I Am A 31 Year Old Male. I Have Been

Brief Answer:
Dr. Google never earned a medical degree...I wouldn't take his advice :)

Detailed Answer:
Thank you for your questions and concerns.

If you are suffering from "tennis elbow" which would be the layman equivalent of elbow tendinitis then, the most likely cause is OVERUSE of that elbow performing repetitive lifting, pushing, or pulling activities which cause either HYPERFLEXION or HYPEREXTENSION of the joint and excessive wear and tear on the joint apparatus. This is addressed by analyzing POSTURE, LIFTING FORM of the upper extremity, and making sure appropriate periods of rest and warmup of the left elbow occur before getting in to the heavy activities of the day that have been resulting in what you're referring to as TENDINITIS.

I'm interested in more detail regarding your statement of "significant atrophy of the forearm, biceps (BTW, no such word as BICEP even if specifying a SINGLE limb), and shoulder over the past 2 years. Do you have photographs from prior to 2 years ago and now that you can upload for me to compare? Do you have measurements that SOMEONE else has been keeping on the circumference of your forearms, biceps, and shoulders? Taking your own measurements is nearly impossible and someone take measurements for you without following standard guidelines or documenting whether you are measuring in a flexed or non-flexed state has no value in terms of comparing numbers over time. Make sense?

If you are able to same amount of weight (in the gym) with your upper extremities then, it would be physiologically extremely difficult to explain how SIGNIFICANT ATROPHY could occur since atrophy by definition is a loss of MUSCLE MASS and this WILL RESULT in a loss of power which will be MAGNIFIED when a person tries to lift any amount of weight...especially weight. Therefore, can you give me some hard core specs to demonstrate what you mean by atrophy? Photographs would be best. And also, amount of weight being lifted as well as what your BODY WEIGHT is now compared to say, 6-12 months ago? Another parameter that could be measured to illustrate loss of muscle mass is how the sizes of your shirts have changed in the past couple of years in terms of the neck and sleeve length. If your clothes have not really changed in how they are fitting you then, there hasn't been any clinically significant loss of muscle mass and hence no significant muscle atrophy has been occurring. Make sense?

As far as the twitching in the left hand and shoulder over the past 3 days there are many things that cause twitching...I'm sure Dr. Google will attest to that, right? I would not worry very much about the WORST CASE SCENARIO since as you probably know ALS in a 31 year is virtually unheard of...and of course, I am aware of the rare cases of young adults diagnosed...but typically speaking, twitching of muscles in the absence of strength changes doesn't happen. Also, patients with ALS typically complain first and foremost of weakness in the lower extremities with stumbles, and later falls which usually precedes the loss of body weight followed by loss of specific muscle mass from groups of large muscles, etc.

If you like going to the gym...do you also take nutritional supplements such as creatinine, muscle powders, are you any medications such as antidepressants or anxiety fighting drinks, or sleep aids, etc. Because I have a number of patients who are young, worried about ALS (because of muscle twitching), and also are taking prescription medications, or nutritional supplements that themselves can result in twitching and irritated muscles.

Now, as far as your hematocrit (HCT) of 54 is concerned, I'm not sure why the ER was so certain that this was the reason for your symptoms. Did you actually do a full workup for all causes of muscle twitching. Did they get an iron panel, thyroid function tests, and a blood smear? It would be unusual if they even got 1 of those results, let alone all 3...which is why they told you to follow up with your primary doctor...

Most lab standard values for HCT in young men your age range from 45- 52%. Your value of 54 which is 3.85% above the upper limit of normal. That doesn't seem too significant to me BUT if you are having these fasciculations then, I would agree that a more indepth METABOLIC workup is necessary.

