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Hello Dr. Saghafi. I’m Todays Appointment, I Showed Brisk Reflexes.
Question: Hello Dr. Saghafi. I’m todays appointment, I showed brisk reflexes. The doctor also order a MRI of the brain and additional bloodwork for Lyme disease like illnesses.
He also doesn’t see any signs of MND - he wants to examine the link between my neck injury and the twitching.
As I stated on our call yesterday, my legs and body have felt tighter over the last week. Should that be attributed to anxiety and inactivity in your experience? My right leg kicked out pretty well. Far greater than our exam two weeks ago. He has not considered an emg yet. He states my strength is great and doesn’t see muscle atrophy.
He also doesn’t see any signs of MND - he wants to examine the link between my neck injury and the twitching.
As I stated on our call yesterday, my legs and body have felt tighter over the last week. Should that be attributed to anxiety and inactivity in your experience? My right leg kicked out pretty well. Far greater than our exam two weeks ago. He has not considered an emg yet. He states my strength is great and doesn’t see muscle atrophy.
Hello Dr. Saghafi. I’m todays appointment, I showed brisk reflexes. The doctor also order a MRI of the brain and additional bloodwork for Lyme disease like illnesses.
He also doesn’t see any signs of MND - he wants to examine the link between my neck injury and the twitching.
As I stated on our call yesterday, my legs and body have felt tighter over the last week. Should that be attributed to anxiety and inactivity in your experience? My right leg kicked out pretty well. Far greater than our exam two weeks ago. He has not considered an emg yet. He states my strength is great and doesn’t see muscle atrophy.
He also doesn’t see any signs of MND - he wants to examine the link between my neck injury and the twitching.
As I stated on our call yesterday, my legs and body have felt tighter over the last week. Should that be attributed to anxiety and inactivity in your experience? My right leg kicked out pretty well. Far greater than our exam two weeks ago. He has not considered an emg yet. He states my strength is great and doesn’t see muscle atrophy.
Brief Answer:
Brisk reflexes are a sign of youth, vim, and vigor.
Detailed Answer:
Many thanks for the update on your appointment with the neurologist back home. It is good to hear that we all happen to be on the same page with respect to the neurological exam which is an extremely important and pivotal part of any exam of patients who are worried or suspected of having MND.
And just to be sure, "brisk" reflexes are not necessarily the same as clinical hyperreflexia which are often a sign of something the matter. Brisk is a sign of youth, vim, and vigor because as we age reflexes become a bit less robust or reactive. So much so that by about age 50 it is not uncommon to find NO ANKLE REFLEXES in an otherwise, normal and healthy person not suffering from anything.
I certainly don't disagree with trying to find an underlying cause for the twitching and so the neck would be a decent think to look at although if you're feeling those twitches all over the body...again, due to such wide dispersion, I find the identification of a single lesion to explain everything at the level of the spinal cord pushing the envelope a bit....but if nothing is found then, we're no worse off for it....
Also, glad to hear your neurologist would like an MRI of the head as I wanted. I was not particularly looking for demyelinating disease or anything else but my search was for an explanation to your ORBITING of the left hand over the right...remember rolling the hands over and back...and I also want to search the left side of your brain carefully just to convince myself that those few subtle findings we talked about involving the right great toe that may have had a movement in it when I scraped the bottom of your foot....don't have a brain correlate....I'm virtually certain they don't.
Guess who I had today for a consultation on HEALTHTAP? A gentleman who is 29 years old who is not dealing well with his father's diagnosis of colon cancer and within several days to several weeks of when his dad was diagnosed started getting twitches....first in an index finger but then, the twitchings seemed to spread and concentrate.....YOU'LL NEVER GUESS.......LOLOLOL
In his CALVES which then, seemed to spread to his shoulders and biceps! Interesting, huh? Oh, and his twitchings get better and worse depending upon situations of intense work activity vs. being nervous, or anxious due to his becoming more forgetful....bottom line is....there are no reasons to believe he needs any significant studies or other tests according to his Neurologists!
Feelings of tightness in the calves certainly could explain his increased fasciculation activity. However, I think that is just because of a looseness in your workout schedule and I believe that once you have been given the green light on your neurological examination your twitchings may very well just calm down....as they've done in the past.
I'm glad to hear that nobody believes that it is imperative to get an EMG/NCV because those tests are really not going to be particularly helpful in my opinion. I do believe we've got plenty of evidence from multiple neurologists now that support a fully normal and operational central and peripheral nervous system. There is no MND to diagnose or worry about at this time....let's see what follows sir and ONCE AGAIN, I can't thank you enough for your words giving more specificity to situations and symptoms than before.
Once again, I wish you all the best and hope you can keep me informed as to the outcome of things should you decide that additional tests and workups need to be performed.
Be well good sir and let's keep fingers crossed for improvements (or explanations(). You definitely deserve the best outcomes!
