Neurological Issue?

Ask your medical question here. *
I keep getting "twitches" in various parts of my body. I mean tiny flutters of muscle contractions. No real pain or even discomfort and they last about 1 - 3 seconds, with intervals of anywhere from 2 minutes to 2 hours. Then I may go a few days with nothing. But it has been going on for months and it seems to be moving around my body. Upper lip for 2 weeks, inner ear for 3 days (most annoying it it like someone doing a soft drum-roll in your ear), eyelash for a day, scalp for 1 week, a different part of the scalp for another week, right hand for 5 days, etc. Just kinda weird. What is it? Anything to be concerned about? Especially since it seems to cover my whole body, but just 1 location at a time.
Gender *	Male
How old are you? *	27
WHEN DID THIS PROBLEM START? *	Wednesday, June 1, 2011
Check all symptoms you are currently experiencing *	Neurological
Describe associated symptoms not listed above	You may also use this area to further explain symptoms checked above.
What have you done so far to remedy this condition? Please include tests and relevant studies here.	Nothing
Check all that apply to you or your immediate family (parents, siblings, grandparents)	Cancer History of Back Pain Psychiatric Disorders
Please list any medication allergies that you have : *	Please do not list any medicines you merely dislike. True allergies produce hives and other symptoms. An upset stomach is not an allergy to a medicine. Thanks!
Please list any medications you are currently taking (and dosage if known) :	Also, please tell us if there is medicine you are supposed to be taking but are not. Thanks!
When was your last menstrual cycle? *	I'm a man, baby!
Are you currently using or do you have a history of tobacco use?	No
Are you currently using or do you have a history of illegal drug use?	No
Please describe your alcohol consumption :	Rarely
HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED? *	Within the next few days
So that we can serve you best, please try to tell us your top three things you wish to be addressed in our response. You will likely get more than you ask for, but we wish to understand your priorities. ---------------------------------------------------------------------------------- Well, pardon the strange format here but we are working on a new way to answer questions and we will figure it out.  Sir, the condition you are talking about is most likely MYOCLONUS, and you can read about by clicking on the link preceding.   As you can see, this condition, if I am correct about what you have based on this history alone, is almost always benign and rarely is a sign of a central neurological disorder.  Multpile sclerosis can have different neurological symptoms over time but muscle twitching and jerking, especially the very short acting bouts you seem to be having, is NOT typical for Multiple sclerosis.  However, if your symptoms persists or worsen over the period of the next few months getting in with a Neurologist would be a good idea. I don't think you need to do that now. The rest of your history, your age, and your problem do not lead me to think of any dread diagnosis. Thanks for your question and please come back anytime.	Do I have some whole body problem, disguised as local tremors? Is this something I need to worry about now? Is this some thing that will get worse over time

A Multi-part Surgical Question

Dear Doctor,

For about 6 months I have had shooting pain down my left leg - it happens about 5 times a day but it REALLY hurts.  An xray or mri or something like that showed one of my lower vertabaes is somewhat shifted, the word the surgeon used was something like "sponge hello less he says". Any way we tried a spinal injection to block the pain and i wore a Boston brace for a while. Now the doctor is recommending surgery to fuse my spine.  I hate the idea of surgery, it seems so life threatening. So I have a question.

Is there any way to find out the historical risks of surgery - including the risks from  a specific doctor?  I mean can I find actual statistics about  1) Surgery in general, 2) different types of surgeries (these must be in some database somewhere right)? AND 3) Statistics about a specific hosptial or doctors track record (at least how many people have died during his surgieries)?  Are these records even kept, and if they are are they kept secret by hospitals?

Oh 1 more question, if that is ok.  If I DONT get surgery, and decide that the pain is better than the risk, am I doing damage - so that the pain will just get worse and worse?

Thank so much for the blog

Gary

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ANSWER TO FOLLOW SHORTLY  DOC1


Okay, Gary,

I will be answering this in parts as I am torn between the yard that needs to be cleaned up, the NCAA football on tv all day, and my desire to help you.

First, "sponge hello less he says".... This can only be something called SPONDYLOLISTHESIS.... if you click on the link you can read all about it from the NIH,  but it is as you describe, a slipping forward on one vertebra on the one below. It is usually a result of trauma but can also be something you were born with. Either way, instability in the supporting elements of the spine allow for the slippage, and if the slip becomes big enough many more problems occur.

