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Old 03-24-2017, 01:21 PM #1
ejbm6798 ejbm6798 is offline
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ejbm6798 ejbm6798 is offline
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Default general neuro question

Need a second opinion. Saw a neurologist, she did the standard office exam an “assay” of some blood, and then ordered an “EMG with NCS”.
45-year-old male. Heavy smoker, diagnosed COPD 2014. Previous heavy drinker, sober 8 months. Food server for over 30 years.
Blood test results:
Aldolase Serpl-cCnc 4.90 U/L
Vit B12 Ser-mCnc 361.0 pg/mL
Ck SerPl-cCnc 115.0 U/L
Diagnosis returned was Carpal Tunnel Syndrome, with instructions to wear a splint. I am a charity patient at the local hospital, earn too much to get HIP 2.0, but not enough to afford insurance premiums.
Below is a list of the progressive symptoms I have had, beginning in mid-2015. They are organized as best as I can recall in order of appearance and progression. Bear in mind that during this time I voluntarily entered into a half-way house for alcoholism treatment, and I am currently in a 12-step program with about 8 months sober.
1. Unexplained emotionality, random sobbing. At the time, I thought it was due to my alcoholism.
2. Clumsiness in right hand (I write with my left, but use my right for most other things)-difficulty swiping credit cards at work, difficulty buttoning shirts and tying shoes.
3. Cramping and aching in right arm and bicep. Saw my primary care doctor at that time, prescribed Gabapentin and a splint. No noticeable relief.
4. Right thumb seizing up- would contract across my hand and remain stiff in that position for seconds and for as long as a quarter hour. Pain in “web” in between thumb and hand.
5. Crawling tingling sensations in right arm from point of elbow to hand. Seemed to follow path of veins on the inside of my arm, but up under the muscle.
6. Pins and needles in pinky and ring finger and edge of right hand.
7. Decreased strength and coordination in right arm. Could only carry water pitchers half-full. Difficulty setting glasses and plates on tables smoothly. Less ability to carry groceries/other heavy objects with right arm.
8. Splinting seem to have no discernable effect.
9. Noticed strange rhythmic electrical pulsing in bottom of left foot, lasting from half hour to many hours at a time.
10. Ongoing clumsiness/inability to use right hand. When I closed that hand around something my index finger would remain pointed on its own. About that time, I noticed the inability to use right thumb.
11. Became difficult to open water/soda bottles. Completely unable to grasp plastic food wrappers and pull apart. Began to notice some weakening and lack of coordination in the LEFT hand. Texting/scrolling using smart phone became more difficult. Writing with became different less accurate, difficult to do. Signature changed.
12. Increased fatigue. Post “rush” at work I was noticeably more tired, but still able to keep up. Noticeable weakness in my legs. Going down stairs legs (at first only the left) would shake, compromising placement on the steps. Nearly fell numerous times.
13. At that time, I noticed I was becoming unable to carry full plates of food with my right ar. Picking up items using fingers became difficult. In order to pick wrappers, silverware etc. up off tables I had to close my entire hand around the item. Increased difficulty with pants buttons, zippers etc. Had to use my teeth to put watch on.
14. Tremor in right bicep started. Began to notice right bicep significantly smaller than had been.
Within the last five months or so rate of progression accelerated. Noticed changes as follows:
1. Constant or near constant tremor in right bicep. Tremor is pronounced, visible and shakes my shirt sleeve. More violent after a period of activity. When I am using that arm (carrying something or reaching for something) tremor can be forceful enough to cause me to fling arm.
2. Tremors run down arm top bottom all over, inside of elbow, “web of thumb”. Fingers shake and twitch. Tremors seem to be independent of one another, IE top of arm doing one thing, bicep another. Tremors are rhythmic, but not coordinated. All muscles in right arm are depleted there are hollows on inside of arm, bones tendons etc. are pronounced, hand is bony.
3. Same tremors as described above have started in my left arm, muscles are beginning to waste on that side as well.
4. Tremors started in shoulders, back of underarm, around neck, up and down back. Can feel tremors inside of chest and abdomen, can see my shirt shaking over stomach.
