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planningguy
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lbeyerl,
Wright would be the best at describing what a "good" EMG process would look like, and what the specialist is looking for (You might want to do a forum search for an earlier response to the EMG question, as I know it has been discussed in detail before). The equipment of both my local neuro and the academic medical center had a monitor to watch the waveforms, but, like BethU, I had a fellow being trained during my exam. Listening seemed to be a critical component, and both doctors used a handful of tricks to get me to relax my muscles to get a valid reading before having me contract. They also retested a couple of areas.
The fact that your GP was concerned at the chart notes, and that the EMG took such a brief time seem to indicate the test wasn't thorough. Has your GP decided on "next steps?" One phrase I have found helpful is, "What would you do if you were in my shoes," or, "Which specialist would you see?"
Best of luck,
Robert
Wright would be the best at describing what a "good" EMG process would look like, and what the specialist is looking for (You might want to do a forum search for an earlier response to the EMG question, as I know it has been discussed in detail before). The equipment of both my local neuro and the academic medical center had a monitor to watch the waveforms, but, like BethU, I had a fellow being trained during my exam. Listening seemed to be a critical component, and both doctors used a handful of tricks to get me to relax my muscles to get a valid reading before having me contract. They also retested a couple of areas.
The fact that your GP was concerned at the chart notes, and that the EMG took such a brief time seem to indicate the test wasn't thorough. Has your GP decided on "next steps?" One phrase I have found helpful is, "What would you do if you were in my shoes," or, "Which specialist would you see?"
Best of luck,
Robert
lydia
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sound of my EMG test
Just have a question related to discussion above:
Recall my EMG supposedly poked 13 muscles (left lower leg & left lower arm) in under 25 minutes (not including NCV in here, that took awhile). I suspect I did not get a thorough EMG based on comments by many forum members.
Ok, so the previous is old news (if you were successful wading through my lengthy posts). What is new is there was no noise on my EMG. There was no sound period. As in volume turned off. I had read enough here to know to at least attend to the sound of the EMG even if I couldn't make sense of it and remember being bummed there was no sound. Is the sound that important for interpretation? There was a monitor displaying the wave forms or whatever. I suspect that particular graphic displays are accompanied by particular sounds; that the two combined together support a particular interpretation. But that you should be able to interpret based on graphic display alone, and being able to associate a particular sound with the display is like icing on the cake. So is the sound necessary for interpretation? Or does it just make interpretation easier when the sound is 'obviously' associated with a particular graphic display?
Just have a question related to discussion above:
Recall my EMG supposedly poked 13 muscles (left lower leg & left lower arm) in under 25 minutes (not including NCV in here, that took awhile). I suspect I did not get a thorough EMG based on comments by many forum members.
Ok, so the previous is old news (if you were successful wading through my lengthy posts). What is new is there was no noise on my EMG. There was no sound period. As in volume turned off. I had read enough here to know to at least attend to the sound of the EMG even if I couldn't make sense of it and remember being bummed there was no sound. Is the sound that important for interpretation? There was a monitor displaying the wave forms or whatever. I suspect that particular graphic displays are accompanied by particular sounds; that the two combined together support a particular interpretation. But that you should be able to interpret based on graphic display alone, and being able to associate a particular sound with the display is like icing on the cake. So is the sound necessary for interpretation? Or does it just make interpretation easier when the sound is 'obviously' associated with a particular graphic display?
wright
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The sound is NOT needed at all to interpret an EMG.
The sounds are created by the positive sharp waves, fibrilations, fasics, etc. that are being detected by the EMG needle . . . that are also scrolling across a monitor that the neuro is looking at . . . that are also being collected by a computer so it can be played back and analyzed if needed.
If your neuro is well versed, he/she will be able to tell you . . . as they are administering the EMG . . . what the results are with or without the sound.
Analogy: everyone has seen "doctor" shows on the television when someone is hooked-up to an EKG and you hear the "beep beep" sound. You can turn that sound off and the docs will still know what is happening to that person's heart.
I wrote a more detailed post about all of this some time ago but I'm not sure where it is. I'm sure if you do a search, you will find it.
