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Good Day Dr. Saghafi, As A Follow Up To Our
Question: Good Day Dr. Saghafi,
As a follow up to our appointment the other day. I am unable to find a therapist who is willing to take on the multi visit per week regime. The other outpatient options are group therapy’s. I’m in a tough spot there.
Also, I’ve had diarrhea for the past few days, and weight loss. My initial weight before this all occurred on March 10th was 217-220 pounds. After the twitching, I’m between 205-210 pounds as of today. So there has been an honest 10-12 pound loss since onset. I must mention, I have been eating a cleaner diet. No fast food, alcohol or things like potato chips and other snacks. I have experienced diarrhea directly after major anxiety attacks like the one I had earlier in the week (Tuesday). When woke up today, I had body aching with soreness in my joints, also high anxiety. My BP was 105/65 and body temperature was down to 96.5 degrees. I’m not feeling well. Not sure if I’m drained from such a hard week or otherwise. I have no noticeable weekness, but I feel drained.
I have noticed twitching (occasional) under my jaw. I have difficulty sleeping now and an increase in spasm like twitching after I move a muscle. I took khlonopin before bed and I woke up hours later very unnerved and anxious.
As a follow up to our appointment the other day. I am unable to find a therapist who is willing to take on the multi visit per week regime. The other outpatient options are group therapy’s. I’m in a tough spot there.
Also, I’ve had diarrhea for the past few days, and weight loss. My initial weight before this all occurred on March 10th was 217-220 pounds. After the twitching, I’m between 205-210 pounds as of today. So there has been an honest 10-12 pound loss since onset. I must mention, I have been eating a cleaner diet. No fast food, alcohol or things like potato chips and other snacks. I have experienced diarrhea directly after major anxiety attacks like the one I had earlier in the week (Tuesday). When woke up today, I had body aching with soreness in my joints, also high anxiety. My BP was 105/65 and body temperature was down to 96.5 degrees. I’m not feeling well. Not sure if I’m drained from such a hard week or otherwise. I have no noticeable weekness, but I feel drained.
I have noticed twitching (occasional) under my jaw. I have difficulty sleeping now and an increase in spasm like twitching after I move a muscle. I took khlonopin before bed and I woke up hours later very unnerved and anxious.
Good Day Dr. Saghafi,
As a follow up to our appointment the other day. I am unable to find a therapist who is willing to take on the multi visit per week regime. The other outpatient options are group therapy’s. I’m in a tough spot there.
Also, I’ve had diarrhea for the past few days, and weight loss. My initial weight before this all occurred on March 10th was 217-220 pounds. After the twitching, I’m between 205-210 pounds as of today. So there has been an honest 10-12 pound loss since onset. I must mention, I have been eating a cleaner diet. No fast food, alcohol or things like potato chips and other snacks. I have experienced diarrhea directly after major anxiety attacks like the one I had earlier in the week (Tuesday). When woke up today, I had body aching with soreness in my joints, also high anxiety. My BP was 105/65 and body temperature was down to 96.5 degrees. I’m not feeling well. Not sure if I’m drained from such a hard week or otherwise. I have no noticeable weekness, but I feel drained.
I have noticed twitching (occasional) under my jaw. I have difficulty sleeping now and an increase in spasm like twitching after I move a muscle. I took khlonopin before bed and I woke up hours later very unnerved and anxious.
As a follow up to our appointment the other day. I am unable to find a therapist who is willing to take on the multi visit per week regime. The other outpatient options are group therapy’s. I’m in a tough spot there.
Also, I’ve had diarrhea for the past few days, and weight loss. My initial weight before this all occurred on March 10th was 217-220 pounds. After the twitching, I’m between 205-210 pounds as of today. So there has been an honest 10-12 pound loss since onset. I must mention, I have been eating a cleaner diet. No fast food, alcohol or things like potato chips and other snacks. I have experienced diarrhea directly after major anxiety attacks like the one I had earlier in the week (Tuesday). When woke up today, I had body aching with soreness in my joints, also high anxiety. My BP was 105/65 and body temperature was down to 96.5 degrees. I’m not feeling well. Not sure if I’m drained from such a hard week or otherwise. I have no noticeable weekness, but I feel drained.
I have noticed twitching (occasional) under my jaw. I have difficulty sleeping now and an increase in spasm like twitching after I move a muscle. I took khlonopin before bed and I woke up hours later very unnerved and anxious.
Brief Answer:
We've spoken on these issues but I'm happy to recap
Detailed Answer:
Good morning sir! We both know that this is the old news....but allow me to touch on the highlights of what we're already both in tune with since our telephone conversation.
I recommended to you that in order to obtain the type of concentrated guidance and supervision that I feel would best help you address issues of health anxiety as related to your symptoms of muscle twitching and other things that you present to the VA Medical Center in your area. However, you mentioned that you are not in possession of your DD214 which as I understand is requisite to becoming connected in for VA Medical Services. However, obtaining a DD214 can be done rather easily these days by going directly to the VA facility itself or going to your VA Regional Office which is generally found in the Federal Building of any major U.S. metropolis. I've heard that with proper documentation in hand a new DD214 can be reissued in a matter of days or weeks and will be delivered via U.S. Mail.
So once you have that in hand you should be able to proceed to your local hospital or CBOC (Community Based Outpatient Clinic) and explain what we've been discussing and then, see what they're response is going to be. It wouldn't XXXXXXX me if they would ask you be fully evaluated and then, triaged for care which will take time and I understand from our conversation that you are "done" with the twitching and other symptoms.
The other option I recommended you consider was the one you have already investigated and looking into which was to check yourself into a program specifically designed to treat people with high states of anxiety. I'm not clear on whether or not those programs are SPECIFIC to Health Anxiety which is what you're exhibiting at this time with the variety of constitutional symptoms and worry about the possibility of having ALS. As I recently reassured you in another message on this same forum there is no evidence that we've been able to discern in your case of muscle twitching, etc. after formal neurological examinations (thusfar 2 personal visits with neurologists) which have documented any criteria in support of motor neuron disease of the ALS type. The down side to these programs is that they are usually very costly, do not really offer FULL PERSONALIZED counseling/coaching that I believe is what you really need on an ONGOING basis at this time and are typically short lived in their after effects (i.e. when the sessions are up and everyone goes home).