Cheers lad!
And as always do not forget that I am here for you with further questions or concerns at: www.bit.ly/drdariushsaghafi
This query required a total time of 30 minutes to read, interpret, research, and synthesize an approach and complete response to the patient.
Brisk reflexes are a sign of youth, vim, and vigor.
Detailed Answer:
Many thanks for the update on your appointment with the neurologist back home. It is good to hear that we all happen to be on the same page with respect to the neurological exam which is an extremely important and pivotal part of any exam of patients who are worried or suspected of having MND.
And just to be sure, "brisk" reflexes are not necessarily the same as clinical hyperreflexia which are often a sign of something the matter. Brisk is a sign of youth, vim, and vigor because as we age reflexes become a bit less robust or reactive. So much so that by about age 50 it is not uncommon to find NO ANKLE REFLEXES in an otherwise, normal and healthy person not suffering from anything.
I certainly don't disagree with trying to find an underlying cause for the twitching and so the neck would be a decent think to look at although if you're feeling those twitches all over the body...again, due to such wide dispersion, I find the identification of a single lesion to explain everything at the level of the spinal cord pushing the envelope a bit....but if nothing is found then, we're no worse off for it....
Also, glad to hear your neurologist would like an MRI of the head as I wanted. I was not particularly looking for demyelinating disease or anything else but my search was for an explanation to your ORBITING of the left hand over the right...remember rolling the hands over and back...and I also want to search the left side of your brain carefully just to convince myself that those few subtle findings we talked about involving the right great toe that may have had a movement in it when I scraped the bottom of your foot....don't have a brain correlate....I'm virtually certain they don't.
Guess who I had today for a consultation on HEALTHTAP? A gentleman who is 29 years old who is not dealing well with his father's diagnosis of colon cancer and within several days to several weeks of when his dad was diagnosed started getting twitches....first in an index finger but then, the twitchings seemed to spread and concentrate.....YOU'LL NEVER GUESS.......LOLOLOL
In his CALVES which then, seemed to spread to his shoulders and biceps! Interesting, huh? Oh, and his twitchings get better and worse depending upon situations of intense work activity vs. being nervous, or anxious due to his becoming more forgetful....bottom line is....there are no reasons to believe he needs any significant studies or other tests according to his Neurologists!
Feelings of tightness in the calves certainly could explain his increased fasciculation activity. However, I think that is just because of a looseness in your workout schedule and I believe that once you have been given the green light on your neurological examination your twitchings may very well just calm down....as they've done in the past.
I'm glad to hear that nobody believes that it is imperative to get an EMG/NCV because those tests are really not going to be particularly helpful in my opinion. I do believe we've got plenty of evidence from multiple neurologists now that support a fully normal and operational central and peripheral nervous system. There is no MND to diagnose or worry about at this time....let's see what follows sir and ONCE AGAIN, I can't thank you enough for your words giving more specificity to situations and symptoms than before.
Once again, I wish you all the best and hope you can keep me informed as to the outcome of things should you decide that additional tests and workups need to be performed.
Be well good sir and let's keep fingers crossed for improvements (or explanations(). You definitely deserve the best outcomes!
Cheers lad!
And as always do not forget that I am here for you with further questions or concerns at: www.bit.ly/drdariushsaghafi
This query required a total time of 30 minutes to read, interpret, research, and synthesize an approach and complete response to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Brisk reflexes are a sign of youth, vim, and vigor.
Detailed Answer:
Many thanks for the update on your appointment with the neurologist back home. It is good to hear that we all happen to be on the same page with respect to the neurological exam which is an extremely important and pivotal part of any exam of patients who are worried or suspected of having MND.
And just to be sure, "brisk" reflexes are not necessarily the same as clinical hyperreflexia which are often a sign of something the matter. Brisk is a sign of youth, vim, and vigor because as we age reflexes become a bit less robust or reactive. So much so that by about age 50 it is not uncommon to find NO ANKLE REFLEXES in an otherwise, normal and healthy person not suffering from anything.
I certainly don't disagree with trying to find an underlying cause for the twitching and so the neck would be a decent think to look at although if you're feeling those twitches all over the body...again, due to such wide dispersion, I find the identification of a single lesion to explain everything at the level of the spinal cord pushing the envelope a bit....but if nothing is found then, we're no worse off for it....
Also, glad to hear your neurologist would like an MRI of the head as I wanted. I was not particularly looking for demyelinating disease or anything else but my search was for an explanation to your ORBITING of the left hand over the right...remember rolling the hands over and back...and I also want to search the left side of your brain carefully just to convince myself that those few subtle findings we talked about involving the right great toe that may have had a movement in it when I scraped the bottom of your foot....don't have a brain correlate....I'm virtually certain they don't.
