Fear is the Enemy EMG today

Howardd

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For the past 6 months or so I have been experiencing alarming symptoms.
*Tremor or Vibration of body.
*Left upper arm seems to be weaker and make it harder to hold up my phone in bed.
*left arm jerks back on occasion
*small jerks throughout body on occasion
*Muscle is smaller in left arm, shakes when normal exercise is attempted.
*frequent fasciculations in left upper arm moved spread throughtout body.
*over the past 3 months the fasiculations have spread, most frequent to my legs but I have had them in both arms, legs, stomach, butt, and face. They are visible and frequent.
1st Visit to Neurologist - Tremor but he did not notice any muscle atrophy - he suggested Ativan.
2nd Visit for EMG -
Denervation found in left thigh - He felt like this was related to back but recent MRI showed no signed of lower back issue.
More signficant Denervation in upper left arm - he believs linked to C7 back issue. This can be supported by MRI findings.
Fasiculations in multiple limbs- in test but not constant.
He said he was not seeing MND but he suggested going to a specialist in another city for evalution at the same time for peace of mind. This seemed rather alarming to me.
I have requested a copy of the report. Thank you in advance for your thoughts.
thank you - HD
 

Nikki J

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It doesn’t sound like he thinks there is concern but is suggesting a second opinion because he sensed you don’t believe him.

post your deidentified emg when you get it - both the summary interpretation and the chart we do not need pictures of tracings even if you have them.
were there any findings on your clinical exam besides tremor? You said no atrophy what about reflexes, muscle strength and muscle tone? Those are the things , along with emg findings that say whether there is cause for concern
 

Howardd

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Nikki - Thank you for your response and thank you for your patience and kindness. I have read enough post to understand the frustration felt when people will not accept, they are in the clear. He noticed some muscle weakness in my left upper arm. He attributed that to the C6-C7 Sever left-sided foraminal stenoses at c5-c6 and c6-C7 from MRI findings. I have a disc issue for almost 10 years. I have requested a copy of report when he finalizes, and I will post. What seemed alarming to me was that I was 100% ready to accept his findings yet he himself seemed a bit unresolved. He on his own volunteered the 2nd opinion with someone he knew at another school. He works at teaching facilitated. He teaches medical students. He recommended a Head of Neurology at another University. Thank you again. P.S. 49 Year old male not sure if that is relevant otherwise very healthy up to this point.
 

Nikki J

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He probably wants to confirm his opinion on the cervical spine issue. Hopefully you get your second opinion quickly
 

Howardd

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Thank you, I am very scared because on the surface It appears I fit the criteria for diagnosis. I hope he provides the EMG report soon too. He did say he did not see the other things normally seen on the EMG that would indicate MND but that he did see the denervation in both my upper left arm and lower left thigh. I am curious if typically you see all the signs in the EMG or if it will on occasion start with this type of findings.
 

Nikki J

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Until you have the emg report it is not at all clear you meet the emg criteria and you have not reported any clinical findings besides the arm which has another explanation and no upper motor neuron signs. If you met all the criteria you would have been diagnosed you should be able to access your emg on the patient portal. It is required that tests be available to patients in a timely manner
 

Howardd

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Here are the notes from recent EMG -

Procedures

EMG/NCS

Motor NCS
1. Left peroneal distal latency 5.17, amplitude 5.6, conduction velocity 49.3
2. Left tibial latency 3.69, amplitude 16.5, conduction velocity 46.8
3. Left femoral latency 5.56,

Sensory NCS
1. Left sural sensory nerve action potential peak latency 3.8, amplitude 9.3

Electromyography
Muscle sampled on the left upper extremity included the cervical paraspinous muscle, the supraspinatus, deltoid, biceps, triceps, brachial radialis, and the first dorsal interossei

All muscles demonstrated normal insertional activity. There were no fibrillation potentials or fasciculations identified. Motor unit potentials were notable for high voltage polyphasic motor unit potentials in the deltoid and biceps. All other muscles demonstrated normal motor unit potentials and there was otherwise full recruitment throughout
 

Nikki J

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Definitely not an ALS emg. There should be more - an interpretation not just a recitation of what should be in the tables you did not include but just from this I can say the emg does not come close to meeting diagnostic criteria

let us know what your second opinion says
 

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Oh that is fantastic!
 

Howardd

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Thank you - This is a 2nd EMG a week after the first. Strangely I still do not have full report from the first one that scared me. Original EMG Neurologist said denervation in two spots when I was in the middle of the procedure. He is supposed to see me again in the next few weeks. But he has not uploaded report! 1st Neurologist saw visible Fasciculations in multiple spots, 2 spots of denervation and I am have some small amount of clonus jerks when is why he said I might want a 2nd opinion. But later he said he did say he did not think it was ALS.
 

affected

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I'm really happy for your Howard, truly that's the end of your need to be here.
Keep working with your doctors and I wish you the best in life.
 

Howardd

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Thank you- and thank you for all your patience on this thread.
 
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