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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 6077
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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Scared I may have ALS please help..

Resolved Question:

Scared I may have ALS please help..
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Z replied 1 year ago.

Dr. Z :

Hello I believe I can help you with your concern

Dr. Z :

I am so sorry to hear about your current fear that you may have ALS, may I ask why do you think this?

Customer:

Let me start from the beginning I have been an anxiety sufferer since I was a teenager. I was on Paroxetine and have stopped taking it now for over 3 months. I have for the last 3 years felt twitching like a golf ball bouncing under my skin on my left abdomen mainly when relaxing. Lately I have been feeling this every night for the last 3 weeks and now for the last 2 days have been experiencing twitching all over, face, legs, arms, neck, back etc. Dont know what to make of it and its really scarring me.

Dr. Z :

Okay, may I ask you did you stop the Paroxetine abruptly or did you wean/taper off the medication?

Customer:

I cut my dose down by taking one every other day for a week then 1 every 3 days until i stopped completely.

Dr. Z :

Well that is very fast to discontinue that medication as discontinuing so fast can cause SSRI discontinuation syndrome which is exactly what you are describing too.

Dr. Z :

It sounds like this is anxiety, or possible rebound anxiety from going off the Paxil

Customer:

Im trying to get this damn ALS out of mind but cant. What can I do..

Dr. Z :

I would recommend two things for you, one would be the use of Cognitive Behavioral Therapy (CBT) as this is the most effective and evidence based treatment for anxiety. CBT has a premise that your symptoms are caused by negative thoughts, so if we change your thought process to be more positive and objective as well, then your symptoms will lessen.

Dr. Z :

Well this is called health anxiety you are having and CBT can "cure" this..

Dr. Z :

Also the use of some medications can help too, but the medications only lessen the symptoms and do not cure you

Dr. Z :

So this link may help you, it contains a technique I use with patients called a thought record. It will help you keep track of any negative thoughts you have. You put the trigger for your health anxiety, the emotion intensity and the intensity of the negative thought associated with that health anxiety trigger. Then you put down how you responded (e.g. panic attack, obsessive compulsive behavior, etc…), what would be an alternative and more rational response to this health anxiety trigger. And then you re-rate your original negative belief.

Dr. Z :

This is an example of what CBT will do for you to change your thought process away from this ALS thinking, although it appears unlikely that you have ALS.

Dr. Z :

If you wanted to though you could go to a neurologist and get a nerve conduction test to rule it out

Customer:

My primary doctor put me on Escitalopam 10MG.

Dr. Z :

That is a very good medication, more effective than Paroxetine

Dr. Z :

But you need the CBT therapy too

Customer:

How long before it starts kicking in?

Dr. Z :

Would you like me to show you some good techniques and books that can help too

Customer:

sure.

Dr. Z :

2-3 weeks where you will see the benefits and 6-8 weeks for the maximum benefits.

Customer:

Are my symptoms related to that of ALS?

Dr. Z :

I doubt it because they came on when you went off the Paroxetine and you have a history of anxiety too. Also at 38 it is rare to have ALS, unless you have a family history of this disease.

Dr. Z :

In addition, these three worksheets are very good at helping lessen anxiety symptoms. It can help you focus on the big picture and the objective/positive thoughts and outcomes.

Dr. Z :

Also individuals with severe anxiety have a poor coping mechanism, so this worksheet will help you develop a better coping strategy to manage your symptoms better.

Dr. Z :

Also these books can help too

Dr. Z :

You may also want to try adding a benzodiazepine (Ativan, Xanax, Klonopin) with the Escitalopram too.

Customer:

Yes but I had the stomach twitches even when I was on it. It started over 2 years ago and now are amplified..

Dr. Z :

Yeah but ALS is very fast so two years with symptoms is unheard of

Dr. Z :

Most likely these are psychosomatic issues you are having related to your anxiety

Customer:

How fast and what other symptoms would show?

Dr. Z :

Well muscle weakness and loss of muscle mass/bulk too

Customer:

Ok so tell me how you would rule out ALS right now.