Guess who I had today for a consultation on HEALTHTAP? A gentleman who is 29 years old who is not dealing well with his father's diagnosis of colon cancer and within several days to several weeks of when his dad was diagnosed started getting twitches....first in an index finger but then, the twitchings seemed to spread and concentrate.....YOU'LL NEVER GUESS.......LOLOLOL
In his CALVES which then, seemed to spread to his shoulders and biceps! Interesting, huh? Oh, and his twitchings get better and worse depending upon situations of intense work activity vs. being nervous, or anxious due to his becoming more forgetful....bottom line is....there are no reasons to believe he needs any significant studies or other tests according to his Neurologists!
Feelings of tightness in the calves certainly could explain his increased fasciculation activity. However, I think that is just because of a looseness in your workout schedule and I believe that once you have been given the green light on your neurological examination your twitchings may very well just calm down....as they've done in the past.
I'm glad to hear that nobody believes that it is imperative to get an EMG/NCV because those tests are really not going to be particularly helpful in my opinion. I do believe we've got plenty of evidence from multiple neurologists now that support a fully normal and operational central and peripheral nervous system. There is no MND to diagnose or worry about at this time....let's see what follows sir and ONCE AGAIN, I can't thank you enough for your words giving more specificity to situations and symptoms than before.
Once again, I wish you all the best and hope you can keep me informed as to the outcome of things should you decide that additional tests and workups need to be performed.
Be well good sir and let's keep fingers crossed for improvements (or explanations(). You definitely deserve the best outcomes!
Cheers lad!
And as always do not forget that I am here for you with further questions or concerns at: www.bit.ly/drdariushsaghafi
This query required a total time of 30 minutes to read, interpret, research, and synthesize an approach and complete response to the patient.
Brisk reflexes are a sign of youth, vim, and vigor.
Detailed Answer:
Many thanks for the update on your appointment with the neurologist back home. It is good to hear that we all happen to be on the same page with respect to the neurological exam which is an extremely important and pivotal part of any exam of patients who are worried or suspected of having MND.
And just to be sure, "brisk" reflexes are not necessarily the same as clinical hyperreflexia which are often a sign of something the matter. Brisk is a sign of youth, vim, and vigor because as we age reflexes become a bit less robust or reactive. So much so that by about age 50 it is not uncommon to find NO ANKLE REFLEXES in an otherwise, normal and healthy person not suffering from anything.
I certainly don't disagree with trying to find an underlying cause for the twitching and so the neck would be a decent think to look at although if you're feeling those twitches all over the body...again, due to such wide dispersion, I find the identification of a single lesion to explain everything at the level of the spinal cord pushing the envelope a bit....but if nothing is found then, we're no worse off for it....
Also, glad to hear your neurologist would like an MRI of the head as I wanted. I was not particularly looking for demyelinating disease or anything else but my search was for an explanation to your ORBITING of the left hand over the right...remember rolling the hands over and back...and I also want to search the left side of your brain carefully just to convince myself that those few subtle findings we talked about involving the right great toe that may have had a movement in it when I scraped the bottom of your foot....don't have a brain correlate....I'm virtually certain they don't.
Guess who I had today for a consultation on HEALTHTAP? A gentleman who is 29 years old who is not dealing well with his father's diagnosis of colon cancer and within several days to several weeks of when his dad was diagnosed started getting twitches....first in an index finger but then, the twitchings seemed to spread and concentrate.....YOU'LL NEVER GUESS.......LOLOLOL
In his CALVES which then, seemed to spread to his shoulders and biceps! Interesting, huh? Oh, and his twitchings get better and worse depending upon situations of intense work activity vs. being nervous, or anxious due to his becoming more forgetful....bottom line is....there are no reasons to believe he needs any significant studies or other tests according to his Neurologists!
Feelings of tightness in the calves certainly could explain his increased fasciculation activity. However, I think that is just because of a looseness in your workout schedule and I believe that once you have been given the green light on your neurological examination your twitchings may very well just calm down....as they've done in the past.
I'm glad to hear that nobody believes that it is imperative to get an EMG/NCV because those tests are really not going to be particularly helpful in my opinion. I do believe we've got plenty of evidence from multiple neurologists now that support a fully normal and operational central and peripheral nervous system. There is no MND to diagnose or worry about at this time....let's see what follows sir and ONCE AGAIN, I can't thank you enough for your words giving more specificity to situations and symptoms than before.
Once again, I wish you all the best and hope you can keep me informed as to the outcome of things should you decide that additional tests and workups need to be performed.
Be well good sir and let's keep fingers crossed for improvements (or explanations(). You definitely deserve the best outcomes!
Cheers lad!
And as always do not forget that I am here for you with further questions or concerns at: www.bit.ly/drdariushsaghafi
This query required a total time of 30 minutes to read, interpret, research, and synthesize an approach and complete response to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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.
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.
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.
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.
Brief Answer:
Can one of the people you've contacted have a conversation with me?
