Muscle wasting?
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OregonGirl
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Yes it all sounds good when he says its an Ulnar Nerve Injury
Just got the report and it states
EMG Summary Table
Spontaneous MUAP Recruitment Muscle Nerve Roots IA Fib PSW Fasc Other Amp Dur. PPP Pattern
L. Tibialis anterior Deep peroneal (Fibular) L4-L5 N None None 1+ N N N N N
L. Gastrocnemius (Medial head) Tibial S1-S2 N None None 1+ N N N N N
L. Vastus medialis Femoral L2-L4 N None None None N N N N N
L. Gluteus medius Superior gluteal L4-S1 N None None None N N N N N
L. Iliopsoas Femoral L2-L3 N None None None N N N N N
L. First dorsal interosseous Ulnar C8-T1 N None None None N N 1+ 1+ N
L. Abductor digiti minimi (manus) Ulnar C8-T1 N None None None N N 1+ 1+ N
L. Abductor pollicis brevis Median C8-T1 N None None None N N N N N
L. Flexor carpi ulnaris Ulnar C7-T1 N None None None N 2+ 1+ N Discrete
L. Flexor digitorum profundus, dig 4 & 5 Ulnar C8-T1 N None None None N N 2+ 2+ Reduced
L. Flexor carpi radialis Median C6-C7 N None None None N N N N N
L. Biceps brachii Musculocutaneous C5-C6 N None None None N N N N N
L. Triceps brachii Radial C6-C8 N None None None N N N N N
Abnormal findings were seen as follows: ? Abnormal spontaneous/insertional activity was found in the L. Tibialis anterior. ? Motor unit action potentials were abnormal in the L. First dorsal interosseous, L. Abductor pollicis brevis, L. Flexor carpi ulnaris, L. Flexor digitorum profundus, dig 4 & 5. ? Abnormal interference pattern was seen in the L. Flexor carpi ulnaris, L. Flexor digitorum profundus, dig 4 & 5.
All Greek (or at least some Latin) to me.
I always though abnormal MUAP and Interference Patterns were pretty consistent with MND.
Just got the report and it states
EMG Summary Table
Spontaneous MUAP Recruitment Muscle Nerve Roots IA Fib PSW Fasc Other Amp Dur. PPP Pattern
L. Tibialis anterior Deep peroneal (Fibular) L4-L5 N None None 1+ N N N N N
L. Gastrocnemius (Medial head) Tibial S1-S2 N None None 1+ N N N N N
L. Vastus medialis Femoral L2-L4 N None None None N N N N N
L. Gluteus medius Superior gluteal L4-S1 N None None None N N N N N
L. Iliopsoas Femoral L2-L3 N None None None N N N N N
L. First dorsal interosseous Ulnar C8-T1 N None None None N N 1+ 1+ N
L. Abductor digiti minimi (manus) Ulnar C8-T1 N None None None N N 1+ 1+ N
L. Abductor pollicis brevis Median C8-T1 N None None None N N N N N
L. Flexor carpi ulnaris Ulnar C7-T1 N None None None N 2+ 1+ N Discrete
L. Flexor digitorum profundus, dig 4 & 5 Ulnar C8-T1 N None None None N N 2+ 2+ Reduced
L. Flexor carpi radialis Median C6-C7 N None None None N N N N N
L. Biceps brachii Musculocutaneous C5-C6 N None None None N N N N N
L. Triceps brachii Radial C6-C8 N None None None N N N N N
Abnormal findings were seen as follows: ? Abnormal spontaneous/insertional activity was found in the L. Tibialis anterior. ? Motor unit action potentials were abnormal in the L. First dorsal interosseous, L. Abductor pollicis brevis, L. Flexor carpi ulnaris, L. Flexor digitorum profundus, dig 4 & 5. ? Abnormal interference pattern was seen in the L. Flexor carpi ulnaris, L. Flexor digitorum profundus, dig 4 & 5.
All Greek (or at least some Latin) to me.
I always though abnormal MUAP and Interference Patterns were pretty consistent with MND.
Nikki J
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Hi
Certainly any day the go to guy for ALS says it is not is a good day.
It is impossible for me to tell what goes in what column the way your emg posted. Is that the way it looks from wherever you copied it? I know some of my online labs have appeared very garbled on the patient portal
Abnormal MUAPs are very non specific. And they can be abnormal in different ways. We have had more than a few posters concerned about large ones. They were told by their neuros not to worry but did. So far none of those people have returned to report they now have ALS. Abnormal interference pattern is also non specific. I also see the interpretation puts question marks in front of every mention of abnormality. A person with ALS has a pattern of several abnormalities From the interpretation and what little I can guess from the body of the report you do not have that. What is the plan for follow up?
Certainly any day the go to guy for ALS says it is not is a good day.
