I first noticed twitches in my right calf muscle. I could both see and feel them. Over the next week the fasciculations developed in both legs, and I became increasingly worried. The suspicion of an anterior horn cell disease began to form, particularly as I have a close relative with an undiagnosed progressive disorder affecting those very cells. My concern was not without a basis.
I (slowly) convinced myself of the potential diagnosis of motor neurone disease. I had a heightened awareness of my fasciculations, combined with a growing conviction that my motor fitness was failing. My sleep and work started to be affected. I approached my colleague, with subsequent examination and referral. The neurologist made a thorough assessment and requested neurophysiology. The evening before my investigation, I considered, with my wife, the huge implications of a diagnosis of motor neurone disease and how our lives might radically change. Shortly into my neurophysiological assessment, normally recruiting muscles confirmed a diagnosis of benign fasciculations.
I had been spared, so it felt, and I could consider my experience in the light of a benign diagnosis. Fortunately, I was assessed and investigated within a short time with, most importantly, a reassuring outcome. Worry and patience cannot be easy bedfellows for patients having to wait for results. I now appreciate their anxieties even more. And what of my failing motor fitness? The ability of the mind to distort reality, when it is consumed with worry, is quite revealing.
The prospect of a degenerative process, during which I would lose motor control and independence, horrified me and has reinforced my empathy for those who must travel that road. We should not underestimate the level of fear with which our patients may approach us and how it might affect their presentation of symptoms. How someone faces his or her uncertain future with strength, stoicism, and often good cheer poses a personal question that, as yet, I cannot answer.