Detailed Answer:
Good morning.
Hmmmm......somehow you're not knocking on the right doors because I find it hard to understand why a counselor or therapist who you would be willing to see on a private basis would turn down the opportunity at seeing someone on a frequent basis for a health anxiety issue such as this....did they give you any reasons for why that would be the case? What about something like 3-4x week.....or maybe M-F and then, take the weekend off type of deal?
Have you contacted your VA facility out there to explain what's going on and how you're feeling. Perhaps, they'd be much more understanding because of the health implications of not being able to break this cycle without close supervision?
I have contact people here in XXXXXXX that I'm sure would not reject you on the basis of frequency need but would you be willing/able to come out here and stay long term for say 4-6 or 8 weeks. Why not contact your VA facility out there and then, based on what they say...perhaps the XXXXXXX Stokes out here in XXXXXXX would be able to take you on in their Domiciliary program so you wouln't have to worry about housing issues and again, I have contacts within the Behavioral Medicine and Psychology Departments who may even be able to "Tag Team" on you in a multidisciplinary fashion so that if the issue of seeing you DAILY or FREQUENTLY for each one is tough.....if they did it "around the horn" so to speak it wouldn't be that difficult since each person might only see you at most twice weekly but you'd still see someone daily or at least VERY FREQUENTLY until the cycle of anxiety can be broken?
I could certainly see you out here on a daily or regular basis....but obviously the cost of THAT particular resource is much different than others who could probably do just as well...if not better since they have their own "tricks of the trade" that they use to get around these problems. However, I could get you into a schedule in the office on days of the week that the other therapists could not see you....or something like that?
Whatever the case may be...I'm sure something could be worked out with people who are really good at what they do and who you need to be talking to in order to "recharge those shields" the way we talked about the other night.
That's great that you're eating so much more cleanly. Can you teach me please? LOL....I haven't dropped one ounce despite all the other activity I've been engaged in.....got a rugby game today as a matter of fact in XXXXXXX I'll be leaving town shortly to rendezvous with the team.
It certainly sounds as if the diarrhea could be linked to your state of anxiety. It's a good thing that you're maintaining good muscle strength. BTW, if you were to come out to XXXXXXX ...or check in to any other outpatient facility away from home.....it would be very important in my opinion that you be engaged and involved in DAILY physical activities of either an aerobic nature or sporting type. Hell man, you are welcome to come and run with our rugby club if you wanted.....we've still another week or 2 of formal practices for the 15's group then, we get started on 7's.....I can't recall whether or not you said you were ever a rugger? Doesn't matter....I wasn't either the first time I laced up the boots....but they ran but butt off all the same! LOL.....And that will do you wonders to help you shift your focus and attention off the things you really don't want to be thinking of but are stuck in a groove with right now.
So, I need to end this message in order to get out to the rendezvous point on time and will wait to see which direction you're interested in moving with getting you connected into some proper therapy and counseling for these issues. Try not assessing your physical status anymore for a few days....all of your parameters are normal....and they're not going to change. Diarrhea should start to slow down. MAKE SURE YOU'RE DRINKING LOTS OF WATER to replace lost fluids....it doesn't have to be pedialyte or Gatorade....those are myths.....you're not vomiting so as long as you can eat CLEANLY as you said.....you'll replace the nutritional elements.....keep the good diet up and maybe this thing will even turn around on its own?
Cheers!
This query required a total time of 30 minutes to read, interpret, research, and synthesize an approach and complete response to the patient.
Can one of the people you've contacted have a conversation with me?
Detailed Answer:
Good morning.
Hmmmm......somehow you're not knocking on the right doors because I find it hard to understand why a counselor or therapist who you would be willing to see on a private basis would turn down the opportunity at seeing someone on a frequent basis for a health anxiety issue such as this....did they give you any reasons for why that would be the case? What about something like 3-4x week.....or maybe M-F and then, take the weekend off type of deal?
Have you contacted your VA facility out there to explain what's going on and how you're feeling. Perhaps, they'd be much more understanding because of the health implications of not being able to break this cycle without close supervision?
I have contact people here in XXXXXXX that I'm sure would not reject you on the basis of frequency need but would you be willing/able to come out here and stay long term for say 4-6 or 8 weeks. Why not contact your VA facility out there and then, based on what they say...perhaps the XXXXXXX Stokes out here in XXXXXXX would be able to take you on in their Domiciliary program so you wouln't have to worry about housing issues and again, I have contacts within the Behavioral Medicine and Psychology Departments who may even be able to "Tag Team" on you in a multidisciplinary fashion so that if the issue of seeing you DAILY or FREQUENTLY for each one is tough.....if they did it "around the horn" so to speak it wouldn't be that difficult since each person might only see you at most twice weekly but you'd still see someone daily or at least VERY FREQUENTLY until the cycle of anxiety can be broken?