I am not surprised that the shots did not help. They are a temporizing measure at best, in other words, they can buy you some time in advance of surgery with some amount of pain relief, but they are not curative.

And for the moment I am going to end with this to return to your more complicated questions in a bit.... Not to make light of your situation but the surgery for this is routinely performed, and, in fact, you happen to be talking with someone who has actually HAD the surgery, usually a fusion procedure. And, perhaps if you could email me your specific concerns about the surgery being life-threatening then I could address them, but with the state of the science of anesthesia and the techniques now employed by spine surgeons I would not look at this surgery as any more risky than an appendix surgery.

I have much more to ad but hopefully this is a good start for you. Back in a bit.

Doc1

Good morning Gary. I thought the above image would be instructive. As you can see, the defect that allows for the slippage of the vertebrae is in the posterior portion of the spine.

Spine surgeon have a grading system for this defect but it is less important than the symptoms and pain you are having. That alone does indicate that the surgery is probably the way to go, and, as you can see from the reference above, fusion surgery provides great results and relief of pain in 95% of patients. I am in that 95%.

As to your question regarding the historical risks of surgery, again, I would ask for some clarification. If we are going to include surgery performed back in the early part of the 20th century to our database then we will get a decidedly different result than if we use, say, the last ten years. This being said, I'm not sure if these statistics are available, though I will certainly check.

And I have now checked! The thought struck me to search for 'intraoperative mortality in the United States'. The bottom line is this... by far and away the most common cause of death in the operating room is cardiac arrrest.... heart attack, and so while I could not find statistics for TOTAL intraoperative mortality, I did find it for cardiac arrest, and you can view it here. The number is about 4 in Ten-thousand surgeries. I hope that is reassuring to you, and if you are healthy going into the surgery your risks are much lower than this.

As to your question regarding specific surgeons there IS a way to find out what patients think about their doctors and surgeons, I just don't know how accurate and valuable the information is. There are websites like Health Grades.com where you can search for particular doctors or surgeons, or search for a particular TYPE of physician or surgeon in your area.

And for the moment, the one thing I DO know you can do regarding malpractice claims, inquiries to the Medical Board in the state where you physician practices will not get you information about specific problems with specific surgeries, but WILL get you information on your surgeon's track record regarding malpractice.

Gary, I am going to try to finish this up a little later, hopefully this has been helpful so far.

Doc1

Smiling Bob

Hey Docs, 

I'm pretty sure I know the answer to this, but is therre any evidence at all that the 'male enhancement' products on the market work at all to increase penis size?

Sheepish in Virginia

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Dear Sheepish,

No need to be sheepish, but you are correct. "Enzyte", "Longinexx" (love that name) and the like are complete scams and the amazing thing is that people actually pay for them. But don't take my word for it, let's check in with the Mayo Clinic. And think of it this way, if they did work, then all of us would have large penises. That WOULD be interesting because we would then actually learn if size matters, but we are as God made us.

Best,

Doc1

Cat Bite

Hey Docs,

I was at a friends and got but by her cat. I ended up in the ER the next day with a bad infection and they took an X Ray of my hand. I didn't say anything at the time but now I'm wondering if I got ripped off? Why do an X Ray?

Just Curious,
Ben in Portland, ME


Hey Ben,

Great question. Cat bites, as you discovered, are very dirty bites and often get infected. One of the WORST things that can happen is for the cat to break a tooth off under your skin. This is why they did the X Ray... To look for a cat tooth in the wound. Evidently you didn't have one or they would have had to get it out and that can be an unholy mess, but you DID NOT get ripped off. You got good care.

Hope you have fully recovered.

Doc1

An APP for healthy choices

Hi Doc1,

I was reading your blog today and wonder you could give me an opinion
on a diet/fitness app I'm making right now ?

For me, I think the problem with being healthy is motivation. It's an
abstract, overwhelming goal. I think the best way to counter this is
to have concrete, winnable games and small victories.

So, this app will makes living healthy, and fitness into a RPG game,
where users earn points, and "level up' as they achieve their goals.
Everytime they eat something healthy like vegetables, they earn
points. Everytime they complete a workout, they earn points. Each
level will present different challenges.

