EMG help please.

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MYWILLOW

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HERE I AM
I have had 3 EMG/NCS done, two on my feet and legs, and recently one on my upper extreamities.
The testing on my legs showed an axonal neuropathy, the first test done around 09/2011 did not show andything on the EMG part. He was mainly checking for neuropathy.
The second one on my legs was 01/2012, it too showed axonal neuropathy, but what a difference between docs. This was suppose to be a specialist, but he didn't act special to me. He stuck the needle in my thigh asked me to push my knee into the table as hard as I could, and I did, as hard as I could. He told me to push repeatedly, then after awhile he pushed my knee into that table... He did something similar with my foot, only this time he was loudly telling me to relax my foot, and I was as far as I knew. He ended up slapping the top of my foot. Because of this, and the fact I think he didn't want to believe something is wrong (I seem very healthy from outward appearance), the results were never recorded, what a waste of time.

The tird test done 06/2012 was on my upper extremities. This showed NCS shanges with nerves tested, nothing huge. The EMG:

Complex motor unit potentials with fasiculations bilaterally, hands and forearms. He said it was complex, no clear electromyographic evidence of anything, may be axonal but not entirely consistent with that.

Dorsal Interossei, Abductor Pollicis Brevis, and Extensor Digitorum on both hand/forearms have fasics, polyphasic ativity, and increased MUP amplitude and Duration.

So, any ideas, cause I've seen a lot of docs over the years, and I think most of them thought I was complaining for no reason. This thing is spreading, and nobody knows what is going on.
 
What have your dr's told you about their findings? I am not an expert but what you describe is not consistent with ALS. When you say the results were never recorded what do you mean by that? These are not like xrays were you can print a picture.

What makes you suspect ALS and why do you not trust the multiple Dr's you have seen?
 
message Wright .He can tell you what the emg showed .The method the specialists used is common practice of a emg

Did he say you had ALS?No!

Pat
 
The second test in Jan. 2012 I had on my legs was done hastily in the middle of an appointment with a neuro specialist. He was training an intern, so she actually did most of the office visit. He came in and basically took me over to the EMG tech, and they acted like they were pretty sure nothing would come of it. The tech had the machine set to "kill" not stun, I guess again they were making sure there was more then enough juice. That was more pain then the other two put together. Well it showed a problem, so then he did the needle exam on my left leg only, and like I said, instead of recording the results (as far as I know) he was trying to manipulate them. I just thought of something, maybe he really didn't want to record anything because he was using me as a training tool. The results said axonal neuropathy, in his report, just like the first test.
This last test said " The findings are complex; there is clearly no electromyographic evidence of motor neuron disease or a myopathy. There may be an axonal neuropathy present but the needle findings are not consistent with this."
His office note said he was trying to see if the test showed a slowly progressive neuropathy, and he wrote peripheral neuropathy, rule out motor neuron disease versus myopathy. So, once again I am in limbo, because he considers it complex, and is still not sure what the heck. is going on.
I actually picked this person because he is a Physical Medicine speacialist. He does these EMG tests all over the state, and has probably seen quite a few of these, yet my case is still too weird to decipher.
All I know is that the part of the test that I quoted: the polyphasic activity is something seen in anterior horn disease and the increased amp and duration are seen in neuropathisc disorders. I keep trying to read all these textbooks on all this stuff, it's going about as slow as my diagnosis.
Do not know what I have, would like to know. I tend to post mostly in the ALS sections because the neurology sections usually have everything from seizures to vague foot pain. All I know is that something is slowly killing my nerves. This latest test says I have an totally unresponsive nerve in my left leg. He checked that one nerve based on previous findings.
 
What the tech did was not an EMG it was a NCV which is a nerve test and is typically conducted right before an EMG. Often a tech will do the NCV but only a Physician may do an EMG. If they found something wrong in the NCV that definitely points away from ALS and towards the neuropathy they mentioned to you. You are confusing the EMG with the NCV.