If you believe you need this type of partial hospitalization program (for which your insurance may or may not cover) I did mention that I would happy to see if we could set something up through the VA here in XXXXXXX (once you got your DD214 squared away) whereby you could see the therapists at the VA (who I know and are accustomed to working with) but that even if they could not work out a schedule of daily or near daily consultations that we could get support from community based therapists and/or psychologists to see you on the off days that you would not be seen through the VA. Again, there are costs involved but I don't think it would come out to nearly as expensive as the free standing 60 or 90 days programs you've investigated. The only other expense if you were to agree with this plan that you would likely have to budget for would be accommodations here in the XXXXXXX area which could be found very economically if you would look into something such as a STAY XXXXXXX RESIDENCE INN, etc. Or perhaps, there'd be a possibility of being able to stay in the CARES Tower at the VA that does house veterans who are here temporarily for inpatient treatment programs that are not related to an acute hospital stay...such as substance abuse, PTSD, or other concentrated or intense types of programs utilizing psychotherapy services.
Symptoms of weight loss in and of itself is not a red flag for ALS when muscle strength is judged to be normal (by a neurologist's criteria for measurement)...BTW, in this particular message note that you do state, "I have noticeable weakness"....which seems to have variability to how you feel going from one time period to time period. Yesterday by telephone I think you quite clearly believed there was at least a PERCEIVED weakness in the right hand because you "feel gravity more" than on the left. Again, we must be clear that a patient's PERCEIVED weakness is not a fulfilled criteria when considering a diagnosis of ALS.....it's weakness as measured and verified by an examining physician (typically a neurologist).
Therefore, although I entirely recognize and feel badly that you've had this unintentional weight loss over the past several weeks along with diarrhea I can once again assure you that these symptoms are entirely irrelevant to the DIAGNOSTIC CRITERIA utilized to make the diagnosis of ALS. Of course, this is not to suggest that your condition of weight loss and diarrhea shouldn't be addressed. We did talk about this during our conversation but I'll re-iterate that if you've been experiencing full watery stools multiple times daily....and you haven't been eating in a NEW CRAZY restaurant with foods that you've never eaten before that you need to REPLACE FLUIDS....and next you should be logging a calorie count so that you can demonstrate exactly what your intake has been. My guess is that you are not eating well, not drinking sufficient fluids and that these are the major contributing factors (oh, also forgot to mention that you are stressed and anxious about things) which are all GREAT REASONS to experience weight loss and GI disturbances.
There is no significance to a body temperature of 96.5 nor a BP of 105/65 and neither of those parameters are worthy of concern on your part.
You also did mention that KLONOPIN taken the other night for sleeping or relaxation appears to be linked to very unpleasant side effects INCLUDING significant exacerbation or precipitation of muscle twitching. You should likely place KLONOPIN on a list of NO-NO medications due to side effects or PARADOXICAL effects.
Please talk over these options (if they remain relevant following our detailed telephone conversation from yesterday) with Iris and see what she thinks of any of them. You'll notice that all require time to set up but I estimate that if you wanted to make the decision on any of them...you could get things rolling inside of 3-4 weeks...maybe sooner if the VA doesn't enter into the equation at all and you wished to simply go fully private (more expensive course of action).
Be well sir!
This query required 75 minutes of professional time to research, assimilate, and file a response.
We've spoken on these issues but I'm happy to recap
Detailed Answer:
Good morning sir! We both know that this is the old news....but allow me to touch on the highlights of what we're already both in tune with since our telephone conversation.
I recommended to you that in order to obtain the type of concentrated guidance and supervision that I feel would best help you address issues of health anxiety as related to your symptoms of muscle twitching and other things that you present to the VA Medical Center in your area. However, you mentioned that you are not in possession of your DD214 which as I understand is requisite to becoming connected in for VA Medical Services. However, obtaining a DD214 can be done rather easily these days by going directly to the VA facility itself or going to your VA Regional Office which is generally found in the Federal Building of any major U.S. metropolis. I've heard that with proper documentation in hand a new DD214 can be reissued in a matter of days or weeks and will be delivered via U.S. Mail.
So once you have that in hand you should be able to proceed to your local hospital or CBOC (Community Based Outpatient Clinic) and explain what we've been discussing and then, see what they're response is going to be. It wouldn't XXXXXXX me if they would ask you be fully evaluated and then, triaged for care which will take time and I understand from our conversation that you are "done" with the twitching and other symptoms.
The other option I recommended you consider was the one you have already investigated and looking into which was to check yourself into a program specifically designed to treat people with high states of anxiety. I'm not clear on whether or not those programs are SPECIFIC to Health Anxiety which is what you're exhibiting at this time with the variety of constitutional symptoms and worry about the possibility of having ALS. As I recently reassured you in another message on this same forum there is no evidence that we've been able to discern in your case of muscle twitching, etc. after formal neurological examinations (thusfar 2 personal visits with neurologists) which have documented any criteria in support of motor neuron disease of the ALS type. The down side to these programs is that they are usually very costly, do not really offer FULL PERSONALIZED counseling/coaching that I believe is what you really need on an ONGOING basis at this time and are typically short lived in their after effects (i.e. when the sessions are up and everyone goes home).
If you believe you need this type of partial hospitalization program (for which your insurance may or may not cover) I did mention that I would happy to see if we could set something up through the VA here in XXXXXXX (once you got your DD214 squared away) whereby you could see the therapists at the VA (who I know and are accustomed to working with) but that even if they could not work out a schedule of daily or near daily consultations that we could get support from community based therapists and/or psychologists to see you on the off days that you would not be seen through the VA. Again, there are costs involved but I don't think it would come out to nearly as expensive as the free standing 60 or 90 days programs you've investigated. The only other expense if you were to agree with this plan that you would likely have to budget for would be accommodations here in the XXXXXXX area which could be found very economically if you would look into something such as a STAY XXXXXXX RESIDENCE INN, etc. Or perhaps, there'd be a possibility of being able to stay in the CARES Tower at the VA that does house veterans who are here temporarily for inpatient treatment programs that are not related to an acute hospital stay...such as substance abuse, PTSD, or other concentrated or intense types of programs utilizing psychotherapy services.
