EMG Testing question for Wright/anyone?

[Angie679]

I have a question regarding the EMG test. I have it scheduled for tomorrow with a local neurologist and have heard from a couple of people that this particular doctor does not have a good reputation and does not have a good bedside manner. My question is is it real important to have this test done by a top notch doctor or is it the type of test that will provide the results without much interpretation from the person conducting the test. I'm just wondering if unreliable test results come from a doctor who may not be performing the test correctly or who may be reading the results incorrectly. It seems like such an important test, and where I live less than an hour from a major teaching hospital (Mass. General) and am thinking it might be wiser to schedule this test with an ALS neurology specialist. I'm so nervous..If anyone has any comments I would truly appreciate it.

Angie679

 

[wright]

In my opinion, I would get the EMG done by the best doc I can find. In talking to two excellent neuro's, they said that if they had to rank one test as being unreliable if done by "local" neuro's, it is the EMG. As important a test as it is, it doesn't require a fellowship for a neuro to administer one, which is completely insane. If you are a neuro, the only thing you need to do, to actually administer an EMG, is the money to buy the equipment. Scary, huh.

. . . and good for you for scheduling the EMG. You will be able to relax when it comes back negative. :-D

 

[Angie679]

Wright:

Thanks so much for your advice...I will get busy and schedule this with a Mass. General Neurology doc. and hopefully not have to wait too long. You are such an asset to this forum. Clearly you have chosen the right field to work in and many people benefit from your wisdom and compassion. Thanks again. I'll keep you posted.

Angie

 

[vmd]

...ditto

Wright, you have certainly become well versed in the vagaries of an ALS diagnosis. How do you find the time!?

 

[Geo]

Ive had 4 EMGs and the first was done by a Uncaring Neuro at Mayo .i was in tears when he Put that Damn needle in the end of my tongue . He didnt even say ,now this may hurt . He was very calous . My wife watched that one and even said he wasnt very nice . My last was done by a very caring Doc. who put his hand on my back and said this will hurt a bit so bear with me for just a bit . Bedside Manner Goes along ways .Just think do you want a calous person poking needles in you ? NO ,So Yah, you better like them. Geo

 

[Angie679]

EMG Results

I had my EMG/NCS test this past Monday and was told at its conclusion that the results are normal. The doctor performing the test had to stop several times because my foot and leg were apparently too cold so she needed to place heating pads on those areas in order to get accurate readings. She seemed frustrated with me but I couldn't help it obviously. I was very nervous during the test and she didn't have much in the way of bedside manner. Anyway, at its conclusion she said despite the trouble with the low temperature in my extremities the test showed normal results. I am very thankful for that and so glad to get that test behind me. I still continue to have twitching here and there and everywhere and did feel it during the test but not on the side they were testing. She could not detect any twitching during the test. Thank you all for your wisdom and encouragement.

 

[PDaddy]

For what its worth, when I had my EMG and NCS at Loma Linda they had me sit with my bare feet in a tub of hot water and my hands in a tray of hot water. I must have sat there for a good 20 minutes or so, warming up.

 

[BethU]

Hi ... I'm glad you're going for the best doctors you can find for the EMG. I had one done by a really uninterested and unsympathetic "local" neuro about eight months ago, and he said the results were normal.

Then I was seen at the neuromuscular center of a teaching university a week ago, for a "re-do" of the EMG, and not only was the test procedure itself very different, but they found that 3 out of the 10 areas they tested had denervation. (The first guy only tested the back of my left shoulder and my left forearm.) At the clinic, they went from my feet up to my tongue.

At the clinic, they used some mild shocks, plus needle tests ... and even the needles were different (much smaller than the ones used by the first guy, and less painful). The clinic also had results immediately. (Had to wait two weeks for the first test to be "read" by someone else.)

They told me at the clinic that many times doctors who don't do EMGs very often miss a lot. Plus, the test equipment the first doctor used seemed to be antique compared to that at the clinic. I'm sure the equipment is expensive, and doctors in private practice probably don't update very often, if ever.

The thing is, at the clinic, they said denervation shows up months before symptoms do ... so since I have had speech and swallowing problems and double vision and a stiff face for 2 1/2 years, clearly denervation must have been present when the first guy did the test. He simply *happened* to test two areas that weren't affected.

So ... I second the motion to get the best people you can find to do the EMG. It can make a big difference!

Beth

 

[DeeMichelle]

Agree with all said EMG must be done by a real top expert and a good neuro team ought to know this. It's the most important test; measuring speed of response before atrophy or loss of strength may occur or are noticed. When my Dad had his EMG in one of the most specialist centres for ALS in the UK they brought in an expert from another hospital. My dad can hardly speak and this guy really took the time to understand him. The doctor and his team also, to my eye seemed saddened by the severity of my dad's symptoms i.e. were compassionate and exert. Why can't they all be like this?
D

 

[Peg B]

Hi,

My first two neuros back in 2002 and 2003 were very uncaring and distant. I asked MS or ALS? The third neuro in 2006, warmed by arms before the EMG. He said this was "standard" practice and was very angry at the other two neuros. He DX me with ALS in about 1/2 hour but continued to check and sent me on to ALS clinic for second opinion. They also warmed my arms and legs for the EMG and NCS. Take Good Care, Peg

 

[kevinw]

Dumb question...........is it standard procedure to warm the limbs that are being tested during an EMG? I was just wondering and although I had one done, I don't really know much about them.

 

[Al]

I've had 6 or 7 and never had limbs warmed.
AL.

 

[wright]

They actually measure the temperature of your limbs with the probes and if it is too low, they will warm them.

I have read and have been told that low limb temperature can affect conduction velocity, which is part of the NCS and to a lesser extent the measurement of fasciculations, which is part of the EMG.

I have had two EMG's but like Al, never had to have my limbs warmed.

 

[Al]

Guess that's because we are naturally warm and cudly. LOL.
AL.

 

[kevinw]

"LOL" Al must be right.......I just remember my feet were freezing (they always are), and I just thought maybe it could mess something up with the test if for some reason my feet & legs were cold and more tense.

Thanks for the replies....it was just one of those questions that popped into my head when I read the start of this tread.

Hope all is well with everyone.....take care.