When you say "all I know is that the part of the test that I quoted: the polyphasic activity is something seen in anterior horn disease and the increased amp and duration are seen in neuropathisc disorders. I keep trying to read all these textbooks on all this stuff, it's going about as slow as my diagnosis" it shows that you are trying to out guess your Dr's. The test report by your own admission says axonal neuropathy and no evidence of MND.

My advice to you is have your Dr's figure out what is causing your neuropathy and get it treated. You are wasting time worrying about ALS spend your time treating what you have not trying to diagnose yourself with something you do not have. Multiple things can cause neuropathies but a computer or textbook or an idiot like me on a forum is not going to be able to tell you what is causing yours only a Dr will.

If you are not happy with your Dr get a new one, just remember we expect Dr's to be omniscient. They are not, they operate like detectives, eliminating the obvious "suspects" or in this case diagnosis first and then move down a list to less common diagnosis.

Good luck
 
Mywillow...I made a longer response but it is in moderation. Bottom line it does not appear you have ALS. You have some type of neuropathy, your Dr's need to figure out what is causing it and how to treat it.
 
Your report states you have a neuropathy and it's my guess you got that diagnosis because you have a neuropathy. The reason you didn't get a diagnosis of ALS is because there is nothing to indicate you have it.

You state that your nerve conduction study had abnormalities and those abnormalities coupled with the abnormalities of your EMG are the reasons you were diagnosed with a neuropathy. It's really that simple.

I'm not at all sure why you're second-guessing your neuro . . . a neuro that you yourself stated is well-respected. Just because your situation is "complex" doesn't mean it's something sinister. Relax and let your physicians do their job and for god's sake, stop reading those things medical when you clearly do not understand the material.

P.S. Just to give you some more peace of mind: the abnormalities in your EMG are not all of the abnormalities needed for ALS to be a viable differential. You have no active denervation and absolutely EVERY ALS patient has active denervation (unless of course the muscle has completely wasted-away). That is what the disease process is: the death of motor neurons and the subsequent denervation of muscle, followed by weakness. Again, RELAX!
 
I'm not doubting anyones diagnosis. I keep being told that I have a neuropathy, fine, but what is causing it. If it is a disorder that can be treated, then treat me.
I was told it was my thyroid, my thyroid tests have been completely normal since a few months after that was diagnosed. I was told to take vitamins because I was lacking something, but those test were within the normal. I had a glucose loading test, it barely got above 105 after drinking sugar for two and a half hours. I don't drink, litterally, if I have more than a glass or two of wine I might fall asleep. I'm not on drugs. I am not showing signs of heavy metal poison. I really don't believe something as major as your nervous system trying to cripple you happens "just because", and what else but something "sinister" is slowly making it harder for me to use my muscles.
Before 2008 a 47 year old woman climbed homemade staging on a 3 story victorian, sometimes climbing up the outside cross bracing, instead of using a ladder. This same woman lugged half bundles of shingles up a ladder to a side roof. And so on, typical farmers wife, if the horse throws a shoe the wife pulls the plow. Now, if I get down on the floor I'm lucky if I can get back up.
In 2010 It was just peripheral neuropathy, with symptoms in my legs and feet, then it hit my head, face and arms. This year is taking it's toll my hands get weaker everyday.
I want to know what it is, I don't care if it's viral HOOF N' MOUTH, just figure it out and treat it.

This last person I saw was not a neurologist, he was a Physical Medicine and Rehab professional, someone who has seen just about every combination of nerve damage in the state, and he said it was complicated. I have seen three different neurologist and have been given three different diagnoses. All of them with the famous N.O.S afterwards.
From a text on Mtor Neuron Disease
EMG findings:
Active denervation (fibrillations and positive waves)
Fasciculations
Chronic denervation (large amplitude, prolonged duration polyphasic MUAPs)
MUAPs fire with rapid rate (>10 Hz)
 
