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Offline Rasalhauge

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Doctors appointment gone bad=/
« on: June 11, 2014, 05:56:02 PM »
Went to my doctor yesterday since I´ve been having constant cramp-like pain in my left hand thenar muscle. I also have the impression that I´ve been loosing quite alot of bulk muscles in the hand, and both the hand itself and the lower part of my under arm is significantly smaller than my right. I have been trying to convince myself that this was all normal since im right-handed (and thus naturally get more training in right hand).

But, my doctor also noted the difference in size and bulk muscles (my left hand is realy skinny, and all tendons are clearly visible). Even so, he didn´t know if I needed an referal to a neurologist or if this was just natural variations in size in combination with slight disuse atrophy. He did however, to my HA´s appreciation, mention that there could be some form of dustrophia causing these diifferences, but I had no clinical weakness so he wasn´t sure whether or not it was plausible. He finnished the examination that it would take 1-2 months before I could get an neurologist appointment, and asked me if I still wanted a referal (which I insisted on).

So, can there realy be significant differense in bulk size of hands without any neurologic disease behind it? I have some quite intense pain problems (the cramp-like feeling and fatigue like pain), but my strength seems ok. I think that some of the pain could be from intentional/unintentional tensions due to anxiety (I do tend to chanel all anxiety to the body part I´m anxious of). Could that be it?

If I had ALS for example, then he would be able to see signs (at the very least) of actual clinical weakness, right?

As if this wasn´t enough, my speech problems and the associated anxiety has been through the roof latelly and I can barely get a single sentence right!

All of this has driven me to the point of actually finally have enough...
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“There is no greater sorrow than to recall in misery the time when we were happy.”

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Offline thenomnomnomicon

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Re: Doctors appointment gone bad=/
« Reply #1 on: June 11, 2014, 06:03:53 PM »
It would be exceptionally unlikely for you to have atrophy without clinical weakness.

Atrophy occurs only after 70% of the motor neurons are dead. It would be even stranger for you to notice 'feelings of fatigue' before clinical weakness.

Post a picture if you can.

My hands are slightly different sizes. I know this to be normal for most people. It is less worrying because it is your non-dominant hand.

That type of atrophy, that without clinical weakness, is far more commonly found in cases of CT. What did you say your age was, again?
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Offline Rasalhauge

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Re: Doctors appointment gone bad=/
« Reply #2 on: June 11, 2014, 06:46:20 PM »
It would be exceptionally unlikely for you to have atrophy without clinical weakness.

Atrophy occurs only after 70% of the motor neurons are dead. It would be even stranger for you to notice 'feelings of fatigue' before clinical weakness.

Post a picture if you can.

My hands are slightly different sizes. I know this to be normal for most people. It is less worrying because it is your non-dominant hand.

That type of atrophy, that without clinical weakness, is far more commonly found in cases of CT. What did you say your age was, again?

The fatigue part is what scares me the most, but it seems to correlate with the state of my anxiety though. When I´m realy anxious fatigue sets in almost instantly when I perform a task. A neurologist once explained that it was due to conversion/somatorform disorder, and that it was benign. But I don´t know, I´m having a hard time seeing of anxiety could make me fatigue easilly. Could it be due to tension?

I can post a picture in a sec, need to take my dog out for a short walk first=)

I´m only 27, but ALS still freaks me out so bad. Especially now when he noted some difference in size and fatty tissue, I know that it could be nothing but my mind is set on either MM1D or ALS.
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“There is no greater sorrow than to recall in misery the time when we were happy.”

- Dante Alighieri

Offline thenomnomnomicon

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Re: Doctors appointment gone bad=/
« Reply #3 on: June 11, 2014, 07:01:16 PM »
There are a few ways anxiety can cause feelings of fatigue.

When anxious your body pools blood into your vitals, leaving your distal regions at a deficit. This can cause feelings of heaviness/fatigue.

Sensitization can also cause feelings of fatigue.
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Offline Rasalhauge

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Re: Doctors appointment gone bad=/
« Reply #4 on: June 11, 2014, 08:09:03 PM »
I´m seriously freaked out beyond my wits. But I´m trying to think logically, if he had suspected any serious neurological issues then he would have gotten me a sooner appointment, right? If he had suspected ALS or any other fast progressing disease, then surely he wouldn´t have let me wait for 2 months?

I´m so scared that all words just seem to be in a haze, everything seems to be in a haze. I can´t focus and my whole body aches=(
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“There is no greater sorrow than to recall in misery the time when we were happy.”

- Dante Alighieri

Offline thenomnomnomicon

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Re: Doctors appointment gone bad=/
« Reply #5 on: June 12, 2014, 01:13:32 AM »
Rasal, I don't even remember, do you twitch or not?