I could certainly see you out here on a daily or regular basis....but obviously the cost of THAT particular resource is much different than others who could probably do just as well...if not better since they have their own "tricks of the trade" that they use to get around these problems. However, I could get you into a schedule in the office on days of the week that the other therapists could not see you....or something like that?
Whatever the case may be...I'm sure something could be worked out with people who are really good at what they do and who you need to be talking to in order to "recharge those shields" the way we talked about the other night.
That's great that you're eating so much more cleanly. Can you teach me please? LOL....I haven't dropped one ounce despite all the other activity I've been engaged in.....got a rugby game today as a matter of fact in XXXXXXX I'll be leaving town shortly to rendezvous with the team.
It certainly sounds as if the diarrhea could be linked to your state of anxiety. It's a good thing that you're maintaining good muscle strength. BTW, if you were to come out to XXXXXXX ...or check in to any other outpatient facility away from home.....it would be very important in my opinion that you be engaged and involved in DAILY physical activities of either an aerobic nature or sporting type. Hell man, you are welcome to come and run with our rugby club if you wanted.....we've still another week or 2 of formal practices for the 15's group then, we get started on 7's.....I can't recall whether or not you said you were ever a rugger? Doesn't matter....I wasn't either the first time I laced up the boots....but they ran but butt off all the same! LOL.....And that will do you wonders to help you shift your focus and attention off the things you really don't want to be thinking of but are stuck in a groove with right now.
So, I need to end this message in order to get out to the rendezvous point on time and will wait to see which direction you're interested in moving with getting you connected into some proper therapy and counseling for these issues. Try not assessing your physical status anymore for a few days....all of your parameters are normal....and they're not going to change. Diarrhea should start to slow down. MAKE SURE YOU'RE DRINKING LOTS OF WATER to replace lost fluids....it doesn't have to be pedialyte or Gatorade....those are myths.....you're not vomiting so as long as you can eat CLEANLY as you said.....you'll replace the nutritional elements.....keep the good diet up and maybe this thing will even turn around on its own?
Cheers!
This query required a total time of 30 minutes to read, interpret, research, and synthesize an approach and complete response to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Can one of the people you've contacted have a conversation with me?
Detailed Answer:
Good morning.
Hmmmm......somehow you're not knocking on the right doors because I find it hard to understand why a counselor or therapist who you would be willing to see on a private basis would turn down the opportunity at seeing someone on a frequent basis for a health anxiety issue such as this....did they give you any reasons for why that would be the case? What about something like 3-4x week.....or maybe M-F and then, take the weekend off type of deal?
Have you contacted your VA facility out there to explain what's going on and how you're feeling. Perhaps, they'd be much more understanding because of the health implications of not being able to break this cycle without close supervision?
I have contact people here in XXXXXXX that I'm sure would not reject you on the basis of frequency need but would you be willing/able to come out here and stay long term for say 4-6 or 8 weeks. Why not contact your VA facility out there and then, based on what they say...perhaps the XXXXXXX Stokes out here in XXXXXXX would be able to take you on in their Domiciliary program so you wouln't have to worry about housing issues and again, I have contacts within the Behavioral Medicine and Psychology Departments who may even be able to "Tag Team" on you in a multidisciplinary fashion so that if the issue of seeing you DAILY or FREQUENTLY for each one is tough.....if they did it "around the horn" so to speak it wouldn't be that difficult since each person might only see you at most twice weekly but you'd still see someone daily or at least VERY FREQUENTLY until the cycle of anxiety can be broken?
I could certainly see you out here on a daily or regular basis....but obviously the cost of THAT particular resource is much different than others who could probably do just as well...if not better since they have their own "tricks of the trade" that they use to get around these problems. However, I could get you into a schedule in the office on days of the week that the other therapists could not see you....or something like that?
Whatever the case may be...I'm sure something could be worked out with people who are really good at what they do and who you need to be talking to in order to "recharge those shields" the way we talked about the other night.
That's great that you're eating so much more cleanly. Can you teach me please? LOL....I haven't dropped one ounce despite all the other activity I've been engaged in.....got a rugby game today as a matter of fact in XXXXXXX I'll be leaving town shortly to rendezvous with the team.
It certainly sounds as if the diarrhea could be linked to your state of anxiety. It's a good thing that you're maintaining good muscle strength. BTW, if you were to come out to XXXXXXX ...or check in to any other outpatient facility away from home.....it would be very important in my opinion that you be engaged and involved in DAILY physical activities of either an aerobic nature or sporting type. Hell man, you are welcome to come and run with our rugby club if you wanted.....we've still another week or 2 of formal practices for the 15's group then, we get started on 7's.....I can't recall whether or not you said you were ever a rugger? Doesn't matter....I wasn't either the first time I laced up the boots....but they ran but butt off all the same! LOL.....And that will do you wonders to help you shift your focus and attention off the things you really don't want to be thinking of but are stuck in a groove with right now.