It is impossible for me to tell what goes in what column the way your emg posted. Is that the way it looks from wherever you copied it? I know some of my online labs have appeared very garbled on the patient portal
Abnormal MUAPs are very non specific. And they can be abnormal in different ways. We have had more than a few posters concerned about large ones. They were told by their neuros not to worry but did. So far none of those people have returned to report they now have ALS. Abnormal interference pattern is also non specific. I also see the interpretation puts question marks in front of every mention of abnormality. A person with ALS has a pattern of several abnormalities From the interpretation and what little I can guess from the body of the report you do not have that. What is the plan for follow up?
OregonGirl
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Yes it was not put in nice columns just one big paragraph that I did my best to make somewhat readable. The weird thing is if I put into a columnar form, the +1's and +2's (which I guess are the indications of abnormal ranges) do not necessarily fall into the column that the doctor said has abnormalities in the "summary". It is very strange. And I may very well have my columns wrong.
Did my best to keep them separate in above message.
Follow up. Hmmmm. HmMmm. Hmmmm.
Well I am going to start taking Paxil for one so I can hopefully at least enjoy the now, the day by day. Stop being quite so anxious.
Would love to find a therapist but closest one is three hours one way. But still probably need to bite the bullet and do that.
The latest Neuro has me scheduled for a 6 month follow up. I will do that. For sure and stay in contact if other things start popping up.
In meantime - I would love to find a doctor who will refer me to the Neuromuscular/ALS Clinic (at OHSU) but that could be challenging.
It was hard enough when I started all this in July/August to get a Primary to provide a referral. The whole rotator surgery even had one Neuro refuse the referral based on "I was already being treated for my shoulder injury " - he obviously did not read the referring physicians notes very carefully.....that was three week waiting game just to get denied. That was when I started calling Neurologists myself and asking how soon they could get me in if I got a referral to them immediately.
SOOOO much wait and see for those who are affected and those who are experiencing other issues that cause the worry of being affected.
My latest fun change has been waking up in the middle of the night with a gasp for air. Mentioned that to latest neuro and he looked unimpressed.
Doing that 2-3 times a night is no fun and it's really affecting me as far as sleep disturbance - so hard to fall back after that happens. That started two weeks ago.
Trying to find normal. Know people on the forums are getting frustrated with my posts but this is a lonely place I am in, when people keep telling me "You look so good".
I wish I felt so good physically and emotionally.
Again those of you with DX and caring for those with DX have my utmost respect and admiration. I have no idea how you keep on keeping on. Strong people for sure.
All my best ~OG
Did my best to keep them separate in above message.
Follow up. Hmmmm. HmMmm. Hmmmm.
Well I am going to start taking Paxil for one so I can hopefully at least enjoy the now, the day by day. Stop being quite so anxious.
Would love to find a therapist but closest one is three hours one way. But still probably need to bite the bullet and do that.
The latest Neuro has me scheduled for a 6 month follow up. I will do that. For sure and stay in contact if other things start popping up.
In meantime - I would love to find a doctor who will refer me to the Neuromuscular/ALS Clinic (at OHSU) but that could be challenging.
It was hard enough when I started all this in July/August to get a Primary to provide a referral. The whole rotator surgery even had one Neuro refuse the referral based on "I was already being treated for my shoulder injury " - he obviously did not read the referring physicians notes very carefully.....that was three week waiting game just to get denied. That was when I started calling Neurologists myself and asking how soon they could get me in if I got a referral to them immediately.
SOOOO much wait and see for those who are affected and those who are experiencing other issues that cause the worry of being affected.
My latest fun change has been waking up in the middle of the night with a gasp for air. Mentioned that to latest neuro and he looked unimpressed.
Doing that 2-3 times a night is no fun and it's really affecting me as far as sleep disturbance - so hard to fall back after that happens. That started two weeks ago.
Trying to find normal. Know people on the forums are getting frustrated with my posts but this is a lonely place I am in, when people keep telling me "You look so good".
I wish I felt so good physically and emotionally.
Again those of you with DX and caring for those with DX have my utmost respect and admiration. I have no idea how you keep on keeping on. Strong people for sure.
All my best ~OG
Nikki J
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I think it would be worthwhile requesting a paper copy of the EMG from medical records. That should be in appropriate columns so you could actually see what was found. While you are at it get any other tests and progress notes you do not already have so you have everything in your possession
Maybe you need a new primary? At this point you need a strong and responsive internist who will assess the respiratory issue and test or refer you as needed
Maybe you need a new primary? At this point you need a strong and responsive internist who will assess the respiratory issue and test or refer you as needed
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Are you still taking the Valium at night???? That might be the reason you're gasping for air. I take it, too, but noticed that taking it at bedtime makes apnea worse or even causes it. Anxiety can cause it, too.
I still don't see ALS in what you posted. If seeing a neuromuscular doctor will get you to put this to rest, go for it. But you have to trust what she/he tells you.
I still don't see ALS in what you posted. If seeing a neuromuscular doctor will get you to put this to rest, go for it. But you have to trust what she/he tells you.
OregonGirl
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Kim - Not taking Prozac at night anymore. He started me back on Gabapentin at nigh for pain so took one last night.
Stress/anxiety - yes I guess your body can't just sleep through that can it.
I am waiting for it all to "even out" and things to stop progressing/changing. For the twitches to reduce, the pain to diminish and the stiffness to go away.
