Chapter Text
Amyotrophic lateral sclerosis (ALS): often referred to as "Lou Gehrig's Disease," is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. In other words, as motor neurons degenerate, they can no longer send impulses to the muscle fibers that normally result in muscle movement. When muscles no longer receive the messages from the motor neurons that they require to function, the muscles begin to atrophy. There is not yet a definite cure.
It started with a twitch. A small twitch that couldn’t have been interpreted as harmful in any way. They had trained hard, so a muscle twitch was natural, welcoming even. So when Toph, the greatest earthbender alive, felt that small but seemingly insignificant muscle twitch, she merely shrugged it off and proceeded to lift another boulder as her workout. But as she was moving it, her eyes widened as she felt a massive cramp on her shoulders, and unwillingly, her arms felt to her sides as the boulder was mere inches away from crushing Sokka, the nonbending water tribe member. He jumped at the near death attempt and proceeded to glare at the small girl, momentarily forgetting that she was blind.
“Oi, Toph! Look where you’re dropping that thing!” Sokka yelled, and though Toph was still trying to process what was happening to her, she couldn’t just leave Sokka hanging.
“I would if I could see, Sokka!” She retorted, waving her hand in front of her face while clearing showing Sokka her milky grey eyes. She heard him hesitate with his next few words bitten back, and she laughed heartily, putting her hands on her stomach. But even then, she felt as if her arms wouldn’t cooperate with her.
Something was wrong. Terribly wrong.
Not that she would say anything about it. She was strong. It was surely nothing.
She didn’t know how wrong she was.
A few days after the incident, Toph woke up and tried flailing her arms like a madman, just as she had done for the other past days. She then sighed in relief as her muscles seemed to work normally. She stretched and then checked once more to see if her arms were fine and to her relief, they were. She put her feet on the ground and got ready to stand up when her foot connected with a small pebble and she felt herself falling to the ground.
“Wha –” Toph began to say as she fell to the floor. A loud bang sounded and she felt people running towards her room.
“Toph, are you ok?” Katara, a waterbending master and sister to Sokka, asked worriedly as she tried to help Toph up. She declined vehemently while shaking Katara’s hand away from her. And at that moment, she felt another muscle twitch and her arm, which she was using to deflect Katara’s helping hand, droped to her side, just like last time.
“I’m fine. Leave me alone!” Toph yelled as she tried lifting her arms once more to push Katara away. She was sure that they were thinking of her as weak.
“What’s going on? Did Appa finally eat Momo?” Sokka’s tired voice came from the door and gave a big yawn.
“Nothing’s going on. Just go and leave me alone. I’ll be out in a second.” Toph said and mentally pleaded them to leave. For a moment, there was a thick silence that felt impenetrable but then, Aang spoke up.
“Are you sure, Toph? You’re not one to suddenly trip.” He said and she shrugged, which for some reason, was as difficult as lifting her arms.
“I’m blind, twinkle toes. Even blind people trip.” She responded and though she couldn’t see, she knew that Aang, as well as the others, were blushing in embarrassment.
“Ok then, Toph. We’ll meet you outside. Sokka, it’s your turn to cook. And don’t you dare eat all the meat again!” Katara scolded as Sokka started to vehemently protest that he did not, in fact, eat all the meat and that it was all Momo’s doing. Their voices started to fade and Toph waited until she couldn’t feel the vibrations of their feet to sigh and let some of her tears fall to the ground.
What was happening to her?
“So, Master Toph, how about we have an earthbending battle?” Aang suggested once they were done with eating breakfast. Toph smirked and pointed her chopsticks to where Aang was at.
“What are you sounding confident for, twinkle toes? Who’s the master here? You’re a thousand years too early to be beating me!” She answered confidently and she felt Aang jumping up and down in excitement.
“Yes! Let’s start right away!”
“Hold it! You are not leaving until you finish cleaning the dishes. It’s your turn.” Katara intercepted and both Aang and Toph groaned.
“Can’t you do the dishes for us this time, Katara? I promise to do them next time.” Aang begged.
