Help! Neurologist thinks probable MND/ALS

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5
Hello... desperate here.

My mother became ill with what was eventually diagnosed as CFS around 7.5 years ago at age 69. Fatigue, flu like feeling, sleep problems, unrefreshing rest etc main issues.

Condition remained stable overall for 7 years (with some weeks or months being worse, and feeling worse after too much activity). All seems to fit with CFS.

Last year, coinciding with a very traumatic period (my father being taken very poorly, 6 weeks in a hospital that was an hour's round trip travel to visit, diagnosed terminally ill late June) my mother's health took a turn for the worse. Very stressed and upset of course, plus voice gradually starting to get hoarse, overwhelming fatigue, muscle weakness particularly in legs. Numerous 'falls' (more crumpling to the ground really - she knew her legs were giving way). Mobility became more restricted by the week and independence lost.

Due to her care needs (unable to get herself out of bed to get to commode by herself etc) she entered a care home for respite. Unfortunately her condition continued to deteriorate, particularly her voice which has now completely gone and she didn't move from bed.

New GP who attends care home was concerned and ordered a neurological MRI to check for anything else.

Before that came around she was rushed to hospital last weekend with breathing issues which have been identified as a small amount of fluid on her left lung - query malignancy or aspiration - at the moment thought more likely the latter. Would make sense as

Doctor concerned about her overall condition and has involved neurologist who thinks she has a degenerative neurological disorder i.e. ALS/MND due to a) complete loss of voice b) swallowing issues, tongue weakness (today she was assessed as not safe to eat/drink by mouth and tube feeding commenced) c) overall weakness (with all these having rapidly deteriorated) and also d) fasciculation in arm and e) strong reflexes.

Neurological MRI has been done now and appears normal - though MND would not be identified through it. EMG and nerve conduction tests booked for early next week.

Mother is now 76 years of age.

I am desperate, clearly I don't want it to be MND or similar with the awful prognosis.

I may well be clutching at straws but I have read that a) to d) above can be severe CFS symptoms. Doctors also say such a rapid deterioration is not CFS. As I said, the deterioration occurred during very high stress levels, my mother was badly affected by my dad's terminal diagnosis.

Advice please... am I trying to unrealistically find hope? Or is there anything in my lay-person's research?

The idea of losing both my parents at the same time is beyond impossible to comprehend.
 

Jyoti

Senior Member
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3,443
How terrifically frightening for you and for your mom. Do remember that doctors certainly don't know everything and they are not always right. My thought--try not to freak out too much, at least until next week's tests are back. I know--that much easier said than done.

But it won't change anything, so if you can find ways to just be with your mom, help her stay as hopeful as possible, it might help you not to go down those scary paths that I think we all know and rarely if ever take us anywhere helpful.

Obviously I know nothing, but I cannot count the times since I got this illness that it looked exactly like I had an array of malignancies, heart failure, etc. All sorts of awfulness that were 'just'ME messing with all my systems.

In other words, you don't know. So hard though it is, try not to surrender to the siren song of fear. Plenty of time to do that later if it is truly warranted.

And this--I am super sorry. It is so not fair.
 

Pearshaped

Senior Member
Messages
583
Im so sorry for you and your parents.
Maybe it helps to research ALS.

It is so hard to tell since every CFS patient is different..
but in general I'd say CFS,even when getting much worse is still often fluctuating,meaning some symptoms wax and wane in severety.(but this is just from my own experience)

And when you wrote she has fluid in her lungs... sounds more like it is not CFS.

