Back after a long hiatus. Hoffman's. Questions for TwitchDoc

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Back after a long hiatus. Hoffman's. Questions for TwitchDoc

Postby Arkansan on March 30th, 2017, 5:00 pm

So I was really doing better with my fear of a certain disease I shall not name. My health anxiety was still a problem, but I moved on to other diseases.

Recently I've fallen back into old patterns, I'm worried about ALS again.

About a year ago I started worrying about my swallowing. When I swallow I frequently feel like I have air go down with the liquid. Sometimes with solids I feel like there is still food on the back of my tongue. I also frequently have a full sensation in the back of my throat, not related to eating it's just there. I can almost always feel my food go down as well.

The other day I noticed a nearly perfectly circular red spot on my tongue, fairly small, but noticeable. In that spot its red and it looks like the little hair like things on the tongue are smaller there. I freaked out and convinced my self it's atrophy of the tongue. Does this sound like atrophy? I can get a picture if needed.

Now I'm in a full blown ALS panic. Just a few minutes ago I tested my self for a hoffmans sign. On my left had my index finger will occasionally give a small downward or upward twitch when testing. Twice it has give a brief series of up and down twitches that were quite fast and very slight in movement. The thumb seems to stay perfectly still. On my right hand my ring finger will twitch down slightly and sometimes my index finger will. Again the thumb stays still on this hand as well.

Now I'm fairly sure that I have had that happen before to some degree with the hoffman testing I did on myself in the past, last year, because I recall being relieved when I read that the thumb should be involved as well for it to truly fit the criteria. I'm scared because one side seems more consistent than the other and I read that a unilateral hoffman is bad news.

The swallowing issues scare me but they first started a year ago and don't seem noticeably worse and it seems like they may have even receded some at points. If it matters on the swallowing stuff I have terrible sinus issues and at the moment my throat is red, mucousy and itchy. I also have untreated acid reflux for years and years.

Twitchy Doc I was hoping to get your opinion because you're a doctor. Though I would be happy to hear from anyone.
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Re: Back after a long hiatus. Hoffman's. Questions for Twitc

Postby TwitchyDoc on March 31st, 2017, 2:19 am

Red spot is certainly not atrophy. Atrophied tongue is wrinkled, with "crevices" or dimples...and you would see a great deal of fasciculations was it caused by lower motor neuron dysfunction.

What you describe might be simply reflux related, get it checked by your ENT to see what is the finding on your larynx. Phlegm is common with GERD.

Hoffman sign matters when it is complete, i.e. there is a movement of the thumb. Anyway, even in that case it might be caused by an issue in cervical spine.
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Re: Back after a long hiatus. Hoffman's. Questions for Twitc

Postby Arkansan on March 31st, 2017, 9:08 am

TwitchyDoc wrote:Red spot is certainly not atrophy. Atrophied tongue is wrinkled, with "crevices" or dimples...and you would see a great deal of fasciculations was it caused by lower motor neuron dysfunction.

What you describe might be simply reflux related, get it checked by your ENT to see what is the finding on your larynx. Phlegm is common with GERD.

Hoffman sign matters when it is complete, i.e. there is a movement of the thumb. Anyway, even in that case it might be caused by an issue in cervical spine.


Thanks for answering. Yeah the whole tongue thing is weird. the area is noticeably different in color and the papillae in that spot are smaller than the rest of the tongue. I do have tongue twitches, but have had them for at least a year now. Though it's hard for me to tell how "real" my tongue twitches are because it's very difficult for me to get my tongue still.

I went to an ENT a few years ago, but they only really looked at my sinuses, which they said had a badly deviated septum and signs of chronic inflammation. The thing that really scares me is that I have choked on liquid twice in the past 6 months, once in October I choked so bad that I vomited, then the other day I had a more minor episode where it felt like some air got caught up in my drink and I could feel the bubble burst as I swallowed it. Though I wouldn't think two episodes in 6 months would be much to worry about right?

On the Hoffman sign it is very odd as well. Sometimes I can test it ten times in a row and have absolutely nothing, other times I will get a slight twitch of just the index finger. Other times when I test it there will be just a slight twitch of the thumb but no other finger moves. Interestingly when other people test it on me it consistently does nothing at all. The left hand is more reactive than the right, but even then sometimes it just does nothing at all. For instance this morning repeated testing and neither hand does anything at all.
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Re: Back after a long hiatus. Hoffman's. Questions for Twitc

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