“Sure, just like the last two weeks when you said the exact same thing.” Katara snorted. “Dishes. Now.” She then ordered and Aang mumbled how this felt more like a mother-son relationship than a lover-lover one.
“Better hurry it up, twinkle toes, or I’m going to find something more fun than you!” Toph commented and Aang ran to clean the dirty plates.
“Hey, Toph, do you have a minute?” Katara asked as she walked closer to Toph. She stiffened but nodded and they started to walk away from their friends. When they were alone, Katara turned to Toph and gently placed her hand on Toph’s shoulder. She stiffened once more.
“Toph, are you ok?” She asked and Toph just nodded.
“I’m fine.” Toph answered simply, yet she couldn’t help but turn her head the other way in hopes that Katara wouldn’t see her eyes.
“Toph, this morning was unnatural. It looked like you couldn’t even lift your arms.”
“I’m fine! When did you become my mom?” Toph exploded and started walking away from Katara, angry more at herself than anyone else. And then she tripped once more, leaving her planted on the ground.
“Toph!” Katara shouted and ran over to her.
“I’m fine!” Toph yelled, trying to get the waterbender away from her. She didn’t want Katara to see her like this.
“You’re not! This is exactly what happened in the morning, Toph! I need to know what’s wrong so I can help you!”
“I’m fine, Katara! Why can’t you just leave me alone? I’m a human being, too! I can trip, just like other people! Stop thinking that’s something’s happening to me because nothing is!” She shouted as she tried to get back on her feet.
“Toph? Katara? What’s going on?” Toph heard Aang asking as she felt footsteps grow closer. “Toph, why are you on the ground?”
“She –” Katara tried to explain but Toph cut her off.
“I tripped. That’s all.” She said and with the strength she could muster, she stood up. “Come on, twinkle toes. You’re done with the dishes, right? Let’s go.” She said as she grabbed Aang’s wrist and started to drag him away from Katara.
“Hey, Katara, what’s wrong?” Sokka asked with a mouth full of jerky as he looked at his sister’s concerned face.
“Sokka, there’s something wrong with Toph. I can feel it.”
“She fell a few times. So what? I do that all the time.” He shrugged.
“No, you don’t understand. She’s having trouble lifting her arms up as well. And she never had that kind of problem.”
“Could be because she hadn’t stretched.”
“And it’s not only that, Sokka. I can’t confirm it but I could feel something wrong. Her muscles are growing weaker. It’s like they’re wasting away.” At that, Sokka finally looked at Katara with seriousness.
“What do you mean?” He asked, his tone different from usual.
“I don’t know. I could confirm this easier if she would just allow me to help her, but she won’t let me do that. There can’t be something wrong with her, right?” Katara asked as her eyes grew panicked.
“Katara, it’s going to be fine. This is Toph we’re talking about.” Just as Sokka finished his sentence did they hear a loud crash. They looked at each other once before running as fast as they could to the origin of the sound. When they finally embarked on the scene, their eyes grew wide.
“Aang, are you ok?” Katara rushed to Aang, whose leg was currently crushed under a boulder.
“Yeah, I’m fine but my leg kind of feels numb.” Aang said while rubbing the back of his neck and smiling at the waterbender.
“Toph, what is wrong with you? Why would you crush Aang like that?” Sokka reprimanded at the blind girl without a second thought. Said girl was not listening to Sokka but was currently in a state of shock.
“Sokka, stop!” Katara then said as she realized that Sokka was in the midst of a rant. He stopped briefly to give his sister an annoyed look when he realized that she was pointing somewhere. Sokka reluctantly looked to where she was pointing at and the next angry remarks died in his throat as he saw Toph’s hands shaking violently.
“Ah, Toph, I’m sor –” Sokka tried to apologize but Toph paid no heed as she started to run away as fast as she could, away from the catastrophic scene.
“Toph!” Katara and Aang yelled together and Katara was about to follow her when Sokka stopped her.
“Let’s get Aang out of here first. We can follow Toph later.” Sokka said and Katara nodded solemnly.
“It’s ok. I can just move the boulder. You guys go first. I’ll be right behind you.” Aang spoke.