P.S. One other thing I must mention:
It is completely normal for there to be "sound" when the needle is first inserted into a muscle. No sound will be heard once the needle "settles into" the muscle . . . unless the neuro is looking at the motor unit potential . . . then the needle will be manipulated in a way to analyze it . . . and there will be sound. Sometimes people will mistake that sound as a sign of denervation.
The sounds are created by the positive sharp waves, fibrilations, fasics, etc. that are being detected by the EMG needle . . . that are also scrolling across a monitor that the neuro is looking at . . . that are also being collected by a computer so it can be played back and analyzed if needed.
If your neuro is well versed, he/she will be able to tell you . . . as they are administering the EMG . . . what the results are with or without the sound.
Analogy: everyone has seen "doctor" shows on the television when someone is hooked-up to an EKG and you hear the "beep beep" sound. You can turn that sound off and the docs will still know what is happening to that person's heart.
I wrote a more detailed post about all of this some time ago but I'm not sure where it is. I'm sure if you do a search, you will find it.
P.S. One other thing I must mention:
It is completely normal for there to be "sound" when the needle is first inserted into a muscle. No sound will be heard once the needle "settles into" the muscle . . . unless the neuro is looking at the motor unit potential . . . then the needle will be manipulated in a way to analyze it . . . and there will be sound. Sometimes people will mistake that sound as a sign of denervation.
lydia
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Thanks Wright, I didn't think the sound was necessary.
But I am curious about the "recording" the computer makes...can one actually get that for outside review; like doing an inter-rater reliability? Is it stored somewhere with your records?
I feel so suspicious that he did not stick 13 muscles (in 25 minutes), and yet recorded on sheet that he did. Could it be that he stuck a few muscles and things looked good so he decided....why bother doing all (especially because I believe I did make it known that the cramps that came with flexing hurt)...perhaps he was sparing me? And if that is even a possibility, should I even care? Just be grateful? If one or two muscles were "good" on the lower leg, would that mean the others on lower leg were ok...so why continue with a test that is producing some discomfort? I believe regular neuro discounted MND possibility based on the EMG results, so I need some assurance that the EMG was a good/thorough EMG (recall I do have weakness, atrophy, twitching-among other things). Based on the duration of test alone I guess I can conclude the EMG was not thorough and maybe my questions are just nit-picking at this point.
Wright, I saw in a previous post you mentioned something about having a 3 hour EMG...wow. Can you elaborate on that somewhere on the forum? Did that include the NCV?
But I am curious about the "recording" the computer makes...can one actually get that for outside review; like doing an inter-rater reliability? Is it stored somewhere with your records?
I feel so suspicious that he did not stick 13 muscles (in 25 minutes), and yet recorded on sheet that he did. Could it be that he stuck a few muscles and things looked good so he decided....why bother doing all (especially because I believe I did make it known that the cramps that came with flexing hurt)...perhaps he was sparing me? And if that is even a possibility, should I even care? Just be grateful? If one or two muscles were "good" on the lower leg, would that mean the others on lower leg were ok...so why continue with a test that is producing some discomfort? I believe regular neuro discounted MND possibility based on the EMG results, so I need some assurance that the EMG was a good/thorough EMG (recall I do have weakness, atrophy, twitching-among other things). Based on the duration of test alone I guess I can conclude the EMG was not thorough and maybe my questions are just nit-picking at this point.
Wright, I saw in a previous post you mentioned something about having a 3 hour EMG...wow. Can you elaborate on that somewhere on the forum? Did that include the NCV?
wright
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Lydia
You have every right to your records and every right to ask your neuro exactly what muscles were EMG'd. Needling 13 muscles in 25 minutes seems a bit quick to me.
You obviously have every right to get another EMG from another neuro, too.
My 3 hour EMG included the NCS. I had many nerves tested in all 4 limbs during the NCS portion, including the motor portions of nerves that are not normally done because of the pain (I insisted they were done, though). I also had 18 muscles needled in 3 limbs and some back and lumbar muscles during the EMG .
It was all methodically done and I knew the results of each nerve and muscle immediately after each of them was done and sometimes, while they were being done.