However, this is not the way ALS presents or how it evolves. I'm curious to know how you were able to get an EMG/NCV study scheduled without seeing a neurologist first? Electrical studies, in my studies, should not be performed unnecessarily since they are invasive tests and should not be used as substitutes to a good neurological examination. A neurologist should schedule an electrical study after he has examined a patient, checked into the full history as I've described as to how this all began, what medications (or other things patients may be taking or using) are being used, and THEN, tailor a diagnostic plan based on those results. I do not think it is fair to the patient to order such an invasive test without doing the first part of the workup (neurological exam) and then, speaking to the patient of what would be the prospect of an electrical study showing something abnormal as well as how the study will help with making a diagnosis as to what's going on.

If in fact, there is muscle atrophy afoot with retained muscle strength and fasciculations that have been occurring in the past few days that are in a diffuse pattern or the body then, I would be much more interested in the metabolic semblance of the patient in someone of your age then, looking for motor neuron disease (after I'd completed a thorough neurological assessment).

In conclusion, on the basis of what you've described I must disagree with Dr. Google and tell you that for what's going on for the past few days there is an infinitely increased likelihood that something else is causing your twitches and that a more complete metabolic workup must be done to find that answer. I would highly recommend you defer the EMG/NCV since it is not only uncomfortable but unnecessary at this stage of development of your symptoms and instead look for a GOOD NEUROLOGIST interested in TALKING TO YOU FIRST and foremost to get a good timline on things...starting if you'd like with your tendinitis and coming forward. If it were me conducting the interview with you I'd also take a bit of time to try and find out what you have developed the type of concern and anxiety over health issues that almost never affect people your age. ALS is really not something to start thinking about until at least the 5th decade of life...and even then, it is a bit on the early side. The vast majority of patients will clock on with the first symptoms which involve clumsiness or mild and almost unnoticed weakness in the hands or more commonly the feet since they may feel clumsier than usual. They almost NEVER START with fasciculations that envelope the entire body in a matter days.....that AIN'T HOW THIS DISEASE works! Make sense?

So yeah....I'd like to know what's up that is making you worried about this problem.

Next, good solid NEUROLOGICAL EXAMINATION in order to rule in or out the NECESSARY PRESENCE of upper and lower motor neuron signs and the time course of evolution as well as mapping out the regions of the body affected and how it's spread. So far, in your presentation I've not heard anything that sounds close to ALS. Then, based on all that accumulated data (including looking for other MORE LIKELY reasons for muscle fasciculations we would strategize for doing diagnostic studies.

I do agree with your last question which is a good one on the time course factor of all this...and as you probably guessed a long time even before I starting writing this response that the TIME COURSE in ALS is one that develops usually over the course of months before patients even think about presenting to a doctor. It then usually takes a number of weeks to even a few more months before most people will have gotten a completed workup (together with all the invasive testing felt to be necessary and imaging studies plus referrals to neuromuscular specialists, etc). So by the time they actually get to see a specialist is about when fasciculations usually start appearing in great numbers over the entire surface of the body.....NOT 3 DAYS....make sense?

So the answer to your last question is: It is LESS LIKELY (actually unheard of in the literature) that your symptoms are the beginnings of ALS which have progressed this rapidly over days WITHOUT LOSING STRENGTH.

And there you have it. Please tell Dr. Google for me when you next talk to him that I wish he would quit giving out such nasty advice. HAHA! Doctors are PEOPLE with live experiences who have put years and years of book learning into PRACTICAL TERMS OF LIVING and know what real life illness looks like. No amount of computer programming (in my opinion) or smart diagnostic lists can ever replace that acquired EXPERTISE. And no amount of internet based knowledge that NONPHYSICIANS gain by reading Dr. Google will ever change how a DOCTOR SHOULD GO about diagnosing patients....that is the good old fashioned way...which I'm sorry to say seems to be happening less than what I'm comfortable with now that medical students and residents in training are so used to pocket lists on a XXXXXXX CARD.

Uggghhhh....when any my residents in training pull out those damned machines on rounds.....I go back to when I used to teach junior high and high school kids. I confiscate their machines and threaten to throw them in a sink of water if they dare use them to diagnose patients on my watch.

