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Sumanth Amperayani
Sumanth Amperayani, Board Certified MD
Category: Medical
Satisfied Customers: 6259
Experience:  Consultant Pediatrician at Kanchi Kamakoti CHILDS Trust Hospital
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I am a 36-year old female with no existing medical

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Second opinion] I am a 36-year old female with no existing medical conditions. I have been having cramp-like feelings in what feels like my whole body, but it is really most apparent in my legs and to a slightly lesser degree in my arms. Over the past few days I've had the pre-cramp feeling (similar to what menstrual cramps feel like where it's not truly a cramp but that burning inflammation feeling). Now today it has become moreso just pain, along with some twitching off and on in the affected muscles. I've been concerned about twitching previously because I've had a persistent one in my left arm (it isn't constant but has persisted on and off for over a month). I do get other random twitches in my body as well. Because of the twitching, I've also been EXTREMELY worried about ALS and now with the cramp-like feelings I am even more worried because both cramps and twitching are listed as early symptoms of ALS. I should also mention that I've been dealing with a collection of symptoms over the course of the past year that resemble something very similar to CFS, but in working with a homeopathic provider she believes it is a lyme co-infection. So I've been doing a protocol to rid my body of the lyme and I do know that many people get what's called a "herx reaction" when doing this type of detox... but I'm not sure that would include this cramp-like feeling?? Really just looking for reassurance that this does not in any way sound like ALS and some concrete reasons why.
JA: The Doctor can help. Just a couple quick questions before I transfer you. What are all your symptoms? Have you talked to a doctor about ALS?
Customer: The symptoms that resemble CFS and are off an on include: fatigue, brain fog, eye strain, dizziness, nausea, general malaise, muscle soreness, twitching, tingling hands/feet, occasional numbness in extremities, neck & jaw tightness/pain, chest pain, ringing in ears, headaches, feeling of low blood sugar, stomach bloating & pain, chills, flushed and/or itchy skin, night sweats, dry eyes, sore throat, trouble sleeping, and anxiety. I've had lots of blood work done - all normal, a CT of my chest, abdomen and pelvis - normal. I've had two separate MRI's with one being done very recently - normal. I discussed ALS with my doctor recently when I was having the twitching and he didn't feel that any testing was needed since I didn't have weakness. But not that I have these cramp-like feelings I'm nervous again because I've seen articles about people who start out with cramps and twitching...
JA: What did you discuss at your last visit to the doctor?
Customer: Approximately 2 weeks ago I discussed my concern about the twitching for which he did a quick strength test which was normal, and then ordered my most recent MRI of my brain and cervical spine to be sure there wasn't anything going on there. A small bulge at C5-6 was found on the MRI, nothing else concerning. There was no nerve impingement.
JA: Anything else in your medical history you think the Doctor should know?
Customer: Not that I can think of!

Hi...Welcome to Just Answer. I am Dr. Sumanth Amperayani and I am here to help you today. I have 14 years of experience in the field of Medicine at a tertiary care referral hospital. I will do my level best to alleviate your health concern. I am currently reviewing your question. I will be back in a moment to guide you further.

If you see a premium phone call request I suggest you ignore it - as the premium request of phone call was a system generated prompt and was not initiated by me. I would be glad to continue here please.

Kind regards - Dr. Sumanth Amperayani

Hello... I understand your concern.

I need some more information please.

1. What is the total duration of symptoms?
2. Are you experiencing any weakness of the arms or legs?
3. Are you having any awkward limb movements?
4. Is there any trouble in speaking or swallowing?
5. Since how long have you had this muscle twitching?
6. Are you frequently tripping and falling?
7. Are you experiencing any sudden mood changes?
8. Is there any family history of neurodegenerative disease or ALS?
9. When was your last calcium and Vitamin D levels checked?
10. Are you currently on any regular medications or supplements?

Please get back to me with the above information so that I can guide you better.

Kind regards - Dr Sumanth Amperayani
Customer: replied 21 days ago.
1. The twitching has been on and off for almost a year, but with more regularity in my left arm specifically about a month ago; the cramping has been on and off the the past couple weeks - possibly related to a herx reaction from the lyme protocol I'm currently doing
2. No noticeable weakness
3. No - just some stiffness from pain, but movement is still functional
4. No
5. See #1
6. No
7. No - just anxiety over these health issues
8. No
9. Pretty recently - I was taking a Vitamin D supplement for a while and then stopped because it had reached a good level
10. No medications, but lots of supplements. Besides the lyme protocol (not sure if you're familiar with this as it is more homeopathic, but it is the Biocidin protocol)... I am take a multivitamin daily, magnesium, and fish oil.
Hello...thank you for getting back with the requested necessary information please.

From you symptom analysis and correlating it with the history that I have gathered from you I feel that the possibilities are -

1. Vitamin D and calcium and magnesium deficiency. (Unlikely as you have already got it checked).

2. Idiopathic twitching.

3.Benign Fasciculation Syndrome.

Benign fasciculations are common. Despite the favorable prognosis of benign fasciculation syndrome (BFS), patients are often anxious about their symptoms. In a recent study published in 2018 - it was quoted that - BFS is a benign disorder that usually persists over time. Commonly associated symptoms include subjective weakness, sensory symptoms, and cramps. BFS is usually not associated with pathologic anxiety.

I suggest you take OTC vitamin D and calcium supplement for a week.

Need not be worried about any serious neurological issues please.

I sincerely hope that I have helped you, and that I have earned my 5 star rating today! Please remember to rate my service by selecting the 5 stars at the top of the screen (this is the only way we professionals get credited for our time and professional effort). We can continue here until you are satisfied, simply use the reply box and let me know.
A bonus is highly appreciated....Thank you!".
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Kind regards - Dr. Sumanth Amperayani
Customer: replied 21 days ago.
So you do not feel the muscle pain and cramping indicate early ALS at all? To be clear, I have not actually had the painful cramps where my muscle contracts... just the inflamed feeling (like a pre-cramp feeling). I would also say I occasionally have perceived weakness but have monitored it more closely lately and feel it is really fatigue versus true weakness. Another way of putting it is that there isn't anything I used to be able to do that I cannot currently, if that helps.
This again goes 100% against ALS please.
Customer: replied 21 days ago.
Are you familiar with herx reaction? Could that be a culprit here??
Jarisch-herxheimer reaction is familiar...but I haven't come across any patient who has presented like this please.
Customer: replied 20 days ago.
Tonight I noticed I was having a little shortness of breath... Probably due to anxiety but of course it got me worried if that too could be a potential ALS symptom?? I know it is, but most of what I've seen indicates it would be later as the disease progresses. But could it be an early symptom???
You can be 100% rest assured that this is not at all a symptom of ALS.
It can never be an early symptom.

Is there anything else where I can be of assistance to you in this regard please?

If I have attended your query to your satisfaction please do remember to rate our interaction with a 5 star rating so that I can get my professional credit.

This is the only way we professionals get credited for our time and effort.

Best regards - Dr Sumanth Amperayani

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I am happy that my interaction was helpful for you and put your mind at ease. In future you can opt me as your favorite medical expert so that you can ask me a question directly. I will be happy to help anytime.

Kind regards - Dr Sumanth Amperayani