So, I need to end this message in order to get out to the rendezvous point on time and will wait to see which direction you're interested in moving with getting you connected into some proper therapy and counseling for these issues. Try not assessing your physical status anymore for a few days....all of your parameters are normal....and they're not going to change. Diarrhea should start to slow down. MAKE SURE YOU'RE DRINKING LOTS OF WATER to replace lost fluids....it doesn't have to be pedialyte or Gatorade....those are myths.....you're not vomiting so as long as you can eat CLEANLY as you said.....you'll replace the nutritional elements.....keep the good diet up and maybe this thing will even turn around on its own?
Cheers!
This query required a total time of 30 minutes to read, interpret, research, and synthesize an approach and complete response to the patient.
Can one of the people you've contacted have a conversation with me?
Detailed Answer:
Good morning.
Hmmmm......somehow you're not knocking on the right doors because I find it hard to understand why a counselor or therapist who you would be willing to see on a private basis would turn down the opportunity at seeing someone on a frequent basis for a health anxiety issue such as this....did they give you any reasons for why that would be the case? What about something like 3-4x week.....or maybe M-F and then, take the weekend off type of deal?
Have you contacted your VA facility out there to explain what's going on and how you're feeling. Perhaps, they'd be much more understanding because of the health implications of not being able to break this cycle without close supervision?
I have contact people here in XXXXXXX that I'm sure would not reject you on the basis of frequency need but would you be willing/able to come out here and stay long term for say 4-6 or 8 weeks. Why not contact your VA facility out there and then, based on what they say...perhaps the XXXXXXX Stokes out here in XXXXXXX would be able to take you on in their Domiciliary program so you wouln't have to worry about housing issues and again, I have contacts within the Behavioral Medicine and Psychology Departments who may even be able to "Tag Team" on you in a multidisciplinary fashion so that if the issue of seeing you DAILY or FREQUENTLY for each one is tough.....if they did it "around the horn" so to speak it wouldn't be that difficult since each person might only see you at most twice weekly but you'd still see someone daily or at least VERY FREQUENTLY until the cycle of anxiety can be broken?
I could certainly see you out here on a daily or regular basis....but obviously the cost of THAT particular resource is much different than others who could probably do just as well...if not better since they have their own "tricks of the trade" that they use to get around these problems. However, I could get you into a schedule in the office on days of the week that the other therapists could not see you....or something like that?
Whatever the case may be...I'm sure something could be worked out with people who are really good at what they do and who you need to be talking to in order to "recharge those shields" the way we talked about the other night.
That's great that you're eating so much more cleanly. Can you teach me please? LOL....I haven't dropped one ounce despite all the other activity I've been engaged in.....got a rugby game today as a matter of fact in XXXXXXX I'll be leaving town shortly to rendezvous with the team.
It certainly sounds as if the diarrhea could be linked to your state of anxiety. It's a good thing that you're maintaining good muscle strength. BTW, if you were to come out to XXXXXXX ...or check in to any other outpatient facility away from home.....it would be very important in my opinion that you be engaged and involved in DAILY physical activities of either an aerobic nature or sporting type. Hell man, you are welcome to come and run with our rugby club if you wanted.....we've still another week or 2 of formal practices for the 15's group then, we get started on 7's.....I can't recall whether or not you said you were ever a rugger? Doesn't matter....I wasn't either the first time I laced up the boots....but they ran but butt off all the same! LOL.....And that will do you wonders to help you shift your focus and attention off the things you really don't want to be thinking of but are stuck in a groove with right now.
So, I need to end this message in order to get out to the rendezvous point on time and will wait to see which direction you're interested in moving with getting you connected into some proper therapy and counseling for these issues. Try not assessing your physical status anymore for a few days....all of your parameters are normal....and they're not going to change. Diarrhea should start to slow down. MAKE SURE YOU'RE DRINKING LOTS OF WATER to replace lost fluids....it doesn't have to be pedialyte or Gatorade....those are myths.....you're not vomiting so as long as you can eat CLEANLY as you said.....you'll replace the nutritional elements.....keep the good diet up and maybe this thing will even turn around on its own?
Cheers!
This query required a total time of 30 minutes to read, interpret, research, and synthesize an approach and complete response to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. I am quite sure that I feel weakness on the right side of my body (hand, foot). I’m not sure if weakness is the correct term, but an slight difference or slight heaviness? I’m trying to convince myself that it is not possible. I’m trying really hard. I went to squeeze a piece of toast this morning and it felt soggy with my right hand. I tried with my left and it was normal feeling. I need to come to XXXXXXX ASAP. I haven’t been able to get to the VA. I’ve requested a copy of my DD214 records which I never received with my discharge paperwork. I have other proof of service, but the DD214 is likely what I’ll need. I’m down to 206-207 lbs and my optimism isn’t as high. As I type this, I can feel something along the lines of fatigue or tightness in my right hand and forearm. I like some of your ideas above. What do you suggest first and foremost for my feeling of heaviness? I’m extremely worried and crying. I woke up to twitching under my chin this morning and there’s is obvious muscle loss in my pectoral area. I’m not feeling good.