Not hat I don't trust him, I do trust him. I just know even the best of the best can misdiagnose - have seen it in posts here as well as first hand with some friends. I guess it is going to be a waiting game for me. He even told me that he thinks the only thing that will put my fears to bed is time.
Appreciate all of your time by the way. You should all get some sort of honorary doctorate in therapy......
I'm off to cook dinner, enjoy the view etc. Best to all.
Hi from my dogs and cats and horses - the furry therapists, think I'll hug them before i do anything else...... ~OG
Stress/anxiety - yes I guess your body can't just sleep through that can it.
I am waiting for it all to "even out" and things to stop progressing/changing. For the twitches to reduce, the pain to diminish and the stiffness to go away.
Not hat I don't trust him, I do trust him. I just know even the best of the best can misdiagnose - have seen it in posts here as well as first hand with some friends. I guess it is going to be a waiting game for me. He even told me that he thinks the only thing that will put my fears to bed is time.
Appreciate all of your time by the way. You should all get some sort of honorary doctorate in therapy......
I'm off to cook dinner, enjoy the view etc. Best to all.
Hi from my dogs and cats and horses - the furry therapists, think I'll hug them before i do anything else...... ~OG
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Hi, OG,
Did you & the neuro discuss/rule out purely UMND (PLS)? I'm not saying that you have it, just that it sometimes produces a similar pattern to what you are reporting.
Did you ask the neuro specifically about a referral to OHSU? Did he examine you yesterday or just do the test?
Starting gabapentin, stopping one SSRI and starting another is going to introduce its variables, so I would be careful about your attribution of any new sx for a while. I will also point out that SSRIs can produce their own sleep issues and it takes 4-6 weeks for the full effect to manifest.
No active denervation is good news indeed. I think the question marks are bullet point icons from a cut and paste, Nikki.
Did you & the neuro discuss/rule out purely UMND (PLS)? I'm not saying that you have it, just that it sometimes produces a similar pattern to what you are reporting.
Did you ask the neuro specifically about a referral to OHSU? Did he examine you yesterday or just do the test?
Starting gabapentin, stopping one SSRI and starting another is going to introduce its variables, so I would be careful about your attribution of any new sx for a while. I will also point out that SSRIs can produce their own sleep issues and it takes 4-6 weeks for the full effect to manifest.
No active denervation is good news indeed. I think the question marks are bullet point icons from a cut and paste, Nikki.
OregonGirl
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HI Laurie,
No I was not gutsy enough to ask for a referral to OHSU. Didn't want to hurt his feelings - how ridiculous huh?
Plus my husband is just so over all of this as I can imagine you all are too. Not to say he isn't 100% supportive and understanding. He wants me to be well, so he and my mom just keep wanting to here all is good. Which is what I should be doing too right, except I looked into so many possibilities on my own, shame on me am my curiosity! And I know my body, as such an active person it seems I am hyper-aware of how my body works.......
We did not dicuss PLS at this appointment- but he has in past and said he did not see that pattern in me.
He did examine me. Said my reflexes are less brisk. My nerve conduction study shows my nerves look better (whatever that means). Still no Babinski's. And my strength is still great. He can't believe how strong I am which makes me wonder if the strength issues will just take longer to show..... Although I must say that when I grasp things there is this weird "ghost" like feeling....my left hand is just not working like it use to. So hard to explain.
I do have another neuro I saw that said she would refer me to neurologist that she knows and trusts. So maybe I start there?
Anyone know the name/reputation of DR Kimberly Goslin - Portland OR associated with Providence Hospital?
Just seems like seeing another general neuro is spinning my wheels.
~OG
No I was not gutsy enough to ask for a referral to OHSU. Didn't want to hurt his feelings - how ridiculous huh?
Plus my husband is just so over all of this as I can imagine you all are too. Not to say he isn't 100% supportive and understanding. He wants me to be well, so he and my mom just keep wanting to here all is good. Which is what I should be doing too right, except I looked into so many possibilities on my own, shame on me am my curiosity! And I know my body, as such an active person it seems I am hyper-aware of how my body works.......
We did not dicuss PLS at this appointment- but he has in past and said he did not see that pattern in me.
He did examine me. Said my reflexes are less brisk. My nerve conduction study shows my nerves look better (whatever that means). Still no Babinski's. And my strength is still great. He can't believe how strong I am which makes me wonder if the strength issues will just take longer to show..... Although I must say that when I grasp things there is this weird "ghost" like feeling....my left hand is just not working like it use to. So hard to explain.
I do have another neuro I saw that said she would refer me to neurologist that she knows and trusts. So maybe I start there?
Anyone know the name/reputation of DR Kimberly Goslin - Portland OR associated with Providence Hospital?
Just seems like seeing another general neuro is spinning my wheels.
~OG
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She directs the Providence ALS Center. So a plausible referral. The additional detail about serial improvement in your tests/exam is encouraging and does point away from MND. The "ghost feeling" coupled with pain suggests the possibility of a sensory component which also points away. So all in all, things are looking good from the MND standpoint.
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