“But your leg’s going to be pretty messed up. You’re going to need some support.” Katara explained and Aang shook his head.
“It’s fine. Just go. I don’t know what’s going on with Toph but I know it’s bad. Katara, you could feel it too, couldn’t you? Toph’s muscles.” Aang looked at her and she nodded, both with worried faces. “Go. I’ll be right behind you, ok?” And with that, Katara grabbed Sokka’s hand and they started to run after the master earthbender.
During the same time, Toph was constantly tripping while running away from the group. She didn’t know what was going on. She was lost, so lost.
Her muscles were twitching all over the place and she could fell her legs grow weaker with every step. Even the smallest pebble could make her trip, and sometimes, it was just thin air that did the trick.
She had no idea what was happening to her. She could feel her breath shorten with every step and that scared her immensely. Her knees finally gave out on her and she fell to the ground painfully. She huffed to get some air into her system but even moving her mouth seemed strenuous.
Why was her body reacting like this? Why wasn’t it working properly? What did she do wrong?
“Toph? Are you there?” A female voice rang out and she stiffened.
“Katara, check the left side. Aang, keep going forward. I’ll go right. Yell if any of you guys find her.” Sokka’s voice ordered and it was followed with a yes from both Aang and Katara.
Toph tried to stand up once more to avoid the people looking for her but her legs wouldn’t respond to her demands. She had no choice but stay put until one of her friends found her. And one did.
“Toph, you’re alright!” Aang exclaimed as he maneuvered his way with his air ball to Toph. She, instead of answering him, just buried her head in her legs.
“Toph?” Aang asked uncertainly as he placed his uninjured foot on the ground.
“Go away twinkle toes. I’m not in the mood.” Toph said, her words muffled.
“Toph, we can help you, you know that, right? We’re your friends. We can help you.” Aang started to say but she buried her head even further.
“I don’t want to talk about it.” She responded.
“Toph –”
“Aang, did you find her? Is she ok?” Katara interrupted as she and Sokka ran to her.
“She’s…” Aang trailed off and as he looked at Toph, he sighed and shook his head.
“I don’t know if she’s ok or not. Toph, we have to check. Please let Katara heal you. Please.” Aang begged but Toph shook her head.
“I don’t need any healing.” She gritted as she finally lifted her head. “I’m fine.”
“You’re obviously not, Toph. Please let me check. We’re all worried about you.” Katara urged but Toph glared at the waterbender.
“I’m fine.” She emphasized and tried to stand up to show that everyone was alright. But her legs just wouldn’t cooperate. She ended up falling down to the ground once more.
“Toph, please. We just want to confirm that you are, in fact, ok. Everyone is worried sick.” Sokka tried to convince but Toph wouldn’t budge. Just as an earthbender should, she was as stubborn as a bull.
“Are you guys deaf of something? I said I’m fine. How many times do I have to say it to get you guys to understand? I. Am. Fine.” She enunciated each word and the group all gave each other worried glances.
“Toph?” Sokka started to ask slowly. Toph turned her head and gave him a glare.
“What now?”
“Your words… They just slurred.” He provided and at that moment, Toph realized that her mouth did feel a lot heavier than normal. Her mouth didn’t seem to cooperate with her.
“Toph, please let me check on you. These things, they’re not normal at all.” Katara said with worry entangling her every word. And though Toph was scared out of her mind and would like nothing more than to have Katara hold her gently and tell that it would all be ok, she still held her ground, as an earthbender should have.
“Why can’t you guys…” She started to retort once more but the sentence was left untold as her mouth drooped, very much like her arms, leaving her unable to finish.
“Toph, that’s it. I’m taking you back and checking on you.” Katara finalized. “Sokka, carry her. Aang, you’re coming, too. I need to heal your leg.”
“My leg is not the first priority to deal with.” Aang huffed but nevertheless, he leaned against Katara to keep his injured leg off the ground.
“I – I’m… F –Fine.” Toph tried to say as confidently as she could but she felt Sokka shake his head.
“Not with that kind of slur, you’re not. Toph, we’re worried sick. Let Katara do this.” His reasoning, though having no support of evidence, seemed so tempting and Toph was close to agreeing, but she knew that if she did agree, it would have been the same as admitting she was weak.
