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glenn gavanaugh

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Went for my EMG yesterday... here's what happened.

the doc checked my reflexes and strength first - reflexes fine (a little brisk on the right leg, but other than that everything was fine, including Babinski) - not as strong as on my good side compared to other (she used this device that was almost like a clamp, had me squeeze it, read strength...). Fingers not as strong on this side either (when she had me hold them out as tightly as I could as she pushed them in...). Checked the size of my arms, they are about the same... but hands are a definitely different in muscle tone...index finger curl, thumb curl.

the EMG and Nerve Conduction:

she didn't find anything wrong with my arm or hand. she poked my throat with a needle and had me move my tongue around and do this and that with it - didn't find anything abnormal.
what she did find was a nerve damage and fascic's in my foot (where the weakness started about a year ago).

she said that a small possibility it could be ALS. Probably not, but she's not ruling it out. Sending me to a neuromuscular specialist...

anyway, my question is this: I started to notice fasci's in September, 8 months ago. and weakness about 4 months before that. Wouldn't I have more nerve damage by now if it was ALS? Mind you I also have noticeable weakness on my strong side - I can still use my arm, no problem - but it is weaker - but if the weakness is noted in my arm, why no fascic's or nerve damage found? Babinski is still fine? If I have MND, could this mean a slow progression?

I'll be getting an actual copy of the EMG soon. But based on what I've just outlined, could anyone help me?
Thanks so much.
 

joelc

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Fasics don't signify anything so don't rely on them to be an indication of anything. There is no way to even begin to speculate what is going on and what the progression rate might be. If it is ALS anything can happen and progression rates are different for everyone. My progression has changed several times so I don't think there is anyway to tell what might happen, or when.

I hope they find it is something other than ALS!
 

glenn gavanaugh

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Yeah, me too.

Don't they have to find nerve damage in four muscles before ALS diagnosis, though? It was only found in my foot - and this is after a full year of noticing symptoms...

*guess I could just read the sticky.
 

glenn gavanaugh

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if all she found was something in my foot, I can't even be diagnosed with ALS, can I (IF I have it)? COuld this drag on for another year or two before I'm told I have it or not (IF I have it)?

she said, "your exam was good on the whole... it's just your foot... and you seem to be weaker on your strong side"

she went thru it so fast I wasn't sure whether she said I have nerve damage in the foot or fascic's or both...

she also noted that I have a lot of cracking over my body, especially the weaker side... and that my sternum cracks... she didn't say that's indicative of ALS, but noted it.
she also poked my neck with the needle and had my wiggle my tongue around - aren't you supposed to do the tongue itself? with the emg, that is...

said that in the early stages the reflexes might still be okay... yet I first experienced problems almost a year ago... wouldn't my babinski show?

I hope I don't have to wait another 3-4 months to see the MND specialist.
 

rose

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Glen,

You can always call the office of the doctor who did your EMG and say you still have questions about results, make an appointment just for consultation to go over what was found.

Yes, read the sticky to learn about what is required for an als diagnosis, it will answer many of your questions.

If the doctor did not talk about a pattern of chronic as well as active denervation and re-innervation, but rather just the weakness, (denervation) that definitely points away from ALS.

Fascis do not CAUSE anything, not weakness or atrophy.

When the needle was put in your neck, and you were asked to wiggle your tongue, that was when she was testing your tongue. Some doctors go through the neck, some stick the needle in the tongue.

Bone cracking is not a symptom of ALS...

I'm certain that if this doctor found something she felt warrants follow up, she will convey that to your referring doctor.

I'm glad you were able to get this done, and that your results were not diagnostic of ALS. I hope you continue to seek answers and are able to receive some sort of treatment that helps you, take care, :)
 

wright

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Rose said most everything I would have said to you but I'll just add this:

If 100 adults got an EMG of their foot, over 50 of them would have the same exact results that you got. I'm surprised your neuro even EMG'd your foot because data from it is inconclusive and not reliable at all. Your EMG was in essence clean and isn't even close to an EMG of someone with ALS . . . NOT . . . EVEN . . . CLOSE! Did you hear me?

Do your best to be patient and let the physicians (neuromuscular specialists, rheumatologists, etc.) try to determine what is going on with you.
 

crystalkk

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Glenn,

They usually don't because most people have got some type of nerve damage to thier feet. (Image the wear and tear on your feet)
I have begged nuero's to emg my feet because I am having problems with them and they always say no it would be inconclusive if something did show up.
 

glenn gavanaugh

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thanks for the responses, people .
the doc who did my EMG is setting me up for an appt with the neuro anyway, just to get a better idea - not to say I have ALS, but just to see why I present weakness and a bit of muscle loss on my good side, and why my reflexes are a bit brisk on that side as well.... a Dr. Melanson... who knows when that'll be... hopefully soon.

also, she found both nerve damage & fascic's in the foot. if the consensus is that this is overall normal, then I won't really worry about it.
anyway, thanks.
 

glenn gavanaugh

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I'm also really freaked out by my emotional lability problem...