Symptoms of weight loss in and of itself is not a red flag for ALS when muscle strength is judged to be normal (by a neurologist's criteria for measurement)...BTW, in this particular message note that you do state, "I have noticeable weakness"....which seems to have variability to how you feel going from one time period to time period. Yesterday by telephone I think you quite clearly believed there was at least a PERCEIVED weakness in the right hand because you "feel gravity more" than on the left. Again, we must be clear that a patient's PERCEIVED weakness is not a fulfilled criteria when considering a diagnosis of ALS.....it's weakness as measured and verified by an examining physician (typically a neurologist).
Therefore, although I entirely recognize and feel badly that you've had this unintentional weight loss over the past several weeks along with diarrhea I can once again assure you that these symptoms are entirely irrelevant to the DIAGNOSTIC CRITERIA utilized to make the diagnosis of ALS. Of course, this is not to suggest that your condition of weight loss and diarrhea shouldn't be addressed. We did talk about this during our conversation but I'll re-iterate that if you've been experiencing full watery stools multiple times daily....and you haven't been eating in a NEW CRAZY restaurant with foods that you've never eaten before that you need to REPLACE FLUIDS....and next you should be logging a calorie count so that you can demonstrate exactly what your intake has been. My guess is that you are not eating well, not drinking sufficient fluids and that these are the major contributing factors (oh, also forgot to mention that you are stressed and anxious about things) which are all GREAT REASONS to experience weight loss and GI disturbances.
There is no significance to a body temperature of 96.5 nor a BP of 105/65 and neither of those parameters are worthy of concern on your part.
You also did mention that KLONOPIN taken the other night for sleeping or relaxation appears to be linked to very unpleasant side effects INCLUDING significant exacerbation or precipitation of muscle twitching. You should likely place KLONOPIN on a list of NO-NO medications due to side effects or PARADOXICAL effects.
Please talk over these options (if they remain relevant following our detailed telephone conversation from yesterday) with Iris and see what she thinks of any of them. You'll notice that all require time to set up but I estimate that if you wanted to make the decision on any of them...you could get things rolling inside of 3-4 weeks...maybe sooner if the VA doesn't enter into the equation at all and you wished to simply go fully private (more expensive course of action).
Be well sir!
This query required 75 minutes of professional time to research, assimilate, and file a response.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
We've spoken on these issues but I'm happy to recap
Detailed Answer:
Good morning sir! We both know that this is the old news....but allow me to touch on the highlights of what we're already both in tune with since our telephone conversation.
I recommended to you that in order to obtain the type of concentrated guidance and supervision that I feel would best help you address issues of health anxiety as related to your symptoms of muscle twitching and other things that you present to the VA Medical Center in your area. However, you mentioned that you are not in possession of your DD214 which as I understand is requisite to becoming connected in for VA Medical Services. However, obtaining a DD214 can be done rather easily these days by going directly to the VA facility itself or going to your VA Regional Office which is generally found in the Federal Building of any major U.S. metropolis. I've heard that with proper documentation in hand a new DD214 can be reissued in a matter of days or weeks and will be delivered via U.S. Mail.
So once you have that in hand you should be able to proceed to your local hospital or CBOC (Community Based Outpatient Clinic) and explain what we've been discussing and then, see what they're response is going to be. It wouldn't XXXXXXX me if they would ask you be fully evaluated and then, triaged for care which will take time and I understand from our conversation that you are "done" with the twitching and other symptoms.
The other option I recommended you consider was the one you have already investigated and looking into which was to check yourself into a program specifically designed to treat people with high states of anxiety. I'm not clear on whether or not those programs are SPECIFIC to Health Anxiety which is what you're exhibiting at this time with the variety of constitutional symptoms and worry about the possibility of having ALS. As I recently reassured you in another message on this same forum there is no evidence that we've been able to discern in your case of muscle twitching, etc. after formal neurological examinations (thusfar 2 personal visits with neurologists) which have documented any criteria in support of motor neuron disease of the ALS type. The down side to these programs is that they are usually very costly, do not really offer FULL PERSONALIZED counseling/coaching that I believe is what you really need on an ONGOING basis at this time and are typically short lived in their after effects (i.e. when the sessions are up and everyone goes home).
If you believe you need this type of partial hospitalization program (for which your insurance may or may not cover) I did mention that I would happy to see if we could set something up through the VA here in XXXXXXX (once you got your DD214 squared away) whereby you could see the therapists at the VA (who I know and are accustomed to working with) but that even if they could not work out a schedule of daily or near daily consultations that we could get support from community based therapists and/or psychologists to see you on the off days that you would not be seen through the VA. Again, there are costs involved but I don't think it would come out to nearly as expensive as the free standing 60 or 90 days programs you've investigated. The only other expense if you were to agree with this plan that you would likely have to budget for would be accommodations here in the XXXXXXX area which could be found very economically if you would look into something such as a STAY XXXXXXX RESIDENCE INN, etc. Or perhaps, there'd be a possibility of being able to stay in the CARES Tower at the VA that does house veterans who are here temporarily for inpatient treatment programs that are not related to an acute hospital stay...such as substance abuse, PTSD, or other concentrated or intense types of programs utilizing psychotherapy services.
Symptoms of weight loss in and of itself is not a red flag for ALS when muscle strength is judged to be normal (by a neurologist's criteria for measurement)...BTW, in this particular message note that you do state, "I have noticeable weakness"....which seems to have variability to how you feel going from one time period to time period. Yesterday by telephone I think you quite clearly believed there was at least a PERCEIVED weakness in the right hand because you "feel gravity more" than on the left. Again, we must be clear that a patient's PERCEIVED weakness is not a fulfilled criteria when considering a diagnosis of ALS.....it's weakness as measured and verified by an examining physician (typically a neurologist).