She was not one to give up so easily.
“Sokka, let me go.” Toph said with much concentration, trying to get her mouth to cooperate with her. “Sokka, I’m not kidding. Let me go.”
“Nope, I ain’t letting you go. Not like this.” He answered and Toph huffed.
“You asked for it.” She mumbled and before Sokka knew it, he was hit on the head with a rock. He was stunned for a moment and a moment was all that Toph needed. She jumped out of Sokka’s arms and stood up, concentrating hard to keep her legs upright.
“Toph!” Aang and Katara yelled as they trailed behind, moving slower because Katara had to support Aang’s weight, and that was Toph’s cue to leave. She plunged herself into the ground and came back up with makeshift lumps of dirt to make her go faster.
“Wait!” The group yelled but Toph paid them no heed. She just wanted to be alone, she wanted to figure this out for herself.
And it failed as quickly as it came. Her legs gave out on her once more and this time, she felt head smash to the ground, leaving her unconscious.
When she awoke, she felt her body in a soft bed, one that must have been made by sheep’s fur or Appa’s. It was blissful, laying on such a comfortable bed and she wished the dream would never end.
Except it did.
With whispers surrounding her ears.
“Katara, how is she?” Aang asked. Katara stayed silent.
“Katara…?” Sokka hesitantly asked and Katara sighed.
“I don’t know. There was nothing to heal. Physically, her body is in perfect health. But I know something’s wrong. There’s something that’s blocking her muscles from acting properly. I’ve never experienced this before in my life.” She explained. There was silence before Aang broke it.
“What should we do then?” He asked concern lacing his words.
“This is out of my expertise. I think we need to go get professional help.” Katara answered.
“Wait, you mean –” Sokka started to ask and was cut off by Katara.
“Yeah, I think we need to go to the Northern Water Tribe.”
“Master Pakku?” Aang supplied.
“You think we really need to go there? I mean, it’s too far and Zuko and Sukki aren’t even here with us yet.” Sokka reasoned.
“Sokka, if we don’t do something now, who knows what will happen to Toph? Aren’t you worried for her?” Katara retorted angrily.
“Of course I am! I’m just saying, maybe it’s not as bad as you think it is. Maybe it’s just an age thing. Maybe it’s going to go away. We can’t make such hasty decisions!” Sokka yelled and soon enough, it was an all-out war with the two siblings.
“We have to go Sokka! You don’t know what I felt when I was checking. It was something I’ve never felt before and it’s bad, ok? We need to go.”
“You’re thinking to quickly about this, Katara! We’re in a remote island, for crying out loud! The North Pole is thousands of miles away and what if Toph gets better while going there? We’d just be tiring Appa out!”
“Are you saying that you’d just risk Toph’s health because you ‘think’ it’s going to go away?” Katara roared.
“Guys…” Aang tried to interrupt but the fire between the two was too great.
“Stop twisting my words around! This is always like you, Katara! Not listening to reasonable arguments and just going about it on your own!”
“I’m not twisting anything around! What I stated is true! You just don’t want to help Toph, do you? That’s it, isn’t it? You’re always annoyed by her sarcastic remarks that you just can’t take it anymore. That’s why, isn’t it?”
“Katara…” Sokka replied hurtfully, just like the time she had accused him of not loving their mother.
“We are going to the North Pole and that’s final.” Katara finished and started walking away. The conversation ended like that and Toph couldn’t help but make a strangled noise. All three of the members immediately ran towards her, asking her all kinds of questions, but she didn’t answer any of them.
She was just so frustrated. With everything.
She didn’t know what was going on.
But it scared her.
And that’s what frustrated her the most.
Early Stage
- Muscles may be weak and soft or stiff, tight and spastic.
- Muscle cramping and twitching (fasciculations) occurs, as does loss of muscle bulk (atrophy)
- Symptoms may be limited to a single body region or mild symptoms may affect more than one region.
- The person may experience fatigue, poor balance, slurred words, a weak grip, tripping when walking or other minor symptoms.