First Post - Waiting for EMG/MRIs

[Clearwater AL]

PR521, You might post the Summary/Conclusion at the bottom of
the report of your EMG on the left side.. and even your middle trap
you said the Neuro did.

 

[PR521]

Thank you both (and everyone else in advance) for your feedback since I may hit my posting limit for the next couple days. I have a follow up with my Neuro on 10/3 so I am trying to gather my thoughts/questions. The EMG summary page is pasted below***. In talking me through it she basically said it was nothing but maybe resting on my elbow too much. She has told me a few times now prior to this ENT appt that “As exam and EMG reassuring, neuromuscular disease is unlikely”. I trust her and hope she’s right but I basically had to kick and scream to force this ENT referral in the first place.

***
PHYSICAL EXAMINATION: Physical examination finds normal strength, normal sensation. He has negative Spurting's maneuver. Negative Tinel's over the ulnar grove, carpal tunnel, fibular head. He notes cramping and fasciculations but none were witnessed. He notes feeling weakness but there is no atrophy.

Nerve conduction studies revealed slow left ulnar motor nerve conduction velocity across the elbow segments of 12 m/sec.

There is prolonged left sural and left superficial peroneal sensory nerve distal latency of borderline degree.

Needle examination of selected left upper limb muscles, including cervical paraspinal muscles, and left lower limb muscles including lumbar paraspinal muscles showed no abnormal spontaneous activity. Motor unit and amplitude, duration, and configuration were normal.
Recruitment was full throughout.

IMPRESSION: Today's electrodiagnostic study is abnormal.

There is electro diagnostic evidence to suggest:
1. A mild left ulnar mono neuropathy at the elbow with focal demyelination without denervation nor axonal findings.

2. Borderline left sensory neuropathy based on prolonged distal latencies of the left sural and superficial peroneal studies.

 

[lgelb]

These are findings that literally millions of people would have. Many people keyboard at a bad angle, use game controllers a lot, rest on/press on their elbows by holding/carrying things, cross their legs when sitting, etc.

It sounds like you are in a good diagnostic process for the ENT stuff and that is really the major issue outstanding. Again, if counseling can help, no reason not to take advantage.

 

[PR521]

My barium swallow study last week was surprisingly normal. I was very pleased to see that.

Completed a PFT today due to my shortness of breath and chest pains. The results seem a bit concerning to me but I will review with my Docs. First time ever doing one so I have no clue what the numbers mean. I pasted the summary below. As a reminder I’m 32, 6’1”, 175 lbs, white; and I have never smoked or had a history of asthma.

The FEVI/FVC is reduced(66). The FEVI/SVC is reduced(65). The FEVI is normal. The FVC is normal. The TLC by body plethysmography is increased. The DLco is normal. The airways resistance is normal. Specific Conductance (sGaw) is normal. Following administration of bronchodilators, there is no significant response.

CONCLUSION:

Mild obstructive ventilatory defect. Hyperinflation is present. Normal Diffusing Capacity.


My Neuro ordered some blood work to test for MG even though they don’t think it’s likely. They also offered to complete another EMG on 10/25 since the first one in August only tested my left side.

 

[lgelb]

Re the PFT, it's not a smoking gun of any kind, but suggests you might be able to help yourself with a diet and exercise regimen geared to what helps you feel better. I would guess frequent small meals preceded by more stretchy than aerobic movement would be best. If you have a vagus nerve injury, that could affect your breathing and getting all the air out of your lungs, a surplus of which |in turn could cause chest/esophageal irritation.

I would also make sure you are keeping a neutral spine and practicing slow mindful breathing as you work, sit, etc.

And of course good sleep is important.

 

[PR521]

Just a quick follow up.
I was fortunate to be able to have another EMG completed by my Neurologist over the past few weeks. It had only been 60 days since my original clean one, but she wanted to do a more thorough one including my tongue... particularly since an APMR Doc completed my first EMG and not my Neurologist.

I was apparently unable to fully relax my tongue but thankfully my results appear to be completely clean again. I am posting them in case anyone has any thoughts/interpretations but I understand that I do not appear to have anything resembling ALS based on my EMG.

I am undergoing additional MRIs/CTs and breathing tests over the coming months to try to reach a diagnosis for what is causing my paralyzed vocal cord, abnormal PFT, and full body cramps/twitching/fatigue/weakness.
I will return for a quick reference post if/when I am diagnosed in case there are others in the future that experience anything similar.
I greatly appreciate this community’s advice and cause. I will continue to support/donate as long as I am able.

 

[PR521]

Checking in with a bit more information.
I received the results of my Spinal MRI and my Neck/Chest CT scans.

CT scans on my neck and chest were unremarkable other than showing the left vocal cord weakness and some “questionable slight asymmetric prominence of the left laryngeal ventricle compared to the right”. There were no lesions or anything to explain my symptoms.

C Spine MRI showed “Mild cervical spondylosis” and “Broad-based calcified disc and osteophyte complex” but my Neuro and Pulmonologist do not this it is severe enough to explain my symptoms.

Biggest next step is with my Pulmonologist. Based on my PFT and symptoms of shortness of breath when laying/pressure when under water.. he seems to think there is a high probability that I am having some diaphragm weakness or paralysis. This suddenly makes a lot of sense to me.

It seems like a vast number of things could cause this.. I am obviously hopeful that if it was neuromuscular that there would have been widespread findings on my limb/tongue EMG. My Neuro didn’t seem to think that EMG of anywhere on my chest/back/phrenic nerve were necessary despite the PFT results and pulmonologist feedback.
I have a more thorough PFT MIP/MEP, Vital Capacity Test to confirm over the next couple weeks and will go from there to hopefully figure out the cause.

Thanks so much in advance for any thoughts.