EMG on Wednesday - What Should I Expect?

[DCDad]

Hello All,

I apologize up front for having to start a new thread as my previous one got locked due to inactivity. For those who followed my initial thread, I've been dealing with a variety of symptoms since at least late March 2017. I am a 41 year old male.

As a patient who uses the VA health system, I went to my PCP in May and finally got a Neurology appointment in mid-July. The neurologist (a resident) noted that I had a radiculopathy at the L4, L5 and S1 levels based on a spinal MRI. She further observed some minor clinical weakness in my left leg when she asked me to overcome downward resistance on my left thigh. Brisk reflexes were also noted in my legs bilaterally. After that exam, I was referred for an EMG given the intermittent fasciculations I've experienced in my hands, legs, arms, and back since approximately late April.

Following my initial July neurology consult, I've endured a seemingly endless 74 day wait for the EMG appointment. The EMG appointment will finally come on Wednesday and I'm quite scared. I'd like to ask the group about what I should expect to experience during the procedure:

How long do you suspect the procedure will take?

Is there anything I need to tell to the examining neurologist or will they know everywhere to test per the EMR notes provided by the referring neurologist?

Should I expect pain?

How should I communicate the new areas where I've experienced twitches since the July exam? Will this make a difference?

The "sluggish" second toe on my right foot is now a bit more noticeable/annoying when I walk and run. Is this something I should emphasize to the neurologist running the EMG. is this something they can "test"?

I've seen other threads discuss "red flag" sounds that suggest ALS during an EMG (e.g. rain on a roof). Is this generally the case? Are there other sounds I should be attuned to?

What findings or impressions are normally conveyed to the patient after the EMG concludes? If things appear not suggestive of MND/ALS do the examiners ever reassure the patient?

Other than ruling out MND/ALS, what else may diagnostically be gleaned from the EMG?

I apologize for all of these questions. I remain incredibly worried for my family in the event the EMG points to MND/ALS. To make matters worse, my wife got sent on work travel this week with her job so I'm home alone with the kids and don't know what shape I'll be in if the EMG suggests a diagnostic turn for the worse on Wednesday. Basically, I have the EMG at 3PM and then pick up the kids from school. Not an ideal situation from my perspective.:-|

Thanks to all for your patience, wisdom, and encouragement over the last few months.

 

[Nikki J]

Hi
Good luck with the EMG.
Much of what you ask is dependent on the protocols but generally the order will state the areas of concern. However often the examiner has discretion to expand the area of examination if there is reason to do so. Twitching is not a reason probably. If they examine the ordered areas with the most symptoms they don't need to examine every place that twitches. The examiner may want to check weakness themselves. Or not.

Don't try to interpret sounds. EMGs are noisy. You are not educated to interpret these sounds.

It depends a lot on the individual for level of discomfort. I found it mildly uncomfortable. No big deal. My sister said it was horrible and would never ever have another. Sadly her first and only EMG was absolutely diagnostic and the question never arose. Try to relax as best you can except when instructed to tense a specific muscle.

Length of time depends on the examiner and on how many muscles need to be tested. My clinic schedules 90 minutes but I think most are significantly shorter. They allow time in case they get someone needs a long time plus time for the doctors to do their reports and other responsibilities

Giving results also depends on protocols. It is certsinly not unknown for someone to be given a verbal ok but if you do not get one and they just say dr x will get this report in 3 days do you have a follow up do NOT panic. Could be standard procedure

Please let us know your results

Good luck

 

[DCDad]

POST EMG UPDATE

I just returned from my NCS/EMG at the VA. The technician and neurologist were very thorough. While they confirmed the previously diagnosed L4/L5/S1radiculopathies, the neurologist who performed the EMG said emphatically, "go home and get ALS out of your head." I don't need to tell anyone here what a relief it was to hear those words. The VA will provide me with a Physical Therapy referral and I hope that will improve things with my leg pain. They did not offer an explanation for the left leg atrophy, but noted that it did not seem severe to them.

I wish to thank everyone here for the incredible support and kindness I've received over the past few months. The daily courage and selflessness I've witnessed on these boards is absolutely humbling. In particular, the bravery Michael Murray (mbmurray) demonstrated during his final days touched me deeply. I don't think that a day has gone by since his passing that I haven't thought of him and his family.

As a token of my appreciation and gratitude, I am making a donation to these forums. I wish the best to all who are living with ALS - both as PALS and CALS - and commend you for continuing this noble mission despite your own illnesses and needs.

 

[Nikki J]

Thank you for letting us know. Congratulations. I hope you can take the advice to get ALS out of your head and have a very long and happy life!

Best wishes