Hello Dr. I am quite sure that I feel weakness on the right side of my body (hand, foot). I’m not sure if weakness is the correct term, but an slight difference or slight heaviness? I’m trying to convince myself that it is not possible. I’m trying really hard. I went to squeeze a piece of toast this morning and it felt soggy with my right hand. I tried with my left and it was normal feeling. I need to come to XXXXXXX ASAP. I haven’t been able to get to the VA. I’ve requested a copy of my DD214 records which I never received with my discharge paperwork. I have other proof of service, but the DD214 is likely what I’ll need. I’m down to 206-207 lbs and my optimism isn’t as high. As I type this, I can feel something along the lines of fatigue or tightness in my right hand and forearm. I like some of your ideas above. What do you suggest first and foremost for my feeling of heaviness? I’m extremely worried and crying. I woke up to twitching under my chin this morning and there’s is obvious muscle loss in my pectoral area. I’m not feeling good.
Brief Answer:
Feeling of heaviness or weakness in the right hand or foot
Detailed Answer:
Since we've already spoken about these issues at length during other sessions....I don't really want to say much more that could confuse what we've already discussed and which adequately describes your situation.
I am happy to reinforce additional reassurances for you that as per the last 2 neurological examinations you've received there's been no evidence on formal testing that the criteria required by the El Escorial guidelines to consider any form of ALS have been met. We've already discussed in detail as well that proving the existence of a process that involves the chronic neurodegeneration of MOTOR NEURONS in the spinal cord (believed to be the basis for the disease) cannot be made and should not be made on using symptoms in isolation to the core requirement of the neurological findings of UPPER AND LOWER MOTOR SIGNS of abnormality in at least 1 body segment with spread and progression to other segments over time.
In other words the presence or sudden appearance of twitchings or fasciculations in a body part or multiple body parts is not a cause for concern or alarm if there are no UPPER AND LOWER MOTOR NEURON SIGNS of abnormality on neurological testing. Loss of weight (as we've discussed) that does not include the loss of MUSCLE MASS over time or atrophy is not a cause for concern or alarm if there are no UPPER AND LOWER MOTOR NEURON SIGNS of abnormality on neurological testing. And weakness (as determined by a patient) in a muscle or group of muscles is not a cause for concern or alarm if there are no UPPER AND LOWER MOTOR NEURON SIGNS of abnormality on neurological testing.
Twitching muscles in the face by the way must involve CRANIAL NERVE MOTOR NEURONS which is not at all how the typical course of how ALS presents or progresses at such an early stage of when your first symptoms of concern appeared 3 months ago. Spinal motor neurons are anatomically distinct from cranial motor neurons. One disease process simply does not affect a separate anatomic compartment of neurons....there's no physical way that can happen given that ALS is not an infection or contagious process of any sort.
As you know we are continuing to work together on this problem and I'm sure that in time we will discover what is the root of these symptoms. For now, I would continue to reassure you that things are not going in an ALS direction by any means....
This query required a total time of 70 minutes to read, interpret, research, and synthesize an approach and complete response to the patient.
Feeling of heaviness or weakness in the right hand or foot
Detailed Answer:
Since we've already spoken about these issues at length during other sessions....I don't really want to say much more that could confuse what we've already discussed and which adequately describes your situation.
I am happy to reinforce additional reassurances for you that as per the last 2 neurological examinations you've received there's been no evidence on formal testing that the criteria required by the El Escorial guidelines to consider any form of ALS have been met. We've already discussed in detail as well that proving the existence of a process that involves the chronic neurodegeneration of MOTOR NEURONS in the spinal cord (believed to be the basis for the disease) cannot be made and should not be made on using symptoms in isolation to the core requirement of the neurological findings of UPPER AND LOWER MOTOR SIGNS of abnormality in at least 1 body segment with spread and progression to other segments over time.
In other words the presence or sudden appearance of twitchings or fasciculations in a body part or multiple body parts is not a cause for concern or alarm if there are no UPPER AND LOWER MOTOR NEURON SIGNS of abnormality on neurological testing. Loss of weight (as we've discussed) that does not include the loss of MUSCLE MASS over time or atrophy is not a cause for concern or alarm if there are no UPPER AND LOWER MOTOR NEURON SIGNS of abnormality on neurological testing. And weakness (as determined by a patient) in a muscle or group of muscles is not a cause for concern or alarm if there are no UPPER AND LOWER MOTOR NEURON SIGNS of abnormality on neurological testing.