I expect doctors in training to use the brains, their stethoscopes, their hands, and their JUDGEMENT to be creative, critical in thinking, self doubting at all times, and to always keep the patient's welfare in front of them...no room for computer lists or computer recommendations....if it didn't come from the doctor....to me....it ain't worth the silicon chip electrified with those bits. LOL!

If I've provided useful or helpful information to your questions could you do me the utmost of favors in CLOSING THE QUERY along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving? I am definitely interested in getting updated information if you'd care to drop me a line at www.bit.ly/drdariushsaghafi as to how you're feeling down the road and how things turned out.

You can always reach me at the above address for this and other questions.

I wish you the best with everything and hope my discussion as well as INTENTIONAL SLAM OF DR. GOOGLE has aided in your understanding of how real doctors conduct business. It's the difference between eating a pizza from Papa John's and ordering a beautiful soft dough pizza with fresh mozzarella at Sorbillo's Ristorante in XXXXXXX Italy. It just don't get any better than pizza made by the REAL EXPERTS who took their time and artistically CRAFTED the pizza just for you because the maker wanted you to truly enjoy a piece of art! HAHA.....just got back from Milano, Italy the other day....MAN WAS THAT A TIGHT TRIP!!

Cheers young man....hoping your workout is awesome tonight in the gym....I'm heading off to rugby practice myself right now....need to hit those young bucks trying to get through my turf! ROFL!!!

This query required 84 minutes of professional time to research, assimilate, and file a response.

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Brief Answer:
Dr. Google never earned a medical degree...I wouldn't take his advice :)

Detailed Answer:
Thank you for your questions and concerns.

If you are suffering from "tennis elbow" which would be the layman equivalent of elbow tendinitis then, the most likely cause is OVERUSE of that elbow performing repetitive lifting, pushing, or pulling activities which cause either HYPERFLEXION or HYPEREXTENSION of the joint and excessive wear and tear on the joint apparatus. This is addressed by analyzing POSTURE, LIFTING FORM of the upper extremity, and making sure appropriate periods of rest and warmup of the left elbow occur before getting in to the heavy activities of the day that have been resulting in what you're referring to as TENDINITIS.

I'm interested in more detail regarding your statement of "significant atrophy of the forearm, biceps (BTW, no such word as BICEP even if specifying a SINGLE limb), and shoulder over the past 2 years. Do you have photographs from prior to 2 years ago and now that you can upload for me to compare? Do you have measurements that SOMEONE else has been keeping on the circumference of your forearms, biceps, and shoulders? Taking your own measurements is nearly impossible and someone take measurements for you without following standard guidelines or documenting whether you are measuring in a flexed or non-flexed state has no value in terms of comparing numbers over time. Make sense?

If you are able to same amount of weight (in the gym) with your upper extremities then, it would be physiologically extremely difficult to explain how SIGNIFICANT ATROPHY could occur since atrophy by definition is a loss of MUSCLE MASS and this WILL RESULT in a loss of power which will be MAGNIFIED when a person tries to lift any amount of weight...especially weight. Therefore, can you give me some hard core specs to demonstrate what you mean by atrophy? Photographs would be best. And also, amount of weight being lifted as well as what your BODY WEIGHT is now compared to say, 6-12 months ago? Another parameter that could be measured to illustrate loss of muscle mass is how the sizes of your shirts have changed in the past couple of years in terms of the neck and sleeve length. If your clothes have not really changed in how they are fitting you then, there hasn't been any clinically significant loss of muscle mass and hence no significant muscle atrophy has been occurring. Make sense?

As far as the twitching in the left hand and shoulder over the past 3 days there are many things that cause twitching...I'm sure Dr. Google will attest to that, right? I would not worry very much about the WORST CASE SCENARIO since as you probably know ALS in a 31 year is virtually unheard of...and of course, I am aware of the rare cases of young adults diagnosed...but typically speaking, twitching of muscles in the absence of strength changes doesn't happen. Also, patients with ALS typically complain first and foremost of weakness in the lower extremities with stumbles, and later falls which usually precedes the loss of body weight followed by loss of specific muscle mass from groups of large muscles, etc.