The challenges will follow a certain structure. First will come
changing your environment such as getting rid of junk food. Then,
reducing stress, as stress leads to eating comfort food. Then concrete
goals like keeping track of everything you eat, or taking the stairs
for a week. Small, concrete goals rather than abstract ones like "be
healthy" or "exercise more".

The whole point is to create a holistic framework/game so people will
rely less on willpower, and more on fun, achievement, and changing our
environment.

What's your opinion on this idea? Would you want to know when I'm done
with it? If this sounds too silly, or absurd, just ignore what I just
said, hehe =)

Best,
Christine

Hi Christine, Doc 2 here. That is a GREAT idea. There are tons of health and fitness apps out there for this thing or that thing. One of the most popular that I see and sometimes use in my weight loss practice is "MyFitnessPal" and the "C25K" (aka Couch to 5K). However, I don't think that there is one with a roll-playing game approach. That would be VERY cool. When I was in medical training, I lost weight because I was in a competition with a patient who was a newly-diagnosed diabetic. The camaraderie and competition that we had in the process gave us BOTH benefit. Perhaps a mode of partnering or grouping people together (just like in an RPG) for a common goal is ALSO something to think about. I personally think that this is a GREAT idea.

I would be interested in collaborating with you on such a project if you are game for it. (No pun intended.) Think about it and get back with me.

-Doc 2

Post Mortem Question

A friend of mine just died in a car crash. It was a terrible crash and evidently not survivable under any circumstance. The cause of death was confusing to us, 'uncal herniation causing respiratory arrest'. What does this mean?

 

Jim S.

Phoenix

 

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Jim, so sorry about your friend. An 'uncal herniation' is merely describing a situation in the head where pressure builds up, usually from bleeding (in the case of trauma), and this pressure forces the brainstem down into the formen magnum, and when this happens our brains can no longer instruct the lungs/ diaphragms to breathe, so breathing stops and the person dies. THIS link is a pretty good one to describe this process in more detail. Again, so sorry to hear about your friend. 

Doc 1

Plantar Fasciitis and its Consequences (pending question)

I was diagnosed with Plantar fasciitis June 2010. The doctor gave me some excersises to do and then said stay off of it as much as possible. So I spent the summer not really over stressing my foot and doing the excersises. 

 

I'm a teacher and school started in September and I'm back on my feet and it's still sore. Sore enough that it takes me a while to get down the stairs in the middle of the night to get to the bathroom. Again this summer I didn't do much walking or over excert myself but I kept busy. 

 

So now I'm gaining weight because I'm trying to keep the foot from getting worse. So this September after all summer of being a slouch (again more or less) I got back on the treadmill and am running again. but it really really agravates the foot. I can't keep babying this foot it's been long enough so I just run through the pain. The first ten minutes are pretty painful and then it smooths out. But when I sit later it's very, very stiff. I'm told theres nothing else to do for this other than Aleve.  I can't take Aleve every day it upsets my stomach.

 

I own the treadmill and can't afford a gym membership. We also have a great bike trail nearby and I bike that as well but it doesn't tone like running does. Is there anything else I can do and why doesn't this get better? I would think after a year and a half it should have improved somewhat.  Am I missing something? I'm a 55 year old woman who is about 30 lbs overweight which I can get off but just need to be active. I have no other illnesses. It may sound trivial and not dramatic enough for your blog but it's really starting to get to me. 

 

Thanks for your input.

Renee

 

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Dear Renee, 

 

Doc1 here, and this is a great question. I think my friend Doc2 can add some to this but you have clearly failed to improve with the conventional therapy for plantar fasciitis. 

 

In my current practice I see tons of young folks with this problem. Recently I learned that our friends in Podiatry have a new weapon against this sometimes debilitating problem and it is borrowed from the Urologists. It's called ECSWT (extra corporeal shock wave therapy), and uses focused sound waves to promote healing of the inflammation in the plantar fascia. 

 

This therapy, by report from patients of mine who have had it, can be dramatic and curative. So, I would recommend seeing a Podiatrist to see if this might be an option for you 

 

Also, a more traditional therapy which DOES work but can only be done once or twice is injection of steroids into the plantar (bottom) surface of the foot. 

 

In any case, take a good look at the Mayo Clinic link I sent and look how many options for treatment there are. There is hope and there's more to do for you. Time to step up the treatment regimen. 

 

Will let Doc2 weigh in (no pun intended) on the weight issue. 

 

Thanks!