5. Extreme fatigue. Severe right arm weakness. Can only carry one empty plate with right arm. Even that requires effort. Very pronounced disconnect-Doors/doorknobs, keys, zippers, putting on socks/shoes, using silverware to eat, grooming activities, computer use all very difficult. Problems more on right arm, but left arm becoming nearly as much a problem. Can only carry one full plate with left arm (before I could do 2 or 3). Working has become extremely difficult, requiring enormous effort, I am increasingly frustrated and anxious at work. After a shift, I feel nearly dead from both the physical and mental effort to endure the work.
6. Noticeable change in gait. I used to take long, sweeping graceful steps. Now shorter gait, less sure of placement occasional stumbling. At times, I walk as though intoxicated, change in gait is constant, stumbling occasional.
7. Tremors infrequent and irregular in right thigh, gluts area around right knee. Stairs are very difficult (I live on the third floor) by the top of the second flight it feels as though my legs are going to give out. Going down, shaking present in both legs. Occasionally either knee might give while walking or standing.
8. Over active reflex response in both legs, more on left side. A tap or bump to area above my left knee up to about three quarters toward my hip will result in a kick.
9. People are asking me to repeat myself more frequently. Phrases I have repeated thousands of times at work come out garbled. “Eses” or hard consonants or groups of sounds incorporating multiple consonants and intermingled vowels are difficult. This symptom seems to be irregular and not constantly present.
10. Extreme day time sleepiness. Trouble sleeping at night. When I do sleep hard (day or night) I sweat excessively (note: very recent negative HIV test, doctor seems to automatically asked that when I talk about the sweating).
11. Occasional nighttime feeling of being unable to breathe (not a wheezy COPD symptom), just an alarming feeling where I have to concentrate on breath.
12. Infrequent trouble holding my head straight. Occasional contraction and cramping of neck muscles.
13. Frequent cramping and stiffness in all muscle groups random and never whole body at same time. Stiffness occurs when a muscle is being used, and arm or leg when bent does not seem to want to return to being extended.
14. Right pinkie finger has pulled away from the other fingers and began to twist.
15. Extreme anxiety, agitation, depression. Saw my primary doctor’s nurse practitioner. Prescribed 50 mg. Sertraline daily taking that. Also prescribed 25mg. Hydralazine 3 times daily as needed, but not taking that since I don’t really know what it is.
16. Occasional over salivation, “spraying” when I speak, drooling.
*Note possibly unrelated but present*
(COPD Diagnosis 2014)
Over last 8 months increased mucus in nose. Constant thick post nasal discharge. Thick white rope like discharge. Shallow cough produces thick gobs. Often feel unable to swallow or clear throat of this discharge. Effects my voice. My voice seems deeper at times than it did before, but I don’t project it the way I used to. Voice sometimes returns to previous higher pitch.

I just don’t understand how a splint and some therapy on my wirst could address these issues. The neurologist is not inclined to spend time to explain this to me since I am uninsured. I do not blame her, as I am similarly disinclined to pay much attention to a guest at the restaurant where I work who has historically not tipped. Any guidance would be appreciated. I could seek an appointment with a different neurologist outside the network from which I receive sliding scale charity care, but the initial appointment would be three hundred plus dollars, more than two thirds of my weekly income. Before I make the choice to be late on rent, fall behind on a utility bill, or eat less for a month, I could use some advice.
Thank you in advance for your time in this regard.
Eric James Muirhead
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Old 03-25-2017, 12:04 PM #2
ger715 ger715 is offline
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ger715 ger715 is offline
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Have you have seen an orthopedic doctor?? This could be shoulder issues, as well as cervical spine; but of course, tests would be necessary.

Also, have you seen anyone regarding sinus issues? Usually an ENT doctor (ears,nose,throat) My daughter is prone to sinus infections and deals with similar issues.

Your frustration is understandable.

Congratulations on 8 months sober.....


Gerry
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Old 03-29-2017, 04:32 AM #3
zygopetalum zygopetalum is offline
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Are you on COPD meds? I have had neuro symptoms from them for years, I am doing better on lower doses.
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