My other post hasn't appeared, so I suppose it was blocked, this one will most likely be to. Did you read what I said, or what you thought I said? The last EMG was not done by a neurologist but a Physical Medicine Specialist. He's the guy lawyers hire to prove or diprove law claims, an expert witness as it were. And I understand more than you think, new nerve damage is different from chronic:
"Damage to motor axons (either at the level of the anterior horn cell, the motor root or the peripheral nerve) results in a series of quantifiable changes in the EMG. It is noteworthy that these changes are triggered by actual disruption of the motor axon and develop in an orderly sequence that can help determine the timing of the injury...
A series of events take place in the individual, denervated muscle fibers that can be detected as abnormal electrical signals. First of all, over the period of a week or two, the denervated muscle fiber becomes progressively more mechanically irritable. Therefore, electrical discharges provoked by movement of the needle can outlast the actual movement by more than a second. This is termed “increased insertional activity.” Although this finding is not particularly specific, it does indicate that the muscle is excessively irritable. Muscle fibers also become chemically sensitive to their microenvironment and their membranes can also become unstable enough to produce spontaneously activity. This is recorded as depolarization of individual muscle fibers. The spontaneous depolarizations of the individual fibers appear as fibrillation potentials (Figure 1B) and positive sharp waves (Figure 1C). These do not occur in normal muscles since the normal muscle fibers are only responsive to the activation of their motor unit by neuromuscular transmission. Typically, it takes more than a week for such potentials to develop and they will disappear with complete degeneration of the denervated muscle fiber.. Needle EMG is very sensitive for the detection of these signals and they most often reflect denervation, although they may also occur in severe muscle disease or injury. The finding of fibrillations and positive sharp waves is the most reliable and objective test that there is for damage to motor axons to the muscle after one week at least up to 12 months after the damage. If there is ongoing damage such as in Amyotrophic Lateral Sclerosis one can see ongoing denervation. Unfortunately, the finding of fibrillations and positive sharp waves is often termed “acute denervation”, although “acute” in this case refers to weeks and months.

Reinnervation of muscle is an ongoing process, occurring whenever a muscle is partially denervated. This process typically involves the development of sprouts from adjacent, unaffected motor nerve fibers that ultimately contact at least some of the denervated muscle fibers. These reinnervated muscle fibers cluster right in the area of other, normally innervated muscle fibers. This process results in the development of clumps of reinnervated muscle fibers attached to individual motor neurons (remember, the normal motor unit innervates muscle fibers scattered throughout the muscle). Typically these motor units become significantly larger both in amplitude and duration, since the needle is likely to be recording from more muscle fibers in this clump. Also, the MUPs often become more irregular (termed “polyphasic”) (Figure 2). This process takes months to develop and indicates the presence of chronic denervation. It should be noted that the needle study is much less sensitive to the process of reinnervation than it is to the findings of fibrillations and positive sharp waves that are seen with recent denervation."

That was taken from one of the text books I don't understand. He tested my upper extremities, and found chronic denervation in muscles inerved by C8/T1. He did not find denervation in my face, and he did not do a needle exam on my legs. Therefore, even if the damage had a lbel printed on it, it does not qualify for the el escorial criteria. And, once again, I don't know what is causing this, I'm trying to find out.
 
However from what you posted about your reports it appears that you issues are being caused by some type of axonal neuropathy, which can be caused by multiple things...also it appears from your post if I am reading it correctly that many of the issues were found during the NCV by the NCV tech...I know nothing of the insurance person you are referring to but to my knowledge only physicians may do EMG's, at least that's how it is here in Georgia.

Not to be rude but if you already have the answers and have read, digested and mastered all of the info in your text books why are you seeking our opinions?
 
I don't have all the answers, I don't know everything I need to know, I, like everyone else, am looking into a community of people with first hand knowledge of serious illness. I don't even know what I have. If read carefully what I stated was that even a MD is finding this situation complex. He is the first one honest enough to print that.(yes he is a doctor, who specialty is physical medicine and rehab.)
Yes, I have an axonal neuropathy, it is evident with the findings in the NCS on my legs, however he did my arms, and he said may be axonal neuropathy but needle exam is not consistent with this. So basically, I have a chronic neuropathy affecting everything. I am searching groups like this because the people in them communicate with each other, right, and perhaps, maybe some of what I list as my complaint trigger a memory of another time and place that leads me in a good direction.
Instead I get a reply, where it is obvious the person read my post, saw a meaning I did not intend, and proceeded to tell me I was trying to second guess my doctor and that I should stop trying to understand what is happening by reading text books because I am clearly not intelligent enough to understand them.
By the way, I would like to apologize for all my typos. I also have intention tremors in my hands that are getting worse, I noticed at work that I was typing strangely, and when my neuro told me about the type Of tremor I was developing it seemed to make sense.
I am not trying to cause any trouble for this community, I am just searching for answers, that is all. I am not trying to convince myself I have ALS or any other disorder, what I have is chronic denervation, and that won't change with a diagnosis. But, a diagnosis might be able to stop what I have from progressing.
 