I hope you'll find answers and hang in there.All the best fir you and especially your mother.
 

andyguitar

Senior Member
Messages
6,888
Location
South east England
breathing issues which have been identified as a small amount of fluid on her left lung - query malignancy or aspiration - at the moment thought more likely the latter.
Yes it is the most likely as she has a problem swallowing.
I may well be clutching at straws but I have read that a) to d) above can be severe CFS symptoms.
Yes they can be.
Doctors also say such a rapid deterioration is not CFS.
They are wrong. Rapid worsening of CFS symptoms does happen. I hope the EMG rules out MND. If your mum has not been able to eat/drink much recently then the tube feeding should improve her health. And also lessens the risk of aspiration. Keep us all up to date on her progress. Good luck to you both.
 

minimus

Senior Member
Messages
140
Location
New York, NY
It is a bit surprising to me that a neurologist would mention a possible diagnosis of MND/ALS to you before running the requisite tests, an EMG and a nerve conduction study. For what it's worth, my experience is that the vast majority of "mainstream" doctors understand nothing about ME/CFS and have no idea how severe it can be. I think at least a few members of this forum have gone through similar fire drills, where doctors speculated that a MND/ALS might be the cause of their muscle dysfunction and/or atrophy.

I myself was in a somewhat similar situation to your mother at the start of last year. I was referred to a well-regarded neurologist in New York by my primary care doctor after a skin biopsy came back positive for small fiber neuropathy. At my office consult with the neurologist, I thought he would propose treatments for this neuropathy. I provided my medical history and explained that I was experiencing a progressive worsening of my ability to walk due to muscle fatigue/leadenness, along with occasional muscle cramps and fasciculations (twitches). I noted to the neurologist that I had a long history of vocal hoarseness.

The neurologist told me that he didn't think ME/CFS or small fiber neuropathy could result in the severe symptoms I was experiencing, and that he thought a neuromuscular disease was the more likely cause of my symptoms. He mentioned Kennedy disease as a possibility, which is a slowly progressive version of ALS, though I suspect ALS was also on his radar since the two diseases are clinically similar to each other.

A few weeks later, the neurologist did an EMG and nerve conduction study. Both were entirely "normal" -- i.e. no signs of upper or lower motor neuron dysfunction. At that point, he said his hunch about a neuromuscular disease was wrong, that there wasn't anything he could do for me, and that I should return to my primary care doctor for further testing and symptom management.

Around this time, I had an email exchange with Paul Cheney, a doctor who has treated thousands of ME/CFS patients since the mid-1980s in the US. He said he has never had an ME/CFS patient who was later diagnosed with ALS or even Parkinson's, that muscle dysfunction is extremely common among patients, and the dysfunction often worsens as the patient ages.

I guess my bottom line is to wait for your mom to have the requisite EMG/NCS testing. Hopefully, it will come back negative. Mostly, I am sorry about your mom's suffering, as well as about your worries on her behalf. I hope that your fears are unwarranted and that your mom's condition stabilizes and then improves.
 
Messages
5
Thank you all so, so much for replying to me.

I have barely known a week so traumatic.

My mother had a full CT scan yesterday to check for malignancy due to the (apparently fairly small) amount of fluid on her lung. The scan has come back clear, which is a big relief of course, although I don't think there was a high degree of suspicion of malignancy. As her swallow was poor and she was eating in a fairly reclined position I think the conclusion is that it is infection or aspiration. She is on antibiotics.

Monday is the EMG/nerve conduction test work. This will involve her being transferred to a different hospital for tests and returned to the original hospital later. I know this will be exhausting for her. She is already struggling as the hospital ward she is on is an elderly ward and some of the other patients have dementia and there is no chance of peace and quiet. Thankfully they were moving her to a different bay this evening which they said would be quieter.

I do have my concerns about the neurologist's knowledge of CFS but didn't know if my concerns had any substance to them. I now feel that there is a possibility his initial thoughts are wrong, although I don't want to become too hopeful in case we do get an ALS/MND diagnosis and I get more upset again - I struggle with anxiety.

I can only hope we can get through the weekend emotionally intact. I will keep you up to date and would welcome any other thoughts on this situation.

Thank you again for taking the time to post.
 
Messages
5
Sorry to say bulbar onset MND has been confirmed today and my mother has a very limited lifespan now.

I'm heartbroken.
 

Jyoti

Senior Member
Messages
3,443
I am so very, very sorry to hear this. I wish there was more to say or do, but do know that I am holding both you and your mother in my heart right now, the grief and the travail and the love that you have for one another.
 
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