Therefore, although I entirely recognize and feel badly that you've had this unintentional weight loss over the past several weeks along with diarrhea I can once again assure you that these symptoms are entirely irrelevant to the DIAGNOSTIC CRITERIA utilized to make the diagnosis of ALS. Of course, this is not to suggest that your condition of weight loss and diarrhea shouldn't be addressed. We did talk about this during our conversation but I'll re-iterate that if you've been experiencing full watery stools multiple times daily....and you haven't been eating in a NEW CRAZY restaurant with foods that you've never eaten before that you need to REPLACE FLUIDS....and next you should be logging a calorie count so that you can demonstrate exactly what your intake has been. My guess is that you are not eating well, not drinking sufficient fluids and that these are the major contributing factors (oh, also forgot to mention that you are stressed and anxious about things) which are all GREAT REASONS to experience weight loss and GI disturbances.
There is no significance to a body temperature of 96.5 nor a BP of 105/65 and neither of those parameters are worthy of concern on your part.
You also did mention that KLONOPIN taken the other night for sleeping or relaxation appears to be linked to very unpleasant side effects INCLUDING significant exacerbation or precipitation of muscle twitching. You should likely place KLONOPIN on a list of NO-NO medications due to side effects or PARADOXICAL effects.
Please talk over these options (if they remain relevant following our detailed telephone conversation from yesterday) with Iris and see what she thinks of any of them. You'll notice that all require time to set up but I estimate that if you wanted to make the decision on any of them...you could get things rolling inside of 3-4 weeks...maybe sooner if the VA doesn't enter into the equation at all and you wished to simply go fully private (more expensive course of action).
Be well sir!
This query required 75 minutes of professional time to research, assimilate, and file a response.
We've spoken on these issues but I'm happy to recap
Detailed Answer:
Good morning sir! We both know that this is the old news....but allow me to touch on the highlights of what we're already both in tune with since our telephone conversation.
I recommended to you that in order to obtain the type of concentrated guidance and supervision that I feel would best help you address issues of health anxiety as related to your symptoms of muscle twitching and other things that you present to the VA Medical Center in your area. However, you mentioned that you are not in possession of your DD214 which as I understand is requisite to becoming connected in for VA Medical Services. However, obtaining a DD214 can be done rather easily these days by going directly to the VA facility itself or going to your VA Regional Office which is generally found in the Federal Building of any major U.S. metropolis. I've heard that with proper documentation in hand a new DD214 can be reissued in a matter of days or weeks and will be delivered via U.S. Mail.
So once you have that in hand you should be able to proceed to your local hospital or CBOC (Community Based Outpatient Clinic) and explain what we've been discussing and then, see what they're response is going to be. It wouldn't XXXXXXX me if they would ask you be fully evaluated and then, triaged for care which will take time and I understand from our conversation that you are "done" with the twitching and other symptoms.
The other option I recommended you consider was the one you have already investigated and looking into which was to check yourself into a program specifically designed to treat people with high states of anxiety. I'm not clear on whether or not those programs are SPECIFIC to Health Anxiety which is what you're exhibiting at this time with the variety of constitutional symptoms and worry about the possibility of having ALS. As I recently reassured you in another message on this same forum there is no evidence that we've been able to discern in your case of muscle twitching, etc. after formal neurological examinations (thusfar 2 personal visits with neurologists) which have documented any criteria in support of motor neuron disease of the ALS type. The down side to these programs is that they are usually very costly, do not really offer FULL PERSONALIZED counseling/coaching that I believe is what you really need on an ONGOING basis at this time and are typically short lived in their after effects (i.e. when the sessions are up and everyone goes home).
If you believe you need this type of partial hospitalization program (for which your insurance may or may not cover) I did mention that I would happy to see if we could set something up through the VA here in XXXXXXX (once you got your DD214 squared away) whereby you could see the therapists at the VA (who I know and are accustomed to working with) but that even if they could not work out a schedule of daily or near daily consultations that we could get support from community based therapists and/or psychologists to see you on the off days that you would not be seen through the VA. Again, there are costs involved but I don't think it would come out to nearly as expensive as the free standing 60 or 90 days programs you've investigated. The only other expense if you were to agree with this plan that you would likely have to budget for would be accommodations here in the XXXXXXX area which could be found very economically if you would look into something such as a STAY XXXXXXX RESIDENCE INN, etc. Or perhaps, there'd be a possibility of being able to stay in the CARES Tower at the VA that does house veterans who are here temporarily for inpatient treatment programs that are not related to an acute hospital stay...such as substance abuse, PTSD, or other concentrated or intense types of programs utilizing psychotherapy services.
Symptoms of weight loss in and of itself is not a red flag for ALS when muscle strength is judged to be normal (by a neurologist's criteria for measurement)...BTW, in this particular message note that you do state, "I have noticeable weakness"....which seems to have variability to how you feel going from one time period to time period. Yesterday by telephone I think you quite clearly believed there was at least a PERCEIVED weakness in the right hand because you "feel gravity more" than on the left. Again, we must be clear that a patient's PERCEIVED weakness is not a fulfilled criteria when considering a diagnosis of ALS.....it's weakness as measured and verified by an examining physician (typically a neurologist).
Therefore, although I entirely recognize and feel badly that you've had this unintentional weight loss over the past several weeks along with diarrhea I can once again assure you that these symptoms are entirely irrelevant to the DIAGNOSTIC CRITERIA utilized to make the diagnosis of ALS. Of course, this is not to suggest that your condition of weight loss and diarrhea shouldn't be addressed. We did talk about this during our conversation but I'll re-iterate that if you've been experiencing full watery stools multiple times daily....and you haven't been eating in a NEW CRAZY restaurant with foods that you've never eaten before that you need to REPLACE FLUIDS....and next you should be logging a calorie count so that you can demonstrate exactly what your intake has been. My guess is that you are not eating well, not drinking sufficient fluids and that these are the major contributing factors (oh, also forgot to mention that you are stressed and anxious about things) which are all GREAT REASONS to experience weight loss and GI disturbances.