P.S. This all doesn't mean everyone has to have a 3 hour EMG for it to be thorough; mine was just extra thorough.
lbeyerl
It sounds as if you need to get another EMG because 5 minutes is just ridiculous. Was your neuro late for his tee time? I bet you might get closer to some answers when it's done in a more thorough manner. Keep us informed. Again, atrophy like you saw in a matter of a month is just not typical of ALS at all. That is how a peripheral neuropathy would behave.
You have every right to your records and every right to ask your neuro exactly what muscles were EMG'd. Needling 13 muscles in 25 minutes seems a bit quick to me.
You obviously have every right to get another EMG from another neuro, too.
My 3 hour EMG included the NCS. I had many nerves tested in all 4 limbs during the NCS portion, including the motor portions of nerves that are not normally done because of the pain (I insisted they were done, though). I also had 18 muscles needled in 3 limbs and some back and lumbar muscles during the EMG .
It was all methodically done and I knew the results of each nerve and muscle immediately after each of them was done and sometimes, while they were being done.
P.S. This all doesn't mean everyone has to have a 3 hour EMG for it to be thorough; mine was just extra thorough.
lbeyerl
It sounds as if you need to get another EMG because 5 minutes is just ridiculous. Was your neuro late for his tee time? I bet you might get closer to some answers when it's done in a more thorough manner. Keep us informed. Again, atrophy like you saw in a matter of a month is just not typical of ALS at all. That is how a peripheral neuropathy would behave.
lostinlouisville
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Write
Do you think as part of our medical expensive we can just fly you to us and have you go to our Dr. visits with us.lol That would be so helpful.
Do you think as part of our medical expensive we can just fly you to us and have you go to our Dr. visits with us.lol That would be so helpful.
BethU
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CB ... I copies the report all out, then lost the message, and don't have the energy to type it again.
First ... obviously I was wrong about the sound being important in an EMG (see Wright's answer), although the neuro who was conducting my second one made a big deal about it.
They tested 10 areas, from my tongue on down, and found chronic and/or acute denervation in three areas. One was my left trapezius, another was my tongue, and I'm not sure about the third. I think it was in the lumbar region.
I don't think my results can tell you anything about your situation, but that's what it was.
Take it easy,
BethU
First ... obviously I was wrong about the sound being important in an EMG (see Wright's answer), although the neuro who was conducting my second one made a big deal about it.
They tested 10 areas, from my tongue on down, and found chronic and/or acute denervation in three areas. One was my left trapezius, another was my tongue, and I'm not sure about the third. I think it was in the lumbar region.
I don't think my results can tell you anything about your situation, but that's what it was.
Take it easy,
BethU
lbeyerl
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Thank you Wright everyone else for the advice.
I am visiting the same neuro today to get my full report and to follow up with him. My atrophy has gotten very bad in the knees, hands, calfs. My legs shake after walking for a while and fingers and toes are jumping constantly.
However, I have already scheduled an appt with a neuromuscular specialist Dr. Bravvar in Charlotte NC. She works with the ALS/MDA clinic so I'm guessing she is very knowledgeable in these types of things. Not saying that I have either one..but I was looking for someone with some type of credentials as opposed to Dr. "Let me just stick this here needle in ya". Hopefully she will repeat the EMG and let me know what the heck is going on with my body.
So I will try again and make sure to request a thorough EMG with all the elements you all have suggested. Thank you!
I am visiting the same neuro today to get my full report and to follow up with him. My atrophy has gotten very bad in the knees, hands, calfs. My legs shake after walking for a while and fingers and toes are jumping constantly.
However, I have already scheduled an appt with a neuromuscular specialist Dr. Bravvar in Charlotte NC. She works with the ALS/MDA clinic so I'm guessing she is very knowledgeable in these types of things. Not saying that I have either one..but I was looking for someone with some type of credentials as opposed to Dr. "Let me just stick this here needle in ya". Hopefully she will repeat the EMG and let me know what the heck is going on with my body.
So I will try again and make sure to request a thorough EMG with all the elements you all have suggested. Thank you!
lbeyerl
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This might be a silly question, and I know i have seen it on this forum before but I can't seem to locate that thread.
