surgery saves teen swimmer’s mobility
https://newsnetwork.mayoclinic.org/discussion/sharing-mayo-clinic-spinal-surgery-saves-teen-swimmers-mobility/
Sharing Mayo Clinic: Using the Art of Medicine to Overcome Fear of Surgery
https://newsnetwork.mayoclinic.org/discussion/using-the-art-of-medicine-to-overcome-fear-of-surgery/
National Library of Medicine: "Cervical cord compression presenting with sciatica-like leg pain"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111492/
Would you consider an appointment at Mayo for a spine consultation? If you would answer yes to that, you may want to call the Mayo billing department to see if your health insurance is accepted at Mayo.
Billing can be found at https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance or call Patient Account Services toll free at 844-217-9591 Monday through Friday.

Then if you wish to continue, you may request an appointment at any Mayo Clinic campus with this link: http://mayocl.in/1mtmR63

If that isn't possible, you'll need to research to find a good spine specialist at a major medical teaching facility.

May I answer any questions for you about my experience as a spine patient?
Jennifer

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@slyfryryeguy

I had no idea BFS could cause cramping. My twitching is mostly in the right leg still but it is appearing in the other leg frequently alongside areas in my torso like my abdomen and back somewhat frequently. My biggest concern isn’t even the twitching now it is the minor ache my right leg is feeling and bottom of foot pain/ache. I am hoping this does subside, just hard not knowing for sure. Thank you for replying as that does make me feel better there is another diagnosis this could be. I know ALS does not cause tingling or numbness and I’ve felt that on the occasion so I’m holding on that for hope.

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I had quite a lot of cramping for a while, and the fasciculations were widespread. They would be in one area for a bit, then go to another, even in my scalp and eyelids. I had stiffness in the muscles as well. It gradually got better, and I only notice it occasionally now. It is really scary at first, especially when you have to wait so long to see the doctor. If you haven't yet, take a look at the BFS thread on this site. I think that will give you some encouragement as well.

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@franksgirl210

I had quite a lot of cramping for a while, and the fasciculations were widespread. They would be in one area for a bit, then go to another, even in my scalp and eyelids. I had stiffness in the muscles as well. It gradually got better, and I only notice it occasionally now. It is really scary at first, especially when you have to wait so long to see the doctor. If you haven't yet, take a look at the BFS thread on this site. I think that will give you some encouragement as well.

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Thank you again for your reply. It’s good to hear BFS can cause similar symptoms to what I am experiencing. I am glad you’re doing better now though. I guess my biggest concern is my cramping/tightness and foot pain is focused to my right side only. I get twitching kn many spots but my right leg and foot is experiencing other symptoms. I will check out the thread!

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I am no expert but it sounds similar to peripheral neuropathy……. Als twitches usually do not start randomly…… what I have read your muscles weaken or experience spasticity then twitch for it to be Als

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@franksgirl210

I had quite a lot of cramping for a while, and the fasciculations were widespread. They would be in one area for a bit, then go to another, even in my scalp and eyelids. I had stiffness in the muscles as well. It gradually got better, and I only notice it occasionally now. It is really scary at first, especially when you have to wait so long to see the doctor. If you haven't yet, take a look at the BFS thread on this site. I think that will give you some encouragement as well.

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One other question, can BFS affect your abdominals, neck and face because I’ve had the odd twitch here and there in those muscles.

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@slyfryryeguy

One other question, can BFS affect your abdominals, neck and face because I’ve had the odd twitch here and there in those muscles.

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I have twitches in my rib cage, the sides of my knee cap and calf bone, my buttocks…. All one twitch and done…. Everywhere…. The twitch will pick a spot and a minute later move to another spot… never in a logical order…..

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@twitchy

I have twitches in my rib cage, the sides of my knee cap and calf bone, my buttocks…. All one twitch and done…. Everywhere…. The twitch will pick a spot and a minute later move to another spot… never in a logical order…..

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I’ve had the same muscle and spot twitch a few times in a row before it’s moved in somewhere else

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@slyfryryeguy

One other question, can BFS affect your abdominals, neck and face because I’ve had the odd twitch here and there in those muscles.

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It did for me. I even had twitches on my scalp. I had a lot of eyelid twitching and sometimes in my lip.

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Sounds like you may have some neuropathy going on too!
However, I am not an expert. I think it's wise to get a Mayo doc as soon as you can!
This would probably shorten your waiting time to get In!
I don't know where you live.
I live in a rural part of MN with a Mayo Clinic Health System Clinic in town. They may be able to either see you for evaluation, or, refer you to a lager Mayo Clinic. E.g. Rochester.
Good luck! God Bless! Pat .

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Don't know if this will help of not. My husband was diagnosed with transverse myelitis after over 100 various tests. He was sent to a neurologist at University of San Francisco. He ends up getting a final diagnosis from the rheumatologist. Sometimes it takes various specialist who sees something out of the tests. His diagnosis was corroborated by the third neurologist he saw. If you are near a university hospital I would suggest you look around and see where you can get in the fastest. We were concerned about ALS and MS Thankful it was not but since there is no treatment for TH all he really gained was a knowledge of what to expect from all the numbness ( from feet to chest and hands). Best of luck to you. God Bless.

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