There is no significance to a body temperature of 96.5 nor a BP of 105/65 and neither of those parameters are worthy of concern on your part.
You also did mention that KLONOPIN taken the other night for sleeping or relaxation appears to be linked to very unpleasant side effects INCLUDING significant exacerbation or precipitation of muscle twitching. You should likely place KLONOPIN on a list of NO-NO medications due to side effects or PARADOXICAL effects.
Please talk over these options (if they remain relevant following our detailed telephone conversation from yesterday) with Iris and see what she thinks of any of them. You'll notice that all require time to set up but I estimate that if you wanted to make the decision on any of them...you could get things rolling inside of 3-4 weeks...maybe sooner if the VA doesn't enter into the equation at all and you wished to simply go fully private (more expensive course of action).
Be well sir!
This query required 75 minutes of professional time to research, assimilate, and file a response.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you doctor. Today I decided to stay in bed. I have been able to sleep. The twitching was very intense I believe partly due to my anxiety and stressload during the last couple days. My psychiatrist prescribed Zoloft today and I’m going to begin taking it ASAP, I’m hopes of calming my racing thoughts and feeling of overwhelming fear. My wife has found an inpatient program for ptsd, anxiety etc here in New XXXXXXX CT..
Today I seem to have some muscle pain and cramping, perhaps from the twitching, I’m not sure. I’m forcing myself to understand what you have explained to me, and then something “new” presents and today is twitching on top of my feet. These are the things that are mentally disruptive to me. These twitches you can only feel with the bare hand. Things cross my mind like the localized spreading of twitches in some areas and “boom” my mind is off to the races. You’ve clearly told me about a hundred times that twitching comes after weakness and other signs and I’m trying to reinforce that in my mind. The twitches in my feet are now constant like the ones in my calves. So, this is where I stand today. I will look into getting my DD214, I’ve requested it online today. I’m hoping tomorrow, I will be more active do some kind of productive activities starting with eating three meals a day. I have an appointment with my GP in the morning to follow up on my ER visits and to share information on what you and the other neurologist have stated thus far. My apologizes for being so insistent on drilling you about MND. I never mean to question your dept of knowledge and experience with doubt, I just have little to no understanding of the condition that I am fearful of. So, tomorrow I will begin to force myself to do normal things. I’m scared to be truthful and that’s after having three neurologist all feel that I’m not presenting any signs of MND. All I’m going to do from here is try to do better.
Doctor, one question I have for you - rather a statement. I’m noticing twitches in muscle areas after I use them. For example, I’m typing this on my phone and I’m having twitches in the forearms and shoulders..... thoughts? I turn over in bed and I get twitching on my side. I’ll move my neck and get a twitch there. You get the idea I’m sure.
Again, thank you for your time and understanding.
Today I seem to have some muscle pain and cramping, perhaps from the twitching, I’m not sure. I’m forcing myself to understand what you have explained to me, and then something “new” presents and today is twitching on top of my feet. These are the things that are mentally disruptive to me. These twitches you can only feel with the bare hand. Things cross my mind like the localized spreading of twitches in some areas and “boom” my mind is off to the races. You’ve clearly told me about a hundred times that twitching comes after weakness and other signs and I’m trying to reinforce that in my mind. The twitches in my feet are now constant like the ones in my calves. So, this is where I stand today. I will look into getting my DD214, I’ve requested it online today. I’m hoping tomorrow, I will be more active do some kind of productive activities starting with eating three meals a day. I have an appointment with my GP in the morning to follow up on my ER visits and to share information on what you and the other neurologist have stated thus far. My apologizes for being so insistent on drilling you about MND. I never mean to question your dept of knowledge and experience with doubt, I just have little to no understanding of the condition that I am fearful of. So, tomorrow I will begin to force myself to do normal things. I’m scared to be truthful and that’s after having three neurologist all feel that I’m not presenting any signs of MND. All I’m going to do from here is try to do better.
Doctor, one question I have for you - rather a statement. I’m noticing twitches in muscle areas after I use them. For example, I’m typing this on my phone and I’m having twitches in the forearms and shoulders..... thoughts? I turn over in bed and I get twitching on my side. I’ll move my neck and get a twitch there. You get the idea I’m sure.
Again, thank you for your time and understanding.
Thank you doctor. Today I decided to stay in bed. I have been able to sleep. The twitching was very intense I believe partly due to my anxiety and stressload during the last couple days. My psychiatrist prescribed Zoloft today and I’m going to begin taking it ASAP, I’m hopes of calming my racing thoughts and feeling of overwhelming fear. My wife has found an inpatient program for ptsd, anxiety etc here in New XXXXXXX CT..
Today I seem to have some muscle pain and cramping, perhaps from the twitching, I’m not sure. I’m forcing myself to understand what you have explained to me, and then something “new” presents and today is twitching on top of my feet. These are the things that are mentally disruptive to me. These twitches you can only feel with the bare hand. Things cross my mind like the localized spreading of twitches in some areas and “boom” my mind is off to the races. You’ve clearly told me about a hundred times that twitching comes after weakness and other signs and I’m trying to reinforce that in my mind. The twitches in my feet are now constant like the ones in my calves. So, this is where I stand today. I will look into getting my DD214, I’ve requested it online today. I’m hoping tomorrow, I will be more active do some kind of productive activities starting with eating three meals a day. I have an appointment with my GP in the morning to follow up on my ER visits and to share information on what you and the other neurologist have stated thus far. My apologizes for being so insistent on drilling you about MND. I never mean to question your dept of knowledge and experience with doubt, I just have little to no understanding of the condition that I am fearful of. So, tomorrow I will begin to force myself to do normal things. I’m scared to be truthful and that’s after having three neurologist all feel that I’m not presenting any signs of MND. All I’m going to do from here is try to do better.
Doctor, one question I have for you - rather a statement. I’m noticing twitches in muscle areas after I use them. For example, I’m typing this on my phone and I’m having twitches in the forearms and shoulders..... thoughts? I turn over in bed and I get twitching on my side. I’ll move my neck and get a twitch there. You get the idea I’m sure.
