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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
Category: Neurology
Satisfied Customers: 52042
Experience:  Medical Doctor Trained at a Top Academic Institution
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41 Year old male, athletic. Run anywhere from 3-5 miles 4

Customer Question

41 Year old male, athletic. Run anywhere from 3-5 miles 4 times per week at a 7:30-8:00 pace.
Been experiencing nervousness/stress/anxiety for approximately 4 months, off and on. Nothing specific that I can pin point, more just general (which I've experienced off/on most my life).
About six weeks ago, noticed muscle twitching in left bicep and right tricep, off and on during the day/evening after working out. Gradually fading a day or two after workout. Didn't pay much mind to it until 4 weeks ago, when my left bicep went crazy after shoveling dirt one day and working out the next. It twitched the following day off/on and all through the night, waking me up. The next morning, I of course went to google and found a story of an ALS patient who described his first symptom as a bicep twitch. From there, I've been in absolute hell.
The bicep subsided in a few days. I hit it hard a week later and no twitch. However for whatever reason I wouldn't let it go and stumbled onto the fact that calves twitch too. Being a more consistent runner, I of course couldn't help but check my calves. This was 12 days go.
Each of them exhibits minor fasciculations (small quick indents/twitches). Primarily on the right calf, but also the left. They fire up and down from right below the knee to the upper ankle. Worse after running, but there for 12 days now. There are times when I'll literally sit and time them to see the frequency and at times in the afternoon nothing is noted over 5 minutes or so. But they can be felt.
I must admit the sensation is minor, and they're not firing all over the place like crazy, but they do twitch (maybe once every few minutes).
I'm basically scared as hell having read all the ALS stuff it seems everyone succumbs to when they notice these things. But the anxiety now has overtaken and I can't shake it. The worry is robbing me of enjoying time with our 3 1/2 year old little girl and my wife at home.
Submitted: 4 months ago.
Category: Neurology
Expert:  Dr. Phil, MD replied 4 months ago.

Thanks for this question

A muscle twitch is very different from a fasciculation

are you sure it is a fasciculation?

Customer: replied 4 months ago.
Small little muscle twitches on my calf muscles. Maybe 1-2" in length. Make small indentations. Not the entire muscle itself, just small portions. Would a twitch not be the entire muscle? I thought there were only two types, fascinations and fibrillations.
Expert:  Dr. Phil, MD replied 4 months ago.

A fasciculation is like a worm under the skin

I think this is a muscle twitch

But the increase in anxiety is interesting

I think you might have a thyroid disorder


that should be tested

Customer: replied 4 months ago.
Also, I had asked for a neurologist's opinion. the website had advertised a neurosurgeon named "Mark".
Expert:  Dr. Phil, MD replied 4 months ago.

I'm not sure about Mark

I don't think he is online

this question was opened to all experts

I'm an internist and quite qualified to answer

Customer: replied 4 months ago.
I'd like another opinion. Thanks
Expert:  Dr. David replied 4 months ago.

This is Dr. David

I am another expert here.

patients who have excessive anxiety symptoms often can have benign fasciculation twitching of small muscle fibers and nerves under the skin.

also dehydration, muscle exhaustion, lack of sleep, low potassium or low magnesium in your system can cause benign muscle twitching fasciculations as well.

since you exercise frequently and run, you could be low in potassium or magnesium.

drinking more fluids can help

are you getting enough sleep.

I am not worried about ALS for you. if you had ALS, you wouldn't be running 3-5 miles 4 times a week.

let me know if you have questions.

Customer: replied 4 months ago.
Thanks. The twitches themselves I can live with perfectly well. I've just managed to paint myself in a corner with the internet (stupidly). It's isolated to my calf muscles for the most part and works its way up my right leg (quad/etc) on occasion. Never, ever noticed it before until I had enough of my bicep twitching and went to the internet. It's the fear of ALS that's the problem, not the twitching symptom itself.Sleep is so/so most nights. Hydration is good (albeit I probably flood myself with too much water). Been taking magnesium supplements and eating bananas for weeks now, but little has changed their.
Expert:  Dr. David replied 4 months ago.

I see

I understand you have bad anxiety symptoms and this is making you worried.

you don't have to worry about ALS

if you had ALS, you wouldn't be running or walking.

I bet it is your anxiety symptoms causing your benign fasciculations and making you worried about ALS.

if your anxiety symptoms are bad, you may benefit from seeing a doctor or psychiatrist about medications to help decrease your anxiety symptoms

medications like hydroxyzine or buspirone can help decrease anxiety symptoms.

let me know if you have other questions.

if done for now, please leave positive rating of 3-5 stars so I can get credit for helping you today

we only get credit for helping clients after positive feedback

you can always reach me directly with "a question for Dr. David" in the medicine or oncology categories if you have other questions

here is my website if you need to reach me:

Thanks for using

Customer: replied 4 months ago.
Thanks and I don't mean disrespect, but are you a board certified neurologist or another area of specialty?It's a general blanket statement to make regarding the disease as to someone not walking, let alone being able to run. And that would be more specific to it's full presentation, no? Everything I've been centered on is early clinical presentation, specifically the fasciculations in my legs and whether that's cause for ALS concern (with no weakness to date or cramping).If the statement can generally be safely made that someone can't exert themselves to a certain level (i.e. distance running, hard exercise, etc.) with EARLY ALS presentation, that would be a measure of reassurance. But someone that can't walk or run period appears to be they would be in the later stages of the disease?That aside, yes this has put undue stress on things. But it's hard for the mind to separate the fear, particularly when you continue to see the twitches in ones legs.
Expert:  Dr. David replied 4 months ago.

I am a board certified MD trained in oncology

but I work closely with many neurologist.

and I have a lot of experience with clients online here

I have helped more than 25,000 clients here online.

ALS is a very rare condition.

even in early ALS, patients have severe weakness and can't get out of bed and can't walk or run.

you can always see a neurologist and get more testing

I bet your testing will not show any evidence of ALS.

Expert:  Dr. Phil, MD replied 4 months ago.

still need help?

Customer: replied 4 months ago.
Can you please find a neurologist who can explain why my calves look like hamsters are wrestling inside them during the evenings? I originally paid to have a board certified neurologist answer a couple questions based on the limited background I provided. I appear to be healthy, no weakness that I'm aware of. Can run anywhere from 3-5 miles at a fair pace. But having continued twitching in lower legs, primarily calf muscles. From what I've read, it's likely benign fasciculations. My anxiety surrounds it possibly being ALS (seems like everyone with muscle twitches fears this...).
Expert:  Dr. Phil, MD replied 4 months ago.
I would get an EMG to be sure. This would rule out ALS. There is no other way to be 100% sure
Expert:  Dr. Phil, MD replied 4 months ago.

Thanks for this question

Please don't forget a positive rating. I appreciate it. :)

If you have more questions, just reply.

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