Bob Hilton--any thoughts?

[CoachFred]

Thanks in advance for any thoughts. I'm a 44 year old male in good health otherwise. Symptoms started about 2 mo ago with mild exercise intolerance, fatigue & low back pain. After a few weeks, I saw my FP, & had normal blood count, ESR, electrolytes, Ca, Mg, UA, BUN, creat, FT4/TSH, L spine xrays. Back pain is gone, but mild fatigue persists. A month ago I noticed

[NURSELPN]

CoachFred.

I'm wondering if you had your thyroid labs tested? You would need a TSH, free T-3, & free T-4. Then perhaps a TSI (for Graves disease) if indicated. You hadn't mentioned it & I just wondered. Fatigue, insomnia, & tremor are symptoms of hyperthyroidism also.

It was probably already checked but many physicans only check the TSH & sometimes the diagnosis can be missed that way. Mine was.

Best Wishes, TJ

[BobbHilton]

So, its not only you  get the symptoms when you are lowering your extremities but also on extending them as well as when the arereaching thier targes (intentional)!!
But the neurologist still said the exam was normal? and no comment on a proximal type " They seem to involve the biceps, shoulder girdle muscles, as well as the trunk "  postural tremor/kinetic? Even the EMG did not show what we call "the fundamental abnormal motor unit entrainment and a specific rate of 4 to 12 Hz?"  do you have the report?
   A brief about essential tremor, though its reported to begin in the upper extremities in up to 90-95% but thats only in the hand +/- forearm some time (distal muscles) while the trunk is the presentation in ~5%.(few other parts of the body could begin with tremor).
    If that was the case then we accept the diagnosis of essential tremor  
  (mainly the postural tremor even if intention tremor or some difficulties with tandom walking)
    But you are describing a proximal tremor (though even the EMG did not show it ) then the possibilities are
1- Unusual presentation of essential tremor
2- Wilson disease ( though  u r > 40 ,but some books screen up to 50)
3-cerebellar outflow trem
4- fragile X  syndrome
5- Cerebellar tremor .
Number 3 and 5 are seen with MS.
The lab investigations, or the neuro-imaging will only be asked for if your examination and the EMG had shown any abnormalities

   Hope this is helpful
  
     Bob Hilton

[CoachFred]

Bob,
Thanks so much for your thoughts. MCV was 83. I cross country ski and cycle also, but haven't had any neck or arm injuries to speak of. I've fallen a few times skiing, but haven't had any injuries. I had a mildly elevated CPK with my initial lab work (275), but that was a day after exercise. With 3 days of rest, that dropped to 155. The arm "tremors" (muscle shaking) are noticeable with daily activities, such as shaving, reaching for the phone, unloading dishwasher, etc. They seem to involve the biceps, shoulder girdle muscles, as well as the trunk (I notice them when doing sit-ups). I'm not saying it isn't mechanical, but it doesn't feel mechanical. Although the strength is there (I can hold arms at shoulder height for greater than 2min), it seems like I get the symptoms when I'm simply extending or lowering my extremities. I have a bit of aching in my shoulders too. I've thought some about an unusual presentation of MS, essential (kinetic) tremor, or a cervical spine abnormality.  Any additional thoughts?  

[BobbHilton]

You are welcome,
   From the name and the running 5 miles X 3/a week, I could say, that part of your problem is a sport related neurologic injury..will come to that later!
   The fatigue is a generalized symptome and as long as you have some thing to chase you should  follow it , I'm talking about
1-The Low normal level B12 plus any other side effect of prilosec..so MMA and homocystine level should have or should be done, and if you say normal blood count (what was the MCV?)
2- The insomnia (could be called that if you cant start or stay asleep) which should be investigated by a sleep study

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