Second thread, now with my Emg report

[BNH4.6]

First, I would like to apologize to each and everyone of you for my rude and inappropriate response to Clearwater. I was on prednisone and scared and frustrated. I got my emg results back Monday. I tried to post a picture of them but I'm computer stupid. Here is what it says.

muscular build with fasciculations noted in bilateral extremities, difficulty relaxing, tremulous; increased tone noted in legs. Rue:delt/bi/tri 4+/5 intrinsic hand 5-5. Lhe:delt/tri/bi5-/5. Rle:ip/quad 5-/5, 5/5 distally. LLE: ip/quad/ham 4/5, ta gastroc 5-/5, emb 3/5 gait stiff walks on left ball foot. Reflexes limited but appear 1, symmetric. No jaw jerk, sensation limited to lt/temp. The emg/Ncs was ordered for myopathy.

Sensory nerve left median normal
Sensory NCS Ulnar showed mild peak latency, moderately reduced amplitude, normal conduction
Sensory NCS left Sural nerve mild peak latency, normal amplitude and conduction
Sensory NCS left superficial normal
Motor NCS left median normal
Motor NCS left peronel and tibial normal

Concentric needle emg of selected muscles in left upper extremity representing C5-T1 myotomes showed diffuse denervation and chronic reinnervation with mildly reduced recruitment in all muscles sampled. EMG of left mid-thoracic para spirals showed moderate chronic reinnervation changes. EMG of left lower extremity representing L3-s1 myotomes showed mild denervation changes in tibialis anterior and gastrocnemius. Mild reinnervation changes and mildly reduced recruitment.

This is a abnormal study. There is electrophysiology evidence of widespread denervation and reinnervation involving cervical, thoracic, and lumbosacral myotomes consistent with a disease of motor neurons or their axons. There is no electrophysiology evidedence of myopathy.

Doctors look at me and say test says als but you are not clinically weak. Let's wait and see, come back in 3-4 months. 2 doctors said that. I asked for spinal taps, MRI of brain any tests. They say wait and see, why? I was being tested for autoimmune problems, I never thought or had any idea about neurological issues. I told the doctors to be honest with me. They ignored me and said wait and see. I went to a therapist, she said I have no mental health issues or anxiety problems and it was a part of the diagnoses. How long will I stay in limbo? Does this sound familiar?

 

[Clearwater AL]

For being computer stupid, as you wrote, you did a pretty good job of transposing the report from whatever, where ever to this Thread.

So, as the Neuros left it... wait and see.

 

[Vincent]

Some of us have been years before getting a definitive diagnosis. It's hard, but you have to be patient.
Vincent

 

[BNH4.6]

Time and typing it out. I wanted to be lazy and post a picture! I will wait, what I'm frustrated with is when I ask what else? Pinched nerve, brain tumor, nerve damage from chemo? I get a blank stare, why is my health a secret? Sorry just venting. I need to learn patience

 

[Atsugi]

Your health is not a secret. But frankly, non-doctors are not educated enough in medicine to understand all the thousands of thoughts the doctor is thinking. If all they're telling you is "wait and see" then they want to see how the symptoms develop before making a conclusion. Unfortunately that's what you need to do.

 

[pelztier86]

I remember that you were the one that claimed to show a gowers sign when standing up from the floor. How IS this possible when you are told you are not clinically weak? For being forced to use this maneuver, you must have a pretty severe weakness of the gluteus maximus.
also, according to your notes here there is mild weakness in some proximal muscles, and moderate weakness in "emb" (whatsoever this abbrevation means) .
Second, your reflexes are said to be diminished; yet you claim that they found an increased tone (indicating spasticity); in MY modest opinion, these two findings do not fit together.
Moreover, the EMG report states much more widespread damage than what is clinically evident which is rather unusual (though not totally impossible)...

If there was ONLY the clinical finding of reduced reflexes and (predominant) mild proximal weakness with EMG changes indicative of motor neurone disease then one could think of SMA (spinal muscular atrophy).