Again, thank you for your time and understanding.
Today I seem to have some muscle pain and cramping, perhaps from the twitching, I’m not sure. I’m forcing myself to understand what you have explained to me, and then something “new” presents and today is twitching on top of my feet. These are the things that are mentally disruptive to me. These twitches you can only feel with the bare hand. Things cross my mind like the localized spreading of twitches in some areas and “boom” my mind is off to the races. You’ve clearly told me about a hundred times that twitching comes after weakness and other signs and I’m trying to reinforce that in my mind. The twitches in my feet are now constant like the ones in my calves. So, this is where I stand today. I will look into getting my DD214, I’ve requested it online today. I’m hoping tomorrow, I will be more active do some kind of productive activities starting with eating three meals a day. I have an appointment with my GP in the morning to follow up on my ER visits and to share information on what you and the other neurologist have stated thus far. My apologizes for being so insistent on drilling you about MND. I never mean to question your dept of knowledge and experience with doubt, I just have little to no understanding of the condition that I am fearful of. So, tomorrow I will begin to force myself to do normal things. I’m scared to be truthful and that’s after having three neurologist all feel that I’m not presenting any signs of MND. All I’m going to do from here is try to do better.
Doctor, one question I have for you - rather a statement. I’m noticing twitches in muscle areas after I use them. For example, I’m typing this on my phone and I’m having twitches in the forearms and shoulders..... thoughts? I turn over in bed and I get twitching on my side. I’ll move my neck and get a twitch there. You get the idea I’m sure.
Again, thank you for your time and understanding.
Brief Answer:
Good that you will be looking into PTSD program
Detailed Answer:
I've read your follow up comments and your plans all sound very positive. Next stop? IMPLEMENTATION of each one without delay.
I'm glad to hear that you were able to avoid the temptation of going to an ER for admission. I think staying in your own home with your family has unparalleled therapeutic benefit and taking something to help calm the nerves down a bit is perfectly reasonable (so long as it's NOT Klonopin!).
Just be aware of 2 things:
1. Muscle twitching and/or your perception of muscle twitching is not going to suddenly halt entirely....at least I wouldn't expect it to given the circumstances.
2. If twitching or perceptions of twitchings get worse or feel more intense then, be aware that all drugs used for psychiatric purposes such as Zoloft, Abilify, Paxil, Prozac, Venlafaxine (some of the more common ones prescribed) can intensify these fasciculations. If that happens don't let your thoughts race ahead of first putting "the horse BEFORE the cart" so to speak and check with the prescribing doctor for an alternative.
3. Remember, that going forward KLONOPIN or CLONAZEPAM should be avoided due to its paradoxical effects per your history of worsening symptoms of nervousness, anxiety, and fasciculations after taking it now on several occasions.
I like the approach of your getting involved with more normal activities, lifting weights, doing aerobic exercises, maybe running on a treadmill, maybe going out on a track and doing a few laps. Don't push yourself beyond getting your heart rate up and going for 20-30 minutes if you're not in shape. The additional physical activity of an aerobic type could result in more twitching due to fatiguing muscle fibers and this would be physiological (i.e. NORMAL). Who knows, maybe if you get a few of those types of twitchings going they could potentially cancel out the ones that are rolling just because of nervousness, anxiety, etc. Make sense?
Eating a healthy, clean diet with good wholesome calories, lots of protein, fruits and vegetables, whole grains, nuts and GOOD CARBS is a great idea. I can't recall your Vitamin D levels of the top of my head but recall that we are shooting for something in the 60-80 ng/dl range so make sure your supplementation is done appropriately and get bloodwork to follow that parameter every 2-3 months.
I believe and I think we should make a concerted effort to put conversations about twitching as far behind us as possible at least for the immediate future. As I said above, I fully expect that the twitchings will continue and you will need to give TIME for the Zoloft to take effect as well as the rest of the plan outlined above AND getting into the PTSD program that your wife found for you.
You need to get the DD214 issue straightened out to take advantage of the services the VA can offer. That also gives us additional support to work with IN THE EVENT you return to XXXXXXX for any reason and we'd like to complement whatever we do in the office with parallel activities or consultations at the XXXXXXX Stokes VA which is a State of the Art facility (3rd largest in the country with Leading Centers of Excellence in the Neurological Sciences and other disciplines).
Those tasks should be front and center for you right now. Any and all other discussions not focused on those issues only represent unnecessary distractions and you shouldn't be engaging or worried about them. I'd like for you to consider reporting your progress on an ongoing basis (as you've been doing) insofar as how your arrangements are going with everything we mentioned above on at least a biweekly basis. Once those TO DO LIST items have been entirely taken care of and you are back into the swing of integrating yourself into your daughter's activities at school, family outings/get togethers, etc.THEN, if there are questions about twitchings, fasciculations, etc. we can think about them at that time.
But I will virtually guarantee you this (and it's rare for me to guarantee very much as you know). But, if you can accomplish the things above that we've outlined which you've agreed to get done, you will virtually all but forget about muscle twitchings. That's the guarantee. That doesn't mean they'll necessarily stop. They may continue to occur but they will not block or detract you from getting things done that need to get done the way they're doing now. That is the guarantee I will give you and at the same time the challenge that is in front of you. In the process of pushing all of this talk on twitchings to the background until they are no longer even on the radar of importance you will be REBUILDING AND REPROGRAMMING your brain to reactivate and solidify once again the filters we talked about that got torn down and started this whole thing in the first place.
Think about it.
Cheers!
As always, your thoughts and critiques of the aforementioned advisements are graciously appreciated and I look forward to continuing to work closely with you as you continue to get better and back to a good state of overall health and wellbeing.
This query required 127 minutes of professional time to research, assimilate, and file a response.
Good that you will be looking into PTSD program
Detailed Answer:
I've read your follow up comments and your plans all sound very positive. Next stop? IMPLEMENTATION of each one without delay.
I'm glad to hear that you were able to avoid the temptation of going to an ER for admission. I think staying in your own home with your family has unparalleled therapeutic benefit and taking something to help calm the nerves down a bit is perfectly reasonable (so long as it's NOT Klonopin!).