Your speech is a perceived issue. This is something I deal with too and thoughts of PLS/ALS haunt the ***** out of me.

'Suspected' atrophy without weakness is hardly reason to get worked up.

You need to remember that there was no clear indication that it was atrophy. In ALS weakness will come before atrophy in 99% of cases. Even with PLS weakness comes first (as well as reflexive change that you don't have). I can tell you right now, looking at my hands, there are a number of very distinct differences. My right hand has less subcutaneous fat and more veins/tendons are apparent. My left is on-the-whole smaller, but less tendon is visible. Until you have weakness, reflex change, atrophy, and widespread fibrillation, you do not have ALS UNLESS a neurologist says so (sometimes they can predict the course of these things).
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Offline ShawnW

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Re: Doctors appointment gone bad=/
« Reply #6 on: June 12, 2014, 07:10:51 AM »
Knowing how you tend to freak out I wonder what was truly said to you.  Because docs don't look at the tendons in the hand for atrophy.  They will have you hold your thumb against your index finger and look at the pad that is there.  It should be smaller in your non-dominant hand.  But, it shouldn't look eroded away.  That is the most typical place atrophy takes place.  If that wasn't his focus, it's possible your doc has little experience looking for atrophy of the hands.  Doesn't make him a bad doc but neuro may not be his strength.  It's not uncommon to be able to see more or less definition of the hands.  That means little.  Even with true atrophy of the hand its rarely ***.  I had a marketing director with true atrophy, and he had a nerve compression issue.

If you want to post some pics, I would be happy to take a look.  Post them with your thumb against your first finger.  No need for you to suffer for 2 months waiting for a neuro appointment just because you misheard your doc or because neuro isn't his strength.
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My insight, thoughts, experiences or advice that may be posted in this forum are not meant as a substitution for the advice of your physician.

Want to know how to address your anxiety?
http://www.anxietyzone.com/index.php/topic,93402.msg521266.html#msg521266

Offline Roman

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Re: Doctors appointment gone bad=/
« Reply #7 on: June 12, 2014, 08:02:52 AM »
Ras I could have written this post. I've been in a panic about als for 6 months and the top of my left hand is much thinner as well as my wrist and upper fore arm is visibly thinner than the right. However I have no weakness. At pt on the grip meter I squeezed a 145 psi with my left and a 150 psi with my right. I do have multilevel cervical spondylosis in my neck. I'm seeing a neuro surgeon next week I'm hoping that's it. Have you had an MRI on ur cervical spine.
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Offline marc

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Re: Doctors appointment gone bad=/
« Reply #8 on: June 12, 2014, 08:14:22 AM »
I have actually known of three people with ALS. The first is still alive after 20 years, which I have never heard of, (confined to wheelchair for years)
the second person was standing at a bus stop, when her legs suddenly collapsed under her and she had trouble getting up.
The third had trouble opening twist off bottles and he was very fit and muscular.
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Offline Rasalhauge

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Re: Doctors appointment gone bad=/
« Reply #9 on: June 12, 2014, 10:35:34 AM »
Knowing how you tend to freak out I wonder what was truly said to you.  Because docs don't look at the tendons in the hand for atrophy.  They will have you hold your thumb against your index finger and look at the pad that is there.  It should be smaller in your non-dominant hand.  But, it shouldn't look eroded away.  That is the most typical place atrophy takes place.  If that wasn't his focus, it's possible your doc has little experience looking for atrophy of the hands.  Doesn't make him a bad doc but neuro may not be his strength.  It's not uncommon to be able to see more or less definition of the hands.  That means little.  Even with true atrophy of the hand its rarely ***.  I had a marketing director with true atrophy, and he had a nerve compression issue.

If you want to post some pics, I would be happy to take a look.  Post them with your thumb against your first finger.  No need for you to suffer for 2 months waiting for a neuro appointment just because you misheard your doc or because neuro isn't his strength.

You are right in that he wasn´t focusing his search on the visibility of my tendons, that was something that I got hung up on. Just like you said he asked me to hold my thumbs to my index fingers to my thumbs, and he didn´t look too concerned. He was even doubtfull whether or not it was worth a referal to a neurologist. I´ve taken some pictures now and uploaded them to imageshack:

http://imageshack.com/a/img842/3190/kqpg.jpg
http://imageshack.com/a/img843/1498/yy6hc.jpg
http://imageshack.com/a/img829/6792/64qb.jpg
http://imageshack.com/a/img853/2633/6lkw.jpg
http://imageshack.com/a/img855/713/wqa7.jpg
http://imageshack.com/a/img855/6992/p8rcs.jpg
http://imageshack.com/a/img822/3149/wtow.jpg

I hope the links works, otherwise let me know. I took several photos just to be sure I got everything=)
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“There is no greater sorrow than to recall in misery the time when we were happy.”

- Dante Alighieri

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