I seriously get these surges of weapy emotions when listening to music or watching t.v. - I can't control myself, it's so powerful... this has never occured in my life...
how do I explain this? ugh... it's all so confusing.
 

BethU

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Glenn ... I sure sympathize with your lability problems. Emotional lability is part of the disease when it reaches the bulbar area: ALS affects the part of the brain that controls emotional expression ... not the emotions themselves. So you may be weeping loudly and uncontrollably at something that is completely unrelated to how you feel. I found that sentimental things (music or anything to do with rescued animals) or unexpected kindnesses were the worst for triggering the crying jags. And you can't stop them. They have to wear themselves down.

This is really a huge problem to deal with on a personal level. It is SO embarrasing. But it's one of the few ALS symptoms that can be "cured." There are meds ... Zenvia if you can get it (it's not approved for ALS use yet in the U.S, but hopefully it can be in Canada. In either case, it can be tailor-made for each patient at a compounding pharmacy). Also, anti-depressants work ... not because you're depressed, but because they also affect that part of the brain. There are other meds, too.

Talk to your neuro. Fortunately, this is one ALS symptom that can be controlled. And, boy, what a relief it is ...


Speechless in L.A.
 

rose

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Glen,

I'm glad you're following up with the doctor after your tests. Please let us know what you find out.

About your emotional manifestations, keep in mind ALS is not a common cause for problems like you describe. Yes, people who have ALS can have emotional lability, but that is not the same thing as concluding that if you experience this, that you must have ALS.

I remember you writing before that you were having problems with depression. This is not something to take lightly. Please let your doctor know that you've been experiencing times of depression.

Also, other possible causes which are much more likely reasons than ALS for what you describe include thyroid imbalance, diabetes, and alcohol abuse.

Keep your chin up, I'm sure there are answers coming for you soon.
 

glenn gavanaugh

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thanks for the responses. appreciate it.

I also notice that when I talk, I'm short on breath. Never happened to me before.
It just seems that the atrophy, weakness, fascic's, cramps, difficulty projecting voice, nighttime drool, finger/toe curl, shortness of breath (and other possibly unrelated/related stuff like bone cracking...even my sternum cracks...and overwhelming surges of emotion) etc. all point towards mnd.
I know other conditions "mimmic" ALS, or it could be that I have a number of conditions going on at once. But I've had MRI, CT, blood work - all fine. So I'm left clueless right now. But Wright is right, I have to let the neuro find out what is wrong...
I was just set up with an appointment with a neuro-muscular specialist, but it's not until the end of Nov. At this point, that seems like an eternity!
 

ktmj

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Good grief November? I know these specialists have waiting lists and I have run into that too in the past. Be aggressive - any other options? If not, call them twice a week (and be polite!) and see if they have had any cancellations. Even if you are on a waiting list, they will remember your name and sometimes you jump ahead just because you are a squeaky wheel. Good luck!
 

glenn gavanaugh

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ya the only thing that freaks me out is that the doc (Dr. Joy Wee) who did my emg said she's not ruling ALS out , said it could be the early stages...and she's sending me to see the neuro-muscular specialist. if it's absolutely NOT ALS, like Wright said, then why didn't she just rule it out, and call it a day?
this is a lady who's very involved in ALS/MND, who proudly stated that she's head of the neuro-muscular clinic I went to in Kingston... so kinda freaks me out.
she wasn't very open about it all - what she did say was that she was worried about my weakness (which is just getting worse) and nerve damage... brisk reflex. finger curl. ugh, it goes on and on.
but then babinski is fine... so doesn't that point away from ALS (is this an ignorant question?)?
 

Jaded-1

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I'm also really freaked out by my emotional lability problem...

I seriously get these surges of weapy emotions when listening to music or watching t.v. - I can't control myself, it's so powerful... this has never occured in my life...
how do I explain this? ugh... it's all so confusing.
I would discuss going on an anxiety medication. This is a sign of depression and not ALS. You dont just get sad spells and not laughing. The emotional liability "Labile affect" is pretty fascinating and it controls other emotions than sadness. If you are just getting oversad from movies or sad sounding songs... tell your doctor. You will feel better and I bet you notice your "ALS" disappears.

in regards to your emg.... Your emg would reveal abnormalities well before your strength loss. If you have an extended period of "weakness" and your emg is clean after 3 months after the onset of said weakness, you do not have ALS.
 
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