Just be aware of 2 things:
1. Muscle twitching and/or your perception of muscle twitching is not going to suddenly halt entirely....at least I wouldn't expect it to given the circumstances.
2. If twitching or perceptions of twitchings get worse or feel more intense then, be aware that all drugs used for psychiatric purposes such as Zoloft, Abilify, Paxil, Prozac, Venlafaxine (some of the more common ones prescribed) can intensify these fasciculations. If that happens don't let your thoughts race ahead of first putting "the horse BEFORE the cart" so to speak and check with the prescribing doctor for an alternative.
3. Remember, that going forward KLONOPIN or CLONAZEPAM should be avoided due to its paradoxical effects per your history of worsening symptoms of nervousness, anxiety, and fasciculations after taking it now on several occasions.
I like the approach of your getting involved with more normal activities, lifting weights, doing aerobic exercises, maybe running on a treadmill, maybe going out on a track and doing a few laps. Don't push yourself beyond getting your heart rate up and going for 20-30 minutes if you're not in shape. The additional physical activity of an aerobic type could result in more twitching due to fatiguing muscle fibers and this would be physiological (i.e. NORMAL). Who knows, maybe if you get a few of those types of twitchings going they could potentially cancel out the ones that are rolling just because of nervousness, anxiety, etc. Make sense?
Eating a healthy, clean diet with good wholesome calories, lots of protein, fruits and vegetables, whole grains, nuts and GOOD CARBS is a great idea. I can't recall your Vitamin D levels of the top of my head but recall that we are shooting for something in the 60-80 ng/dl range so make sure your supplementation is done appropriately and get bloodwork to follow that parameter every 2-3 months.
I believe and I think we should make a concerted effort to put conversations about twitching as far behind us as possible at least for the immediate future. As I said above, I fully expect that the twitchings will continue and you will need to give TIME for the Zoloft to take effect as well as the rest of the plan outlined above AND getting into the PTSD program that your wife found for you.
You need to get the DD214 issue straightened out to take advantage of the services the VA can offer. That also gives us additional support to work with IN THE EVENT you return to XXXXXXX for any reason and we'd like to complement whatever we do in the office with parallel activities or consultations at the XXXXXXX Stokes VA which is a State of the Art facility (3rd largest in the country with Leading Centers of Excellence in the Neurological Sciences and other disciplines).
Those tasks should be front and center for you right now. Any and all other discussions not focused on those issues only represent unnecessary distractions and you shouldn't be engaging or worried about them. I'd like for you to consider reporting your progress on an ongoing basis (as you've been doing) insofar as how your arrangements are going with everything we mentioned above on at least a biweekly basis. Once those TO DO LIST items have been entirely taken care of and you are back into the swing of integrating yourself into your daughter's activities at school, family outings/get togethers, etc.THEN, if there are questions about twitchings, fasciculations, etc. we can think about them at that time.
But I will virtually guarantee you this (and it's rare for me to guarantee very much as you know). But, if you can accomplish the things above that we've outlined which you've agreed to get done, you will virtually all but forget about muscle twitchings. That's the guarantee. That doesn't mean they'll necessarily stop. They may continue to occur but they will not block or detract you from getting things done that need to get done the way they're doing now. That is the guarantee I will give you and at the same time the challenge that is in front of you. In the process of pushing all of this talk on twitchings to the background until they are no longer even on the radar of importance you will be REBUILDING AND REPROGRAMMING your brain to reactivate and solidify once again the filters we talked about that got torn down and started this whole thing in the first place.
Think about it.
Cheers!
As always, your thoughts and critiques of the aforementioned advisements are graciously appreciated and I look forward to continuing to work closely with you as you continue to get better and back to a good state of overall health and wellbeing.
This query required 127 minutes of professional time to research, assimilate, and file a response.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Good that you will be looking into PTSD program
Detailed Answer:
I've read your follow up comments and your plans all sound very positive. Next stop? IMPLEMENTATION of each one without delay.
I'm glad to hear that you were able to avoid the temptation of going to an ER for admission. I think staying in your own home with your family has unparalleled therapeutic benefit and taking something to help calm the nerves down a bit is perfectly reasonable (so long as it's NOT Klonopin!).
Just be aware of 2 things:
1. Muscle twitching and/or your perception of muscle twitching is not going to suddenly halt entirely....at least I wouldn't expect it to given the circumstances.
2. If twitching or perceptions of twitchings get worse or feel more intense then, be aware that all drugs used for psychiatric purposes such as Zoloft, Abilify, Paxil, Prozac, Venlafaxine (some of the more common ones prescribed) can intensify these fasciculations. If that happens don't let your thoughts race ahead of first putting "the horse BEFORE the cart" so to speak and check with the prescribing doctor for an alternative.
3. Remember, that going forward KLONOPIN or CLONAZEPAM should be avoided due to its paradoxical effects per your history of worsening symptoms of nervousness, anxiety, and fasciculations after taking it now on several occasions.
I like the approach of your getting involved with more normal activities, lifting weights, doing aerobic exercises, maybe running on a treadmill, maybe going out on a track and doing a few laps. Don't push yourself beyond getting your heart rate up and going for 20-30 minutes if you're not in shape. The additional physical activity of an aerobic type could result in more twitching due to fatiguing muscle fibers and this would be physiological (i.e. NORMAL). Who knows, maybe if you get a few of those types of twitchings going they could potentially cancel out the ones that are rolling just because of nervousness, anxiety, etc. Make sense?
Eating a healthy, clean diet with good wholesome calories, lots of protein, fruits and vegetables, whole grains, nuts and GOOD CARBS is a great idea. I can't recall your Vitamin D levels of the top of my head but recall that we are shooting for something in the 60-80 ng/dl range so make sure your supplementation is done appropriately and get bloodwork to follow that parameter every 2-3 months.
I believe and I think we should make a concerted effort to put conversations about twitching as far behind us as possible at least for the immediate future. As I said above, I fully expect that the twitchings will continue and you will need to give TIME for the Zoloft to take effect as well as the rest of the plan outlined above AND getting into the PTSD program that your wife found for you.