We are not do ct ors. We can not give you any me dical op inio ns outside of our limited knowledge of NCV/EMG fin dings regarding ALS and ALS only. The one do ct or who kindly participates in this forum has already given his opinion and I doubt he will answer again no matter how much you persist with po sting.

Since you clearly state you agree it's not ALS, and that you don't want it to be ALS, you need to get off this fo rum and seek answers elsewhere. I get that you are VERY frustrated with your situation, but yelling at seriously disab led and ill folks over the in t e r ne t to help you try to d i a g n o s e yourself is not the way to seek the help and empathy you desire. Good luck to you.
 
MYWILLOW, no need to apologize for typos we all have those. You are skipping the most important part...while the needle readings may not axonal neuropathy and you may have chronic neuropathy which while not a Dr. I do not believe are mutuallt exclusive diagnosis, anyway the part you are ignoring is that the EMF also does not support ALS. So while your situation may be complex it does not appear to be fatal!

Wright is the most knowledgeable person here about EMG's he gave you his educated opinion.

I am not nearly as educated about EMG's as he is but I agree with what he is saying.

You need to follow up with your Dr's, you can not get diagnosed on line. Educating yourself and being your own best advocate is important but your case I believe the medical cliche "when you hear hooves clicking on the street you should be looking for a horse not a zebra"

Good luck and please follow up with your Doctors!
 
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Just to add to TedH5: there are rare times when it turns out to be a zebra rather than a horse, but it is never, ever, a unicorn.

I hope you can find doctors you trust to help you; good luck!
 
Well I hope it's not fatal. And, yes I agree I need to follow up with a Doc., and I have been right along. Also, I don't know any people in these blogs personally, but an insult is an insult.

Just like everyone else who ever goes online, this is a chance to vent and a chance to learn. I am exploring, and while it may not seem logical to others it makes perfect sense to me. I just learned something new the other day, I have hypothyroidism, night sweats ( more like dry roasting), and edema. These seperate conditions are all linked to the hypothalamus. I had cobalt therapy to the left side of my head when I had problems with a parotid tumor, so just monday I asked my PCP if it was posible that this effected my hypothalmus in a negative way, he say maybe, but it would be extreamly hard to prove.

The hardest thing for me to grip is it has been almost 4 years, this was progressing slowly, until recently, so why can't they tell me what is. I have seen 3 Neurologist, the Physiologist, and have had 3 PCPs. The first PCP thought I had a heart problem, and when that proved normal, she lost interest. The second PCP said maybe MS, but that never panned out. My current PCP knows I have been concerened about this for a long time, but everytime I talk to him he tends to act like I experiencing a new problem, not a new symptom. So he starts us all over again. It's frustrating, and I sat quietly bye for about 3 yrs letting my first neurologist talk me into vitamins etc. Finally I chose to see someone else and within a month confirmed I had evidence in both legs of an axonal neuropathy, he said it was probably inherited, but not CMT because my feet weren't ugly enough. Then just a month ago when we discused the fact that my hands were getting worse, he suggested I get tested on my upper extremities. The other neurologist really was a waste of time. For whatever reason, he had decided that I was wasting his time. My insurance company paid him $1000 to not treat me. He let an intern do the exam, then when he deigned to do the emg/ncs it was cursory, and he actually from the other docs I asked, forced my test to confirm his thoughts not what was actually going on.
I have been following their instructions, something is not working.
 
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