If you like going to the gym...do you also take nutritional supplements such as creatinine, muscle powders, are you any medications such as antidepressants or anxiety fighting drinks, or sleep aids, etc. Because I have a number of patients who are young, worried about ALS (because of muscle twitching), and also are taking prescription medications, or nutritional supplements that themselves can result in twitching and irritated muscles.

Now, as far as your hematocrit (HCT) of 54 is concerned, I'm not sure why the ER was so certain that this was the reason for your symptoms. Did you actually do a full workup for all causes of muscle twitching. Did they get an iron panel, thyroid function tests, and a blood smear? It would be unusual if they even got 1 of those results, let alone all 3...which is why they told you to follow up with your primary doctor...

Most lab standard values for HCT in young men your age range from 45- 52%. Your value of 54 which is 3.85% above the upper limit of normal. That doesn't seem too significant to me BUT if you are having these fasciculations then, I would agree that a more indepth METABOLIC workup is necessary.

However, this is not the way ALS presents or how it evolves. I'm curious to know how you were able to get an EMG/NCV study scheduled without seeing a neurologist first? Electrical studies, in my studies, should not be performed unnecessarily since they are invasive tests and should not be used as substitutes to a good neurological examination. A neurologist should schedule an electrical study after he has examined a patient, checked into the full history as I've described as to how this all began, what medications (or other things patients may be taking or using) are being used, and THEN, tailor a diagnostic plan based on those results. I do not think it is fair to the patient to order such an invasive test without doing the first part of the workup (neurological exam) and then, speaking to the patient of what would be the prospect of an electrical study showing something abnormal as well as how the study will help with making a diagnosis as to what's going on.

If in fact, there is muscle atrophy afoot with retained muscle strength and fasciculations that have been occurring in the past few days that are in a diffuse pattern or the body then, I would be much more interested in the metabolic semblance of the patient in someone of your age then, looking for motor neuron disease (after I'd completed a thorough neurological assessment).

In conclusion, on the basis of what you've described I must disagree with Dr. Google and tell you that for what's going on for the past few days there is an infinitely increased likelihood that something else is causing your twitches and that a more complete metabolic workup must be done to find that answer. I would highly recommend you defer the EMG/NCV since it is not only uncomfortable but unnecessary at this stage of development of your symptoms and instead look for a GOOD NEUROLOGIST interested in TALKING TO YOU FIRST and foremost to get a good timline on things...starting if you'd like with your tendinitis and coming forward. If it were me conducting the interview with you I'd also take a bit of time to try and find out what you have developed the type of concern and anxiety over health issues that almost never affect people your age. ALS is really not something to start thinking about until at least the 5th decade of life...and even then, it is a bit on the early side. The vast majority of patients will clock on with the first symptoms which involve clumsiness or mild and almost unnoticed weakness in the hands or more commonly the feet since they may feel clumsier than usual. They almost NEVER START with fasciculations that envelope the entire body in a matter days.....that AIN'T HOW THIS DISEASE works! Make sense?

So yeah....I'd like to know what's up that is making you worried about this problem.

Next, good solid NEUROLOGICAL EXAMINATION in order to rule in or out the NECESSARY PRESENCE of upper and lower motor neuron signs and the time course of evolution as well as mapping out the regions of the body affected and how it's spread. So far, in your presentation I've not heard anything that sounds close to ALS. Then, based on all that accumulated data (including looking for other MORE LIKELY reasons for muscle fasciculations we would strategize for doing diagnostic studies.

