Trou­bling twitches are likely be­nign

Cape Breton Post - - ADVICE/GAMES - Keith Roach Dr. Roach re­grets he is un­able to an­swer in­di­vid­ual letters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Email ques­tions to ToYourGoodHealth@ med.cor­ or re­quest an or­der form of avail­able health news­let­ters at 628 Virgin

DEAR DR. ROACH: I have a 53-year-old daugh­ter who is trou­bled by mus­cle twitches. They oc­cur on var­i­ous parts of her body, some last­ing for sev­eral min­utes, and oth­ers much longer. No pain is as­so­ci­ated with th­ese mys­te­ri­ous twitches, but re­cently their fre­quency seems to be in­creas­ing, along with the sever­ity.

She has seen sev­eral neu­rol­o­gists and in­ternists, and had nu­mer­ous tests, and no­body has made a di­ag­no­sis. My daugh­ter is re­lieved that noth­ing se­ri­ous has been dis­cov­ered, but is quite ner­vous that the prob­lem per­sists. Do you have any thoughts or sug­ges­tions? -- Anon.

AN­SWER: I have pub­lished col­umns re­cently on de­gen­er­a­tive neu­ro­log­i­cal dis­eases, and many of them in­clude mus­cle twitches, or “fas­ci­c­u­la­tions,” in med­i­cal jar­gon. It is per­fectly un­der­stand­able to be wor­ried about th­ese, es­pe­cially when they seem to be long-last­ing or wors­en­ing. Up to 70 per­cent of peo­ple get mus­cle twitches from time to time, but there is a sub­set of those peo­ple -- and it sounds like your daugh­ter is in this group -- whose symp­toms are sig­nif­i­cantly more se­vere.

How­ever, in my role as a gen­eral in­ternist, the vast ma­jor­ity of peo­ple I see with this con­cern do not have any iden­ti­fi­able dis­ease. In this case, the term “be­nign fas­ci­c­u­la­tions” is used, even if it doesn’t seem so be­nign to the per­son suf­fer­ing with them.

A care­ful his­tory and exam usu­ally is enough to con­firm the be­nign na­ture of the per­son’s con­di­tion. Some­times an EMG (elec­tromyo­g­ra­phy) test is per­formed, just to be sure. If the EMG is also nor­mal, the risk of a se­ri­ous con­di­tion is just about zero.

DEAR DR. ROACH: I am a 66-year-old fe­male in great health. I was di­ag­nosed with atrial fib­ril­la­tion about eight years ago. I don’t feel like I have a-fib of­ten, or an in­tense case of it. I have been tak­ing dil­ti­azem with an as­pirin daily. Al­though, over the past three months I have been try­ing to wean my­self from the dil­ti­azem and have been tak­ing it ev­ery other day in­stead.

My doc­tor is en­cour­ag­ing me to go on blood thin­ners, which he knows I do not want to do. What is your opin­ion on blood thin­ners and their side ef­fects? There are so many peo­ple be­ing di­ag­nosed with a-fib th­ese days, with many dif­fer­ent paths to fol­low with med­i­ca­tions. I don’t like tak­ing med­i­ca­tions, be­cause the side ef­fects are some­times worse. I don’t take meds for any other med­i­cal is­sues at this time. It seems doc­tors don’t agree on how to treat a-fib. -- K.N.

AN­SWER: It may seem that doc­tors don’t agree how best to treat a-fib, but one rea­son for that is that ev­ery­one has his or her own in­di­vid­ual risks. The de­ci­sion of whether to use an­ti­co­ag­u­lants in a per­son with atrial fib­ril­la­tion thus needs to be in­di­vid­u­al­ized, and most ex­perts use a scale called the CHA2DS2-VASc score to eval­u­ate an in­di­vid­ual’s risk.

Your score is at least 2, and in a study us­ing peo­ple with a score of 2 or higher, an­ti­co­ag­u­la­tion had more ben­e­fit than risk, so I would agree with your doc­tor’s rec­om­men­da­tion to use an an­ti­co­ag­u­lant, such as war­farin, or one of the newer agents (which have the ben­e­fit of not need­ing pe­ri­odic blood tests).

I have men­tioned be­fore that there are al­ter­na­tives to an­ti­co­ag­u­la­tion. I dis­cussed the WATCHMAN, a left atrial ap­pendage oc­clu­sion de­vice, in a pre­vi­ous col­umn. For peo­ple who re­ally don’t want to be (or can’t be) on an an­ti­co­ag­u­lant, it is worth con­sid­er­ing.

The book­let on ab­nor­mal heart rhythms ex­plains atrial fib­ril­la­tion and the more com­mon heart rhythm dis­tur­bances in greater de­tail. Read­ers can ob­tain a copy by writ­ing: Dr. Roach, Book No. 107, 628 Vir­ginia Dr., Or­lando, FL 32803 En­close a check or money or­der (no cash) for $4.75 U.S./$6. Can. with the re­cip­i­ent’s printed name and ad­dress. Please al­low four weeks for de­liv­ery.

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