I cannot believe that doctors would tell you simply because of the EMG findings that ALS may be suspected since your clinical picture and findings do not support this assumption (at least at this moment)
You don't have hyperreflexia and your clinically weak muscles are mostly the proximal muscles, and this is rather symmetrical which is both not true in ALS.
SMA instead begins with the proximal muscles, and is rather symmetrical and causes reduced reflexes - but yet again, there would be no increased tone.

In any cases, just as it was true with your last thread, there are many contradictions in your description. In my modest opinion - too many.
I cant help but wonder like the lady that commented as a doctor in your last thread if you make something up. Perhaps not everything, but too many contradictions are evident for someone with a better understanding/medical background.
Everyone can make up their own mind here; just wanted to point things out so that patients here don't waste their precious time if they share my doubts.

 

[pelztier86]

Hyperreflexia with hypotonia is certainly possible; hyporeflexia with hypertonia/increased tone is not.

 

[BNH4.6]

Peztier86, I think people are not understanding or glancing at what I said in the original thread. I said " cannot stand up without helping myself by walking my hands up my legs or holding onto something." That means from a chair or getting out of car or off toilet. No where did I mention anything about gower sign. Someone else did maybe but I never typed that. I also said "I cannot move my feet correctly, I cannot do more than a few body weight squats. A year ago I could squat over 400 pounds." I never said I was unable to move on my own. Things are just becoming more and more difficult. The only thing I said from my words about reflexes was this from the last thread "Something about deep reflex high, some other reflex slow." I heard them talking to each other and not me. I caught bits and pieces of what they were saying. The first post in this thread with all the terminology is not my words. I wanted to take a picture of the report and post it. I couldn't figure out how. I typed word for word what it said. I don't know what half of that stuff means. I'm honestly not trying to bother or cause issues with anyone or confuse anyone. I'm just trying to learn. I'm sorry if I have offended. Thank you all for the advice.

 

[pelztier86]

cannot stand up without helping myself by walking my hands up my legs or holding onto something." That means from a chair or getting out of car or off toilet.

This would bei indicative of pretty severe weakness of the gluteus maximus (bis muscle in your butt) . But you dont seem to have significant clinical weakness there.
I can tell the difference since i do have the problem you mentioned and I do have significant weakness in these muscles (i don't have ALS, just motor neurone signs along with much neurological stuff). No matter what you say it is just not possible for someone to have these symptoms and not be significantly clinically weak in these muscles; these symptoms would indicate strength grade 2-3/5.
I am aware that you claimed having typed the report word for word. You would be more convincing if you posted a picture of it - unless you do so, i cant help but doubt its existence as i cant picture that a report written by a professinal would contain such nonsense and contradictions. But there is always more to learn...so feel free to prove your honesty...
There are websites where you can upload a picture for free.

 

[Nikki J]

To post a picture do not use quick reply go advanced. Scroll down below the message box to manage attachments. Once you open that choose file

 

[pelztier86]

Hereditary spastic paraplegia might be a differential diagnosis as well - yet again, the hyporeflexia with hypertonia /spasticity don't come together.

 

[BNH4.6]

Thank you I just tried. It said moderator has to approve

 

[Nikki J]

Whatever you did BN it did not work correctly. Did you pick an existing picture from your computer files?

 

[BNH4.6]

No, from tiny pic. I'll try again I've never uploaded from a website to another.

 

[Dusty7]

Thank you for posting the EMG summary.
Since ALS is a disease of widespread, acute and chronic denervation and reinervation--which is exactly what is reported in the EMG summary--I can understand why the neuros would be leaning toward ALS.
I would prefer to see the actual detail results, but I trust the EMG tech to have gotten the interpretation right. (Bu widespread is a fairly subjective word.)

What still bothers me is that you say, "Doctors look at me and say test says als but you are not clinically weak." But in your first post you said, "I cannot stand on my tip toes anymore..." This is sort of an
automatic test in any clinical exam, and it is a dead giveaway for clinical weakness. When they determined you had no clinical weakness, had they asked you to stand on toes, on heels, etc.? If so how could
they miss that obvious clinical weakness?

Of course, if it is ALS, there is nothing you can do about if anyway, so waiting for a followup EMG and clinical exam is not improper. There's no treatment anyway. And as we have talked about on this forum,
some neuros like to say ALS right away while others are very slow to pronounce it.