question about neuro exam ...

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SEproud

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I had a post last week but thought of a new question (as I think about the neuro exam I had over and over in my head). Is it normal for a neurologist to tell you that you do not need an EMG just because you have no signs of clinical weakness? Does he just want to torture me by making me "wait and see" when he could just do the EMG and know the answer?
 

sportsfan

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i had an emg done and im still tormented by inceasing symptoms and my emg was clean.If i were you i would demand an emg for two reasons, one to help ease your mind and two i believe that the nuero exam only excludes umn .gtoodkuck and keep us posted
 

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I had a post last week but thought of a new question (as I think about the neuro exam I had over and over in my head). Is it normal for a neurologist to tell you that you do not need an EMG just because you have no signs of clinical weakness? Does he just want to torture me by making me "wait and see" when he could just do the EMG and know the answer?

What question would an EMG answer for you that he hasn't already answered for you? You have no clinical (objectively measurable) weakness. That takes the vast majority of conditions that could be detected by the EMG off the diagnostic table and leaves him open to accusations of unnecessary testing as well as subjecting you to unnecessary risks from the procedure (such as infection).

Let's say that the neuro gave you an EMG and it came back clean? What are you going to do then? You see what it's done for sportsfan. Is that the way you'll react too?

When you came here, you had no idea what an EMG was or probably that such a test even existed. Now, you're "tortured" because your neuro won't waste his time and yours doing a test you don't need? Why is that, exactly?
 

SEproud

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I'm tortured because I hate waiting to see if I get worse. I have random cramps so does that mean I'm really worse? or really crazy? (I guess I shouldn't ask that because I can guess what most people will say.) A loved one (not biologically related to me) had ALS so I do know of EMG but your are correct that I really am not that educated on how the test works or what the results mean. I was just wondering if it was normal practice to not do an EMG based soley on the fact that there was not clinical weakness? So I guess that's a yes from you trfogey :) thank you for your answer.
 

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Its quite normal for a neuro to refuse a patient an EMG. Mine did also. But then I drove him and my self and these good people here, completely nuts for several months, and he finally caved and gave me one. All along he had told me that it would be clean and of course....he was rite. Now that I understand more about how ALS works and how the EMGs work, I now know that I should have listened to him all along. No wonder the guy treated me like a nut case. I was, and I didnt listen. Do your self a favor and listen to your neuro, they know what they are talking about, and so do the good people here. So heed their advise, alot of them know this disease better than the doctors do.

And believe me, if they see something on exam that is worrisome to them, you wont have to ask for an EMG, they will be ordering it rite up for you. If the neuro says you dont need one, take that and run, trust me. Believe your neuro, this is what they go to school for.


Take care and relax


Robynn:)
 

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I think it shows that you have a good neurologist, who is confident in his clinical ability. Remember to have ALS you dont only have the LMN signs but UMN signs, which are very easy for a neurologist to test for.

I often read posts and are amazed how many people get EMGs just to allay the irrational fear, in a person that has no signs of a neurological disorder other than some widespread twitching, a bit of cramping and maybe some percieved weakness. It would be those neurologists that I would wonder about, especially if they do the tests themselves, boosting there revenue and upgrading their cars to the latest porsche.

I think therefore you should take it that not needing an emg is a good thing. I have had heaps with another coming up and I wouldnt want one if its not necessary :(

Unfortunately waiting and being patient, although terribly hard, is a must for many of these symptoms. I know I am still waiting and its been 4 years. You do learn that each day is too precious to waste worrying.

Hope your symptoms settle. These things often do.
Aly
 

kmendsley

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If you have no clinical weakness or obvious signs then why in the world would you suspect that you needed an EMG? It is an expensive test, and if you have no reason for getting it, healthcare, if you have any, will protest it and you will pay out of pocket for that one. Trust the Neuro, if they see no reason for you to get it, then there isn't one! Also, it is a horribly uncomfortable test...you don't want this one unless is is absolutely essential.
 

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I'm tortured because I hate waiting to see if I get worse. I have random cramps so does that mean I'm really worse? or really crazy? (I guess I shouldn't ask that because I can guess what most people will say.)

Random cramps are simply that -- random cramps. They don't mean that you're worse and they certainly don't mean you're crazy. They simply are. What they mean, if anything, will be shown over time if they are part of some pathological process.

A loved one (not biologically related to me) had ALS so I do know of EMG but your are correct that I really am not that educated on how the test works or what the results mean. I was just wondering if it was normal practice to not do an EMG based soley on the fact that there was not clinical weakness?

You do know that your loved one's ALS has nothing to do with you, don't you? He/she wasn't a blood relative, so you couldn't have inherited any genetically based disease from that person. ALS is not contagious, so that person couldn't have "infected" you with it.

What does appear to have happened is that the experience of losing that loved one has made you very anxious and hypervigilant about your own health, especially where symptoms that resemble, however superficially, those of ALS are concerned. That's a problem no EMG and no neurologist can help you with.

So I guess that's a yes from you trfogey :) thank you for your answer.

Yes, that was a "yes" to that particular question. You don't expect the doctor to send you for an MRI of your head every time you get a headache, do you? Why expect a neuro to do an EMG on a person whose clinical exam was absolutely normal -- "perfect", in fact?

Anxiety has the best of you right now. Please, please, please consider getting some help for it.
 

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I run my wifes cradiology practice, that is to say I do the books. She does hearts and I do charts. We often get people who insist on test they do not need, it is almost like they are looking for something to be wrong. In this day of diminished resources and outragous cost, and not to mention litigation happy people why would any practioner do an unnessacary test?
 

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My loved one seemed so happy and strong. I feel guilty that I didn't realize how hard it must have been. I should have been more ALS aware. She seemed so tough. I never once saw her cry. I just know that if I had or have ALS there would be no way in the world I could be the amazing person she was. I will be a wreck. So, the only thing she did "infect " me with is wishing that I could get one more day with her. This has nothing to do with my question but I just had to say just how wonderful she was ...
Thank you all for your responses. trfogey you are so helpful and smart. thanks.
 
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