OpenHealth Q&A

Chronic Fasciculations, Discomfort, Sleep Disruption, and Unexplained Weight Loss

Greetings, I am a 35-year-old male weighing 150 pounds. Starting in March, I began experiencing widespread muscle fasciculations along with intermittent tingling sensations in both my hands and feet. A visit to an urgent care facility left me quite alarmed when a physician’s assistant suggested the possibility of ALS. Subsequently, I consulted with a neuromuscular specialist who conducted an EMG test; while it confirmed the presence of fasciculations, it indicated no signs of active denervation, alleviating my fears of ALS—thankfully, my neurological examination was normal, leading the specialist to recommend a follow-up in six months. Around the same period, I unexpectedly started waking up five or more times each night, facing severe sleep disturbances that I had never dealt with before. Moreover, my hamstrings and calves have been uncomfortably tight, making movement feel painful, as if they are stretched excessively or contain tiny, sharp shards. Walking has become quite painful. I do not have a history of injury. By April, I began to experience discomfort in my forearms, elbows, shoulders, and neck, on both sides of my body, again with no injury history. Initially, the pain was tolerable, but it progressively worsened over the following months, forcing me to miss work several times. A sports medicine evaluation identified calcific tendonitis in my right rotator cuff, along with tennis elbow and radial tunnel syndrome in both arms. Although my left shoulder exhibits similar symptoms, it was not imaged. The tingling in my hands persists, and the intensity of pain in my elbows, shoulders, and neck is severe enough to disrupt my sleep, often waking me up. The discomfort often manifests as a deep, burning sensation, with episodes of palpable muscle pain alongside frequent joint discomfort. Additionally, I have experienced a significant weight loss of nearly 25 pounds since March. I initially attributed a 10-pound drop between March and April to heightened anxiety affecting my appetite. However, my anxiety has since been better managed, and without making any dietary changes, I have reduced my weight from 175 pounds in March to 150 pounds currently. The muscle fasciculations continue to persist. A three-month follow-up with my neurologist revealed no changes and yielded another reassuring neurological examination; my EMG follow-up is scheduled for September. Current Medications: - Propranolol 80 mg extended-release for headaches - Pantoprazole 40 mg for GERD - Duloxetine 60 mg for anxiety and depression, recently initiated in June. Medical History: - Hemicrania continua - Hiatal hernia with Schatzki rings and esophageal dysmotility - PTSD related to military service and COVID-related emergency nursing. Laboratory Tests: - CBC: Within normal limits (WNL) in March - Chemistry panel: WNL in March - TSH: WNL twice - Lyme disease test: negative in July - Calcium level: WNL in March - Magnesium level: WNL in March - ANA: **180 homogeneous** in July - RF Factor: negative in July - Anti dsDNA: WNL in July Additional Notes: I have experienced a somewhat unusual number of calcific conditions, but I am uncertain of what is typical. My medical history includes bilateral tibial calcific tendonitis and likely issues with my left rotator cuff, along with calcium deposits in the shaft of my penis. When these conditions arise, my doctor typically dismisses them as non-concerning, yet I am beginning to wonder if there is a more significant underlying issue at play. Moreover, I am a veteran of the Iraq war, with exposure to burn pits. I appreciate your attention to this matter!

Answers (1)

8/3/2025, 3:11:13 AM

OpenHealth AI

Thank you for providing detailed information about your symptoms and medical history. It sounds like you are experiencing a challenging combination of issues, including muscle fasciculations, pain, sleep disturbances, and significant weight loss. Your anxiety and military background also add to the complexity of your situation.

Key Points:

1. Ongoing Symptoms: You have persistent muscle fasciculations, significant discomfort, sleep issues, and noticeable weight loss.
2. Medical Evaluations: You have consulted specialists, undergone EMG tests, and received diagnoses for multiple conditions, yet there are lingering concerns about potential systemic issues, particularly given your previous exposure to burn pits.

Explanation:

The combination of muscle fasciculations, pain, and sleep disruption with unexplained weight loss warrants careful consideration. Although you have been reassured regarding ALS and have negative tests for other conditions like Lyme disease, your chronic pain, muscle issues, and particular findings (like the elevated ANA) suggest that a broader scope of investigation might be beneficial. It's crucial to explore both physical and psychological aspects, as stress can amplify many physical symptoms.

Next Steps:

1. Monitor Weight and Symptoms: Keep a weekly record of your weight and any changes in symptoms. This will help track patterns and provide valuable information for future consultations.

2. Address Sleep Hygiene: Create a peaceful bedtime routine aimed at improving sleep quality. This includes:

   • Limiting screens an hour before bed
   • Keeping your sleep environment dark and cool
   • Trying relaxation techniques like deep breathing or gentle stretching before sleep.

3. Nutrition Review: Ensure that you're consuming balanced meals to support your body during this time. If appetite remains an issue, consider high-calorie snacks or small, frequent meals to help stabilize weight.

4. Pain Management Techniques:

   • Engage in gentle physical therapy or stretching exercises to improve mobility and pain from tendonitis.
   • Consider heat or cold packs on painful areas to alleviate discomfort.
   • Discuss with your healthcare provider about possibly adjusting your pain management medication, as stronger medication might provide more relief if approved for your condition.

5. Follow-Up with a Rheumatologist: Given the high ANA and the unusual calcification issues, a visit to a rheumatologist could provide insights into potential autoimmune conditions or metabolic issues that might explain your symptoms, especially in light of military exposure risks.

6. Mental Health Support: Continue addressing anxiety and PTSD with mental health professionals. It may be beneficial to explore therapy options like cognitive-behavioral therapy (CBT) to help manage stress and its physical manifestations.

Support and Further Actions:

You are not alone in navigating this complex situation. Keeping an open line of communication with your healthcare providers, and advocating for further investigation into your symptoms, is essential. If your symptoms worsen or you experience new troubling symptoms (e.g., extreme fatigue, severe joint issues, or neurological changes), do not hesitate to seek care more urgently.

Feel free to update me on your progress or if you have further questions. Take care!