I do agree with your last question which is a good one on the time course factor of all this...and as you probably guessed a long time even before I starting writing this response that the TIME COURSE in ALS is one that develops usually over the course of months before patients even think about presenting to a doctor. It then usually takes a number of weeks to even a few more months before most people will have gotten a completed workup (together with all the invasive testing felt to be necessary and imaging studies plus referrals to neuromuscular specialists, etc). So by the time they actually get to see a specialist is about when fasciculations usually start appearing in great numbers over the entire surface of the body.....NOT 3 DAYS....make sense?

So the answer to your last question is: It is LESS LIKELY (actually unheard of in the literature) that your symptoms are the beginnings of ALS which have progressed this rapidly over days WITHOUT LOSING STRENGTH.

And there you have it. Please tell Dr. Google for me when you next talk to him that I wish he would quit giving out such nasty advice. HAHA! Doctors are PEOPLE with live experiences who have put years and years of book learning into PRACTICAL TERMS OF LIVING and know what real life illness looks like. No amount of computer programming (in my opinion) or smart diagnostic lists can ever replace that acquired EXPERTISE. And no amount of internet based knowledge that NONPHYSICIANS gain by reading Dr. Google will ever change how a DOCTOR SHOULD GO about diagnosing patients....that is the good old fashioned way...which I'm sorry to say seems to be happening less than what I'm comfortable with now that medical students and residents in training are so used to pocket lists on a XXXXXXX CARD.

Uggghhhh....when any my residents in training pull out those damned machines on rounds.....I go back to when I used to teach junior high and high school kids. I confiscate their machines and threaten to throw them in a sink of water if they dare use them to diagnose patients on my watch.

I expect doctors in training to use the brains, their stethoscopes, their hands, and their JUDGEMENT to be creative, critical in thinking, self doubting at all times, and to always keep the patient's welfare in front of them...no room for computer lists or computer recommendations....if it didn't come from the doctor....to me....it ain't worth the silicon chip electrified with those bits. LOL!

If I've provided useful or helpful information to your questions could you do me the utmost of favors in CLOSING THE QUERY along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving? I am definitely interested in getting updated information if you'd care to drop me a line at www.bit.ly/drdariushsaghafi as to how you're feeling down the road and how things turned out.

You can always reach me at the above address for this and other questions.

I wish you the best with everything and hope my discussion as well as INTENTIONAL SLAM OF DR. GOOGLE has aided in your understanding of how real doctors conduct business. It's the difference between eating a pizza from Papa John's and ordering a beautiful soft dough pizza with fresh mozzarella at Sorbillo's Ristorante in XXXXXXX Italy. It just don't get any better than pizza made by the REAL EXPERTS who took their time and artistically CRAFTED the pizza just for you because the maker wanted you to truly enjoy a piece of art! HAHA.....just got back from Milano, Italy the other day....MAN WAS THAT A TIGHT TRIP!!

Cheers young man....hoping your workout is awesome tonight in the gym....I'm heading off to rugby practice myself right now....need to hit those young bucks trying to get through my turf! ROFL!!!

This query required 84 minutes of professional time to research, assimilate, and file a response.

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Brief Answer:
Rest easy and start saving for COLLEGE FUNDS for the kids!

Detailed Answer:
Good evening kind sir....many thanks for your complimentary words indicating that the information I provided was of some value. I'm hoping that this response will add even some additional comfort to how you are feeling even though I can tell you are still very nervous about things.

The dryness of your mouth and burning/stinging of the skin diffusely as well as difficulty swallowing WINE (liquid) are all signs that point AWAY, WAY AWAY FROM motor neuron disease or ALS. Why? Because, MOTOR NEURON disease is exactly what it says it is....it is an entity that strikes MOTOR NERVES. Sensory phenomenon such as burning and stinging skin are symptoms of something which is NON-MOTOR as an underlying cause. Those symptoms can be caused by anxiousness or psychological stress. Or they could be caused by metabolic or chemical deficiencies in the bloodstream (low levels of Vit. B12, D, folate, or B6) as well as thyroid or adrenal problems. Since you described things as sort of "coming and going" including cramping in the arms and fatigue then, the odds on favorite for cause might turn out to be something in the psychological realm of things....make sense?