In any muscle/nerve condition, not just als, would you have to have a fasciculation during the EMG for the EMG to pick something up? I did not have any during the EMG but had them in the areas the needles were after the EMG.
Can abnormalities of any kind be picked up without an fasciculation present during the EMG?
In any muscle/nerve condition, not just als, would you have to have a fasciculation during the EMG for the EMG to pick something up? I did not have any during the EMG but had them in the areas the needles were after the EMG.
Can abnormalities of any kind be picked up without an fasciculation present during the EMG?
BethU
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I think I'm right on this (I seem to be right about 50% of the time, so don't take this to the bank 
) ... but you do not need any surface (visible) twitches or fasics for an EMG to determine how the muscle is behaving.
At least in my case, I did not have any twitches or fasics anywhere except on my tongue, yet the EMG found denervation in two additional areas. I don't know about "abnormalities of any kind" ... you'll probably need Wright for that.
BethU
) ... but you do not need any surface (visible) twitches or fasics for an EMG to determine how the muscle is behaving. At least in my case, I did not have any twitches or fasics anywhere except on my tongue, yet the EMG found denervation in two additional areas. I don't know about "abnormalities of any kind" ... you'll probably need Wright for that.
BethU
planningguy
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Thank you Wright for setting the record straight. A professor of mine once offered a couple of pieces of advice as we were heading out into our chosen profession:
1. It's no a question of if you will be sued but when.
2. Always admit when you are wrong.
The advice has proven helpful. I was drug into a lawsuit for a development that was illegally subdivided when I was a toddler, and I was wrong about sound and EMG.
Robert
1. It's no a question of if you will be sued but when.
2. Always admit when you are wrong.
The advice has proven helpful. I was drug into a lawsuit for a development that was illegally subdivided when I was a toddler, and I was wrong about sound and EMG.
Robert
lydia
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I don't know if anyone has really been wrong about the sound being important to an EMG; it seems to me that the sound can be very helpful...it is just not necessary for interpretation. Obviously some of the neuros really attend to the sound, it has to be helpful for them to bother doing that and to go to lengths to demonstrate listening to an EMG to beginning doctors, it must be an additional important clue...just not necessary. I know I would never be able to differentiate the sounds if their difference was subtle. I still can't get over the neuro described above that only used the sound; how scary.
Lydia
Lydia
lbeyerl
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I visited my neuro again today. I felt like I was at a drive through.
He did the same exam he did to me last time and said he didn't notice any twitches and couldn't tell if i had atrophy because he had not really seen my body before hand (what!).
I did ask him what my muscle enzymes were from my initial regular doctor visit in early august he said they were 40. When he tested me two weeks ago, they were at 54. I asked why this was, he said vigorous exercise will do that. I told him I do not exercise except for walking a few nights a week....and that is not what I would call vigourous. He said it was normal.
He did notice a lot of shaking in my fingers and limbs when strethced but said it is something to have my 2nd opinion doctor look into. Wow. Thanks.
I am so frustrated and thinking maybe I should just quite with the doctors. I feel and look worse almost every day. My parents are coming up to see what can be done, I have not felt good since late july/august and they are worried. I have never really been the type to get sick.
I think I will at least go to the other doctor and talk to her about the EMG and see what she says.
He did the same exam he did to me last time and said he didn't notice any twitches and couldn't tell if i had atrophy because he had not really seen my body before hand (what!).
I did ask him what my muscle enzymes were from my initial regular doctor visit in early august he said they were 40. When he tested me two weeks ago, they were at 54. I asked why this was, he said vigorous exercise will do that. I told him I do not exercise except for walking a few nights a week....and that is not what I would call vigourous. He said it was normal.
He did notice a lot of shaking in my fingers and limbs when strethced but said it is something to have my 2nd opinion doctor look into. Wow. Thanks.
I am so frustrated and thinking maybe I should just quite with the doctors. I feel and look worse almost every day. My parents are coming up to see what can be done, I have not felt good since late july/august and they are worried. I have never really been the type to get sick.
I think I will at least go to the other doctor and talk to her about the EMG and see what she says.
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