You need to get the DD214 issue straightened out to take advantage of the services the VA can offer. That also gives us additional support to work with IN THE EVENT you return to XXXXXXX for any reason and we'd like to complement whatever we do in the office with parallel activities or consultations at the XXXXXXX Stokes VA which is a State of the Art facility (3rd largest in the country with Leading Centers of Excellence in the Neurological Sciences and other disciplines).
Those tasks should be front and center for you right now. Any and all other discussions not focused on those issues only represent unnecessary distractions and you shouldn't be engaging or worried about them. I'd like for you to consider reporting your progress on an ongoing basis (as you've been doing) insofar as how your arrangements are going with everything we mentioned above on at least a biweekly basis. Once those TO DO LIST items have been entirely taken care of and you are back into the swing of integrating yourself into your daughter's activities at school, family outings/get togethers, etc.THEN, if there are questions about twitchings, fasciculations, etc. we can think about them at that time.
But I will virtually guarantee you this (and it's rare for me to guarantee very much as you know). But, if you can accomplish the things above that we've outlined which you've agreed to get done, you will virtually all but forget about muscle twitchings. That's the guarantee. That doesn't mean they'll necessarily stop. They may continue to occur but they will not block or detract you from getting things done that need to get done the way they're doing now. That is the guarantee I will give you and at the same time the challenge that is in front of you. In the process of pushing all of this talk on twitchings to the background until they are no longer even on the radar of importance you will be REBUILDING AND REPROGRAMMING your brain to reactivate and solidify once again the filters we talked about that got torn down and started this whole thing in the first place.
Think about it.
Cheers!
As always, your thoughts and critiques of the aforementioned advisements are graciously appreciated and I look forward to continuing to work closely with you as you continue to get better and back to a good state of overall health and wellbeing.
This query required 127 minutes of professional time to research, assimilate, and file a response.
Good that you will be looking into PTSD program
Detailed Answer:
I've read your follow up comments and your plans all sound very positive. Next stop? IMPLEMENTATION of each one without delay.
I'm glad to hear that you were able to avoid the temptation of going to an ER for admission. I think staying in your own home with your family has unparalleled therapeutic benefit and taking something to help calm the nerves down a bit is perfectly reasonable (so long as it's NOT Klonopin!).
Just be aware of 2 things:
1. Muscle twitching and/or your perception of muscle twitching is not going to suddenly halt entirely....at least I wouldn't expect it to given the circumstances.
2. If twitching or perceptions of twitchings get worse or feel more intense then, be aware that all drugs used for psychiatric purposes such as Zoloft, Abilify, Paxil, Prozac, Venlafaxine (some of the more common ones prescribed) can intensify these fasciculations. If that happens don't let your thoughts race ahead of first putting "the horse BEFORE the cart" so to speak and check with the prescribing doctor for an alternative.
3. Remember, that going forward KLONOPIN or CLONAZEPAM should be avoided due to its paradoxical effects per your history of worsening symptoms of nervousness, anxiety, and fasciculations after taking it now on several occasions.
I like the approach of your getting involved with more normal activities, lifting weights, doing aerobic exercises, maybe running on a treadmill, maybe going out on a track and doing a few laps. Don't push yourself beyond getting your heart rate up and going for 20-30 minutes if you're not in shape. The additional physical activity of an aerobic type could result in more twitching due to fatiguing muscle fibers and this would be physiological (i.e. NORMAL). Who knows, maybe if you get a few of those types of twitchings going they could potentially cancel out the ones that are rolling just because of nervousness, anxiety, etc. Make sense?
Eating a healthy, clean diet with good wholesome calories, lots of protein, fruits and vegetables, whole grains, nuts and GOOD CARBS is a great idea. I can't recall your Vitamin D levels of the top of my head but recall that we are shooting for something in the 60-80 ng/dl range so make sure your supplementation is done appropriately and get bloodwork to follow that parameter every 2-3 months.
I believe and I think we should make a concerted effort to put conversations about twitching as far behind us as possible at least for the immediate future. As I said above, I fully expect that the twitchings will continue and you will need to give TIME for the Zoloft to take effect as well as the rest of the plan outlined above AND getting into the PTSD program that your wife found for you.
You need to get the DD214 issue straightened out to take advantage of the services the VA can offer. That also gives us additional support to work with IN THE EVENT you return to XXXXXXX for any reason and we'd like to complement whatever we do in the office with parallel activities or consultations at the XXXXXXX Stokes VA which is a State of the Art facility (3rd largest in the country with Leading Centers of Excellence in the Neurological Sciences and other disciplines).
Those tasks should be front and center for you right now. Any and all other discussions not focused on those issues only represent unnecessary distractions and you shouldn't be engaging or worried about them. I'd like for you to consider reporting your progress on an ongoing basis (as you've been doing) insofar as how your arrangements are going with everything we mentioned above on at least a biweekly basis. Once those TO DO LIST items have been entirely taken care of and you are back into the swing of integrating yourself into your daughter's activities at school, family outings/get togethers, etc.THEN, if there are questions about twitchings, fasciculations, etc. we can think about them at that time.
But I will virtually guarantee you this (and it's rare for me to guarantee very much as you know). But, if you can accomplish the things above that we've outlined which you've agreed to get done, you will virtually all but forget about muscle twitchings. That's the guarantee. That doesn't mean they'll necessarily stop. They may continue to occur but they will not block or detract you from getting things done that need to get done the way they're doing now. That is the guarantee I will give you and at the same time the challenge that is in front of you. In the process of pushing all of this talk on twitchings to the background until they are no longer even on the radar of importance you will be REBUILDING AND REPROGRAMMING your brain to reactivate and solidify once again the filters we talked about that got torn down and started this whole thing in the first place.
Think about it.
Cheers!
As always, your thoughts and critiques of the aforementioned advisements are graciously appreciated and I look forward to continuing to work closely with you as you continue to get better and back to a good state of overall health and wellbeing.
This query required 127 minutes of professional time to research, assimilate, and file a response.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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