I looked at your photos for quite a while and magnified the images taking simple and accurate measurements of various parts of the upper extremities and I do AGREE that your LEFT side in general is smaller than the right side. And so, I'm very sorry to say, that YOU ARE JUST LIKE EVERYONE ELSE! There is no such body out there that has a perfectly SYMMETRIC right and left sides. Your dominant hand usually dictates which side of the body is DOMINANT.

Remember about EMG/NCV's.....they can never indicate WHAT is causing a junctional block or regional weakness (PARESIS). All the electrical study does is show the INTEGRITY of the electrical system. It does not talk about WHAT is causing weakness, what is causing numbness/tingling/strength, etc.

In short it appears to me that you may have a a mild issue of DOMINANCE on the right side compared to left which then, can be seen as larger, thicker, and weightier muscle groups BUT it falls within PYHSIOGOGLICAL LIMITS OF NORMAL.

As far as the cramping is concerned and the sense of fatigue again, those are things which should first be assayed for in the bloodstream and do not represent any characteristics of ALS that we'd be looking for....honestly, just based on the current physical data that you've provided I would try and convince the patient that they really do not need to go through the "pain and suffering" of an electrical which is not going to give us any information more than we already have on hand.

I think in my last response I spelled out certain labs that you should get done just to check things out such as THYROID PANELS, INFLAMMATORY MARKERS looking for any type of collagen disease or vasculitic picture which as it turned out really didn't speak of any significant loss of muscle strength or mass.

For example, if you were to come to my office here in the XXXXXXX OH area I would be measuring the hands and the fingers using a dynamometer to test grip strength and if I felt MEASUREMENTS were important I would MEASURE YOU MYSELF. There is a special technique of how to measure muscles for size and VOLUME and one is...."GET SOMEONE ELSE TO DO IT FOR YOU."

The hemibody involvement on your left makes me wonder about a nerve root being pinched or caught in the cervical spinal cord or column which might be the reason I'm seeing the left of your body a bit smaller. That is actually a normal thing for the body NOT to be perfectly symmetric. But in this case I will concede that it looks like something could be causing that change in how much mass the left side has compared to the right and that is usually due to nerve roots being compressed or the spinal cord itself being the culprit and being squeezed. So that's where I would look first.

Again, your evidence pretty much points entirely away from MOTOR NEURON disease and supports the entity of either a radiculopathy or neuropathy of some type.

I hope that's good news. I realize it's something you want to believe but may have a hard time believing due to your stress and anxiety over various things. I can tell you though that at least in my opinion, and after looking at the current evidence of what's going on with your concerns over losing muscle mass that you will not be taken away early from your children by something like ALS.....And so, feel free to take a few breaths and let all your muscles just melt into the next phase...literally....because your doing very well as far as I can see. Hope the headache subsides. I would recommend lots of good fresh water so you can stay hydrated as well as eating your meals regularly and on type...that can also lead to things like fatigue, headaches, etc.

Cheers young man! Now go help that wife of yours keep roll call going without a hitch! We got 4 little ones also....well, at one time they were very little....now, they are 25, 24, 23, and 21 YEARS old....all living at home still in school (college or graduate schools)....and we gotta track them with GPS satellites since they're playing this game where they make us sweat it out to get information out of them whenever we wanna know where they're going! LOL.

This query required 140 minutes of professional time to research, assimilate, and file a response.

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Brief Answer:
Rest easy and start saving for COLLEGE FUNDS for the kids!

Detailed Answer:
Good evening kind sir....many thanks for your complimentary words indicating that the information I provided was of some value. I'm hoping that this response will add even some additional comfort to how you are feeling even though I can tell you are still very nervous about things.

