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Weakness in leg, joints and twitching, numbness in hands.

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About last week of December I started getting some symptoms

Weakness in legs
join weakness
numbness in hands
tingling in feet
pain in both legs
pain in my right arm
face and throat area getting stiff

I googled and ALS cam up. So I was scared so I went to my PCP twice and he checked my reflexes and hit me with a small hammer on my joints. He said I don't have any typical signs of ALS and everything is normal. But the fear did not leave so I went back and this time he did a more extensive test and still said everything is normal

I made an appointment with a neurologist. She asked me roll up my sleeves and my pant

She had a vibrator she touched my ankles,joints,elbows and she asked me if I can feel the vibration and 2nd thing she said was to let her know when I stop feeling the vibration

She hit me with a small hammer on ankes,elbows,joints. My left knee jerked maybe a inch it moved a tiny bit when she hit me with a hammer. But she said everything is NormaL

She pinched me in different spots like feet,legs and hands and she said everything is normal

She made me walk on My toes which I did but not in a 100% straight line(are humans suppose to walk 100% straight 2 hen walking on toes and heels? Than she made me walk in a strip hy line with both feet one after another and again I could walk fine but not 100% straight but she said it's normal

She said if it will give me peace of mind she can order an EMG and nerve test. EMG was normal on both legs and arm. Nerve test did show some minor things but that was due to my high sugar for a while

She looked inside my mouth
she made me You my nose with me fingers

So I was very happy. Than I did something stupid and I looked onine again. i was having some issues with swallowing. i went to ER because i was having issues with swallowing and mu upper chest felt painful and just unconfortable

they did a swallow test and it was normal

i drank a lot of sodas and in july 2014 i was told i am pre diabatic. my A1C was 6.4 in august. chances are i had high sugar withoutknowing for a while.

my vitamin B level was 218. normal range was 190 to 900. my doctor said that my vitamin B level should be over 500

vitamin D level was low at 11.9H normal range 30 to 90

my thyroid was a little off but doctor said nothing serious

here is my current issue

trouble swallowing
i feel like food and water get stuck but its really not
i have developed a really soar throat
i am always clearing my throat
sometimes i have to make a 2nd or 3rd effort to swallow my saliva
my mouth feels so sour
sinus issues runny nose
i cough a lot and it hurts and i have stuff like saliva coming out of my throat
at night i am drooling sometimes
my mouth gets really dry so does my throat

i am 31 years old

my question is could these be Bulbar onset( i have read that bulbar onset starts with slur speach. and i was told bulbar onset is almost always with older people. average age for bulbar onset is 68 if i remember correctly

sometimes my face gets stiff and i have a tight feeling in my throat. when this started i had a lump like feeling in my throat

one neurologist did the clinical exam
another did the EMG and nerve test

both said i dont have ALS

my PCP told me twice and gave me exam twice for clinical weakness

sorry about writing such a long essay, i just wanted to provide a detailed history

i have been told that i have high anxiety. i scored a 21 on neurologist office test and she said it was quite high

Thank you for your help in advance.

i feel like symptoms started in my legs and arms and after EMG i started thinking abouy throat and tongue emg. if anything was abnormal wouldnt a EMG show something since it was done on both legs and arms

Category: Neurologist, Medical

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Category: Pediatric Neurologist
 20 Doctors Online

Thank you for your query at
I am pleased to assist you.
The good thing is a thorough clinical examination has already been done, and there is nothing suggestive of ALS. In fact with the recent awareness about ALS, a lot of patients are coming with such symptoms, and they are scared of ALS. The anxiety is natural, however in your case there is absolutely nothing suggestive of ALS.
There is no obvious muscle atrophy, or progressive weakness in the limbs. In Bulbar onset ALS, as you rightly said the first symptom is that of difficulty in swallowing, however it is almost always associated with speech issues and loss of tongue movements.
Mostly if there was any minute features of ALS, EMG would have been conclusive. A normal EMG on both limbs rule out ALS completely. Anxiety can itself lead to a lot of symptom manifestations. So you can be rest assured you have nothing to worry about. If anxiety is persistent you can meet your local physician who will prescribe you anti-anxiety medicine for a couple of weeks.

Patient replied :

Thank you for your reply.
So since my EMG was done on both legs and arms something would have shown if it was ALS related right?
Also you said that BULBAR ONSET starts out with tongue or slur speech right? My issue is something putting enough energy to swallow my saliva. But than other times everything is fine and swallowing also is sometimes fine
My face is trembling when I smile My lips are trembling Sometimes I feel like there is to much saliva in my mouth.
But I read the saliva issue isn't that your mouth is making too much of it. It's that you can swallow so a lot of it gather inside your mouth. My problem isn't that. My problem is my mouth is making too much of it but other times it's really dry inside my mouth
So again it's not persistent
Is Trembling Part Of ALS
My left hand also trembles when it's at rest or when I lift it it's still shaking
Thank you again for your help

Thank you for getting back.
Yes, EMG would have shown changes in legs and arms, if it was ALS.
Yes, the symptoms in ALS would be persistent and would not come on intermittently.
Trembling is not a symptom of ALS, and it is unrelated. It could be related to anxiety or a condition called as essential tremors.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Patient replied :

Okay thank you very much for your help. Just one last set of questions

I visited a neurosurgeon yesterday in my city in Pakistan and he said he don't see aNY symptoms
he sent me to a neurologist who did the physical. I want to know if he did everything or should I get another EMG.

He asked me to roll up my sleeves and take off my pants for a physical

He hit me with a small hammer on my joints, ankles, elbows, and under my lip
he said he did notice some hyper activity but he said it's minor and it's mostly due to my being so full of anxiety. My question is can anxiety cause some hyper muscles
he said he didn't notice any jaw jerking so he said that pretty much rules out bulbar onset. He said if I had bulbar than when he tapped my lip my jaw would have jerked.
he flexed my muscles when he asked me to relax and I was laying down. And said everything was good

He basically gave me a clean bill of health and said my tremors wee because of what you said earler.
he said in Pakistan when they do an EMG they do it on arms,legs and tongue so should I go ahead and get an EMG again or no is my question to you?

Also could als symptoms progress as fast as within weeks? Mine started with lump feeling I'm throat to tight throat and trouble swallowing and now I have stiffness around my neck and face. I also have tremors and or twitches around my face and throat. But he told me that tremors,stiffness,numbness,tingling,burning feelings are not part of ALS

He said people with bulbar have nasal speech and I have had a bad sinus problem since this thing started. I always have running nose,always coughing or clearing my throat.

He also said that in bulbar your tongue shrinks and you can whistle or your tongue is so small that it can't touch outside of your lip.

In your opinion after everything we have discussed should or can I rule out ALS completely?

Does a EMG on tongue hurt? Also do they have an EMG for thorat. I feel like my face muscles are rearly stiff and tense

Thank you for your help

Thank you for getting back.
I am very impressed with your neurologist and he has done a thorough clinical examination. This has ruled out ALS, and I agree with his opinion.
I think you need not go for another EMG.
I usually include needle study of tongue and chin muscles in my EMG, however, since you do not have any features of ALS, you can wait for that.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Dr. Sudhir Kumar
Category: Pediatric Neurologist
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
Dr. Sudhir Kumar and 4 other Medical Specialists are ready to help you

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