Dr. Z :

Well I am not a neurologist, so you would not go to me for ALS. But I would ask about family history, length of symptoms (the mean survival rate I believe is 3-5 years), muscle loss or weakness, difficulty swith speech, loss of sensation in extremeties especially the arm, and then the results of the nerve conduction test too

Dr. Z :

Also difficultly breathing and swallowing as well

Customer:

Well I have only the twitching right now and dont feel any of the other symptoms.

Dr. Z :

Yeah I think this is anxiety, and twitching is a very common somatic symptom of anxiety.I suggest asking for the benzodiazepine to help with your anxiety and also to look into the CBT therapy with a qualified therapist

Dr. Z :

If you like I can recommend some therapists in your area

Customer:

I also feel some muscle pain in my arms as of yesterday..

Dr. Z :

It would be weakness and loss of sensation, not pain if it was ALS

Dr. Z :

ALS is causing a degeneration in your nervous system, so if you feel pain then that means the nerves are working

Dr. Z :

So most likely you do not have ALS

Customer:

What do experience first with ALS I heard twitching

Customer:

I am so stuck on this ALS it is making me sick..

Dr. Z :

Again I am not a neurologist, but the twitching is first then comes the weakness in your extremities. Then you will have weakness in your arms and legs, difficulty breathing and swallowing, then you will be unable to walk or move your arms, then it just gets worse from there

Dr. Z :

I know you are stuck on the ALS, but I believe that this is health anxiety and seeing a CBT therapist will be best for you

Customer:

I also was doing push ups, sit ups, curls today to test my strength and it was normal.

Dr. Z :

Then you are physically fine

Dr. Z :

Try going to a few therapy sessions and wait for the Escitalopram to kick in too

Customer:

Just not mentally..

Dr. Z :

Anxiety can be very debilitating, but with CBT it has a high success rate to cure it

Customer:

What is CBT?

Dr. Z :

Cognitive Behavioral Therapy, that was links to the techniques and books I typed in above in the chat earlier

Customer:

Have you ever dealt with case's like mine?

Dr. Z :

Yes I have, for a variety of illnesses

Dr. Z :

The CBT is the most effective treatment out there for this level of anxiety

Customer:

Your saying that twitching is mostly a cause of anxiety?

Dr. Z :

Yes I believe so

Customer:

Does the twitching go away?

Dr. Z :

Yes it will go away once your anxiety lessens, it just takes time for the treatment to work so you must be patient with it

Customer:

Have you ever heard of the twitching in the abdomen?

Dr. Z :

Yes I have heard of it, and this is a psychosomatic symptom from the anxiety. It will go away with the treatment and the medication your doctor prescribed for anxiety as well

Customer:

I hope your are right..

Dr. Z :

I think you are going to be just fine, the anxiety will lessen for you with the right treatment and so will these thoughts

Customer:

Have also been under a lot of stress lately with a new job I started 2 weeks ago

Dr. Z :

And stress/anxiety go hand in hand and that can express it self with those somatic symptoms

Customer:

How rare is it for a person to have ALS under 40?

Customer:

Sometimes I dont feel stress or anxious but still feel the twitching..

Dr. Z :

Well again I am not a neurologist, but I thought it was 10-15 percent of cases before 40

Dr. Z :

Also your doctor also believes this is anxiety as well because of the prescription of Escitalopram

Customer:

Yes and he did not want to refer the neurologist when I asked

Dr. Z :

Because your symptoms fit anxiety more and I agree

Customer:

Why do I feel the twitching when I am not feeling anxious?

Dr. Z :

Somatic symptoms occur to help you cope with the anxiety, so you may have felt anxious on a subconscious level

Customer:

Well I appreciate the help. I think you are right but as always we tend to self diagnose ourselves and come across ALS.

Dr. Z :

I understand and I think you are going to fine with these CBT techniques and the medication. I wish you the best of luck with everything and I hope these somatic symptoms go away soon. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime. Before you sign off though, I would very much appreciate if you could rate my performance in helping you so that I can get credit for this question. Thank you very much

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 6077
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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Dr. Z
Dr. Z
Psychologist
5457 Satisfied Customers
Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.