The dryness of your mouth and burning/stinging of the skin diffusely as well as difficulty swallowing WINE (liquid) are all signs that point AWAY, WAY AWAY FROM motor neuron disease or ALS. Why? Because, MOTOR NEURON disease is exactly what it says it is....it is an entity that strikes MOTOR NERVES. Sensory phenomenon such as burning and stinging skin are symptoms of something which is NON-MOTOR as an underlying cause. Those symptoms can be caused by anxiousness or psychological stress. Or they could be caused by metabolic or chemical deficiencies in the bloodstream (low levels of Vit. B12, D, folate, or B6) as well as thyroid or adrenal problems. Since you described things as sort of "coming and going" including cramping in the arms and fatigue then, the odds on favorite for cause might turn out to be something in the psychological realm of things....make sense?

I looked at your photos for quite a while and magnified the images taking simple and accurate measurements of various parts of the upper extremities and I do AGREE that your LEFT side in general is smaller than the right side. And so, I'm very sorry to say, that YOU ARE JUST LIKE EVERYONE ELSE! There is no such body out there that has a perfectly SYMMETRIC right and left sides. Your dominant hand usually dictates which side of the body is DOMINANT.

Remember about EMG/NCV's.....they can never indicate WHAT is causing a junctional block or regional weakness (PARESIS). All the electrical study does is show the INTEGRITY of the electrical system. It does not talk about WHAT is causing weakness, what is causing numbness/tingling/strength, etc.

In short it appears to me that you may have a a mild issue of DOMINANCE on the right side compared to left which then, can be seen as larger, thicker, and weightier muscle groups BUT it falls within PYHSIOGOGLICAL LIMITS OF NORMAL.

As far as the cramping is concerned and the sense of fatigue again, those are things which should first be assayed for in the bloodstream and do not represent any characteristics of ALS that we'd be looking for....honestly, just based on the current physical data that you've provided I would try and convince the patient that they really do not need to go through the "pain and suffering" of an electrical which is not going to give us any information more than we already have on hand.

I think in my last response I spelled out certain labs that you should get done just to check things out such as THYROID PANELS, INFLAMMATORY MARKERS looking for any type of collagen disease or vasculitic picture which as it turned out really didn't speak of any significant loss of muscle strength or mass.

For example, if you were to come to my office here in the XXXXXXX OH area I would be measuring the hands and the fingers using a dynamometer to test grip strength and if I felt MEASUREMENTS were important I would MEASURE YOU MYSELF. There is a special technique of how to measure muscles for size and VOLUME and one is...."GET SOMEONE ELSE TO DO IT FOR YOU."

The hemibody involvement on your left makes me wonder about a nerve root being pinched or caught in the cervical spinal cord or column which might be the reason I'm seeing the left of your body a bit smaller. That is actually a normal thing for the body NOT to be perfectly symmetric. But in this case I will concede that it looks like something could be causing that change in how much mass the left side has compared to the right and that is usually due to nerve roots being compressed or the spinal cord itself being the culprit and being squeezed. So that's where I would look first.

Again, your evidence pretty much points entirely away from MOTOR NEURON disease and supports the entity of either a radiculopathy or neuropathy of some type.

I hope that's good news. I realize it's something you want to believe but may have a hard time believing due to your stress and anxiety over various things. I can tell you though that at least in my opinion, and after looking at the current evidence of what's going on with your concerns over losing muscle mass that you will not be taken away early from your children by something like ALS.....And so, feel free to take a few breaths and let all your muscles just melt into the next phase...literally....because your doing very well as far as I can see. Hope the headache subsides. I would recommend lots of good fresh water so you can stay hydrated as well as eating your meals regularly and on type...that can also lead to things like fatigue, headaches, etc.

Cheers young man! Now go help that wife of yours keep roll call going without a hitch! We got 4 little ones also....well, at one time they were very little....now, they are 25, 24, 23, and 21 YEARS old....all living at home still in school (college or graduate schools)....and we gotta track them with GPS satellites since they're playing this game where they make us sweat it out to get information out of them whenever we wanna know where they're going! LOL.

This query required 140 minutes of professional time to research, assimilate, and file a response.

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