Twitching muscles in the face by the way must involve CRANIAL NERVE MOTOR NEURONS which is not at all how the typical course of how ALS presents or progresses at such an early stage of when your first symptoms of concern appeared 3 months ago. Spinal motor neurons are anatomically distinct from cranial motor neurons. One disease process simply does not affect a separate anatomic compartment of neurons....there's no physical way that can happen given that ALS is not an infection or contagious process of any sort.
As you know we are continuing to work together on this problem and I'm sure that in time we will discover what is the root of these symptoms. For now, I would continue to reassure you that things are not going in an ALS direction by any means....
This query required a total time of 70 minutes to read, interpret, research, and synthesize an approach and complete response to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Feeling of heaviness or weakness in the right hand or foot
Detailed Answer:
Since we've already spoken about these issues at length during other sessions....I don't really want to say much more that could confuse what we've already discussed and which adequately describes your situation.
I am happy to reinforce additional reassurances for you that as per the last 2 neurological examinations you've received there's been no evidence on formal testing that the criteria required by the El Escorial guidelines to consider any form of ALS have been met. We've already discussed in detail as well that proving the existence of a process that involves the chronic neurodegeneration of MOTOR NEURONS in the spinal cord (believed to be the basis for the disease) cannot be made and should not be made on using symptoms in isolation to the core requirement of the neurological findings of UPPER AND LOWER MOTOR SIGNS of abnormality in at least 1 body segment with spread and progression to other segments over time.
In other words the presence or sudden appearance of twitchings or fasciculations in a body part or multiple body parts is not a cause for concern or alarm if there are no UPPER AND LOWER MOTOR NEURON SIGNS of abnormality on neurological testing. Loss of weight (as we've discussed) that does not include the loss of MUSCLE MASS over time or atrophy is not a cause for concern or alarm if there are no UPPER AND LOWER MOTOR NEURON SIGNS of abnormality on neurological testing. And weakness (as determined by a patient) in a muscle or group of muscles is not a cause for concern or alarm if there are no UPPER AND LOWER MOTOR NEURON SIGNS of abnormality on neurological testing.
Twitching muscles in the face by the way must involve CRANIAL NERVE MOTOR NEURONS which is not at all how the typical course of how ALS presents or progresses at such an early stage of when your first symptoms of concern appeared 3 months ago. Spinal motor neurons are anatomically distinct from cranial motor neurons. One disease process simply does not affect a separate anatomic compartment of neurons....there's no physical way that can happen given that ALS is not an infection or contagious process of any sort.
As you know we are continuing to work together on this problem and I'm sure that in time we will discover what is the root of these symptoms. For now, I would continue to reassure you that things are not going in an ALS direction by any means....
This query required a total time of 70 minutes to read, interpret, research, and synthesize an approach and complete response to the patient.
Feeling of heaviness or weakness in the right hand or foot
Detailed Answer:
Since we've already spoken about these issues at length during other sessions....I don't really want to say much more that could confuse what we've already discussed and which adequately describes your situation.
I am happy to reinforce additional reassurances for you that as per the last 2 neurological examinations you've received there's been no evidence on formal testing that the criteria required by the El Escorial guidelines to consider any form of ALS have been met. We've already discussed in detail as well that proving the existence of a process that involves the chronic neurodegeneration of MOTOR NEURONS in the spinal cord (believed to be the basis for the disease) cannot be made and should not be made on using symptoms in isolation to the core requirement of the neurological findings of UPPER AND LOWER MOTOR SIGNS of abnormality in at least 1 body segment with spread and progression to other segments over time.
In other words the presence or sudden appearance of twitchings or fasciculations in a body part or multiple body parts is not a cause for concern or alarm if there are no UPPER AND LOWER MOTOR NEURON SIGNS of abnormality on neurological testing. Loss of weight (as we've discussed) that does not include the loss of MUSCLE MASS over time or atrophy is not a cause for concern or alarm if there are no UPPER AND LOWER MOTOR NEURON SIGNS of abnormality on neurological testing. And weakness (as determined by a patient) in a muscle or group of muscles is not a cause for concern or alarm if there are no UPPER AND LOWER MOTOR NEURON SIGNS of abnormality on neurological testing.
Twitching muscles in the face by the way must involve CRANIAL NERVE MOTOR NEURONS which is not at all how the typical course of how ALS presents or progresses at such an early stage of when your first symptoms of concern appeared 3 months ago. Spinal motor neurons are anatomically distinct from cranial motor neurons. One disease process simply does not affect a separate anatomic compartment of neurons....there's no physical way that can happen given that ALS is not an infection or contagious process of any sort.
As you know we are continuing to work together on this problem and I'm sure that in time we will discover what is the root of these symptoms. For now, I would continue to reassure you that things are not going in an ALS direction by any means....
This query required a total time of 70 minutes to read, interpret, research, and synthesize an approach and complete response to the patient.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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