Flesh coloured, painful HEMORRHOIDS. Need an INCISION?

Hello,
Thank you for posting your query at DoctorSpring.com
I have noted your symptoms, and seen the pictures of your hands. I agree with you that there is muscle wasting present, although it is mild in nature. I presume that there is wasting in feet also, though there are no pictures. I am also assuming that your sensations are normal and you are able to perceive all sensations in hands and feet. How are your reflexes, especially deep tendon reflexes?
Thew most important considerations in this case are peripheral neuropathy (a damage of nerves of hands and feet) and anterior horn cell disease. We expect NCV/EMG to pick up both these conditions. It may be worthwhile repeating the NCV/EMG after six months at another center.
As of now, you should concentrate of muscle building and strengthening exercises. Also, a diet rich in protein (meat, fish. poultry and eggs) would help.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Sir,
Thanks for your reply ans advice. One the questions you asked, please find my answers below.
Sensations on hand and feet are normal. So are deep tendon reflexes as of now. This was tested by the doctor before doing the NCV/EMG test. NCV indeed turned out normal and EMG was tested by using needles on by bicep muscles and they were also normal.
The slowly progressive wasting was noticed by me some 7-8 years back and when I checked with my regualr doctor he said its just that I have low body fat. But it just kept on increasing and then I felt my grip strenth is a bit low (like when opening a bottle cap) or even while hitting somethign with palm, I could feel pain on palm. There is some excessive sweating on palm and feet as well. same is the situation of feet. they have thinned over years. I consulted a neurologist here (I working in middle east) who suggested it could be a case of inflammatory myopthy and adviced me to do further tests. Thats how I went to a doctor in kerala, but got nothing conclusive from their side.
Right now I feel muscle twitching (while at rest) on feet, lower legs and at times on the thigh and rarely on bicep muscles.(All these are nor very regular, but happens often). I could see loss of fat/muscle happening on arms and lower legs as well, but slowly.
In my family no one has even been reprted with such problems earlier.
Thanks for your kind help.
Regards
Bip

Thank you for getting back and providing more information.
The additional information was helpful and I feel you have had adequate tests done so far. The only thing is that I would have like to sample more muscles for EMG, especially smaller muscles of hands such as APB and interpose as that is where the wasting is maximum.
The next step would be to do a muscle biopsy, if your disability worsens, otherwise just wait and watch.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)

Thanks Doc,
Could you please suggest any good hospital in South India (Bangalore, Coimbatur, Manipal are easily accessible to me) where I could get these tests done properly (i dont see any performing biopsy for neuro conditions in kerala).
And appreciate if you could name few conditions I should look for (of course with the help of doctors, but it just helps me in getting prepared)
Appreciate your help,
Regards
Bip

Thank you for getting back.
If you can manage to reach CMC Vellore, Dr Mathew Alexander is very good. At Bangalore, you can see Dr Murali Srinivas at Manipal hospital, old airport road.
The main conditions we are looking for are muscle disease versus anterior horn cell disease.
(In my previous reply, interossei got auto-corrected to 'interpose'. I had meant interossei muscles.)
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)