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Sammantha

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I went over one of my EMG's with my new one. It turns out that the two muscles they tested the second time were the exact same ones that showed no abnormalities on my first test. My thighs left and right (vast medialis) had 2+ psw 2- amp and 1+ recruitment pattern. R and L tib anterior had 1+ psw 1+ amp. My L and R peron longus had 1+ psw 1+ amp and 1+ recruitment pattern. My L ext hall long had 1+ psw and 2+amp. The right had 1+psw. L bic fem head had 2+ psw and 2- amp. R was normal. L deltoid had 1+ psw and 1+amp R deltoid had 1+fib and 2+ amp. L and R biceps had 2+fibs, 2+psw, 2+amp and 1+ recruitment pattern. L flex carpi uln had 1+psw, 1+amp. R gasrtocn med had 1+fib and 1+amp. That was my first EMG, the second EMG he tested my Left Gastrocn med, and my Left Tricep. They were normal even though he took three hours to test them and they sounded like a helicopter the whole time. Guess what, they were normal on my last test too. They did not test any of the other muscles to see if there was damage or improvement. Like doc said, no matter what muscle is tested if it were ALS it would be abnormal...... So what is it? Has anyone had test results like these with brisk reflexes? I am glad it is not ALS but i would like to know what it is... Thanks Sam.
 

CindyM

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I hear you, Sam. we would all like to know what it is! Cindy
 

guwainengle

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Interesting-- At least they didn't tell you it was anxiety or too much caffine-- They told me too much caffine at first-- I don't drink coffee and rarely drink soda... Anxiety-- I didn't have it till I had the symproms... It will always go back to the story-- lets wait a few more months and see you back and check you out again.

G
 

Jamiet

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Sam,

Everything i've read and even spoke about to the ALS spec, is that an EMG on two muscles is not adequate, no matter how long it took. And the fact that ALS would be in every muscle is BS and 100% will not apply to every case, i'm sure some PALS and CALS here can testify to that. Two muscles don't even come close to meeting the El Escrorial (Sp.) criteria for diagnosed ALS via EMG.

Is this an ALS clinic that did this EMG? Have you seen an ALS specalist at an ALS clinic, it seems weird to only test two muscles.

Sorry to say bad news, but its the truth.

rgds,

Jamie
 

ltr

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Jamie's right on, and too many times are EMG's are pointless. I had two needle sticks and the doc's just can't figure out how nothing showed up, yet my biopsy was positive. To me, it seems easy, but I didn't get the med license, so I must be missing something. :)
 

Jamiet

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I bet with a little more training on how to read muscle waves, all of us in here would do a hell of alot better EMG than 90% of the Neuros out there!

Maybe, we should all open an "adequate EMG business"....funds going to ALS assn.

And before we finish the EMG, sit with the patient for about 20 mintues, let them calm down, then ask them if they think it was adequate, make sure you spend at least two hours doing it, testing every limb and muscle. Then sit with the patient again, ask them again if they want any more muscles tested and if they thought they heard something funny too and address it right there with them and re-do that muscle.

I paid $1,900 for each of my two EMGs at the ALS clinic and they were about 15 - 20 mintues each.
 

brooksea

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Y'all - here is the summary from my husband's EMG, proving Jamie's point that you have to test more than 2 limbs:

"His EMG demonstrates predominantly fasciculations and sparse fibrillations throughout the left upper extremity. Very limited fibrillations with more prominent fasciculations in the right upper extremity, no significant abnormalities noted in the legs or paraspinal musculature."

What if the neuro only tested the legs and/or the paraspinal muscle area? How do they choose which area to test and why?
 

lhagsjr

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Jamie

Did u pay out of pocket for your EMGS or your insurace?

Ive had 2 EMG's done. One in March which was done by a local neuro. He tested 8 muscles all on my right side. This was basically 100% clean. It showed increased insertational activity in only one muscle(calf). This is non diagnostic if its by itself. This took about 25 mins. This cost only $600.

In June, I had it done on my left side by the ALS Doc. This took about 45 minutes and was different. He dug a lot deeper with the needle and moved it around a lot once inserted. This again showed increased insertational activity and some other small abnormalities. Zero Fibs, PSW's or Fasics. This cost $6500 so you can see the differences....
 

Jamiet

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Insurance paid, but they wanted me to write a check right there before i convinced them that i met all my deductibles !

It may have been 45 mintues, but it seemed like 20 or so. He did do about 5 muscles, hand web about 2 - 3 diff places, bicep, tricep, quad, calf feet and when he found the NCV defect, he stopped the needle part. He did spend alot of time in each muscle. He did my right calf, which was the smaller one and it showed nothing.
 

brooksea

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Husband's EMG was covered by insurance. I have to say that we were very "lucky" to have been referred to a neurologist that was very precise and knew exactly what he was doing. But before the EMG, he asked us an open ended question regarding symptoms/diagnosed. We told him we feared ALS. He told us that was what he thought as well, but needed to run tests to make sure. He was very thorough and took a very long time with my husband on each visit and even allowed us to stay in his office privately to pull ourselves together. His office staff were very caring. This doctor went beyond what I've ever experienced in healthcare. He asked if my husband would like to continue seeing him or would he like to go to Emory. He explained that Emory would have all the specialists in one location and we would not have to travel around and make multiple appointments. He even took me on as a patient so he could prescribe an antidepressant to help me over the shock.

My husband recently dropped in on him to tell him thank you for his kindness. He graciously took the time out to speak with my husband.

I wish you all had the same experience while facing such a devastating possibility.
 

ltr

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Jamiet said:
I bet with a little more training on how to read muscle waves, all of us in here would do a hell of alot better EMG than 90% of the Neuros out there!

Maybe, we should all open an "adequate EMG business"....funds going to ALS assn.

And before we finish the EMG, sit with the patient for about 20 mintues, let them calm down, then ask them if they think it was adequate, make sure you spend at least two hours doing it, testing every limb and muscle. Then sit with the patient again, ask them again if they want any more muscles tested and if they thought they heard something funny too and address it right there with them and re-do that muscle.

I paid $1,900 for each of my two EMGs at the ALS clinic and they were about 15 - 20 mintues each.


That's all it would take....spending some time with the patient, listening and making sure that they (we) are comfortable and all our questions answered. Something we could take home with confidence.
 

Sammantha

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Thank you for all your replies, i really really hate all of what I (we) have to put up with, sometimes i try to block it out of my mind, but when i am really feeling it, like today it is good to know that there are people out there that i can talk to and know what they are talking about..... Thanks, Sammantha
 

Sammantha

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One other thing i forgot, on my first test i had facics in the vast medialis and right tibe anterior.... Neither of muscles were tested the second time.
 

robc

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I dont get the whole EMG thing. I had super thorough EMG 6 weeks ago at the Cleveland Clinic that was completely normal.

Yesterday I had an EMG at OHSU that was not normal. The doctor who performed the EMG had a resident in the room & kept saying things like "ohh that's very myopathic", "small motor unit potentials" & even said in front of me to the resident "they will probably have to repeat the biopsy".

And then when the test was over, he wouldn't answer my questions except to say that he would be sending a report to my neurologist.

How's that for frustrating?

I think I understand enough in this case to gather that what they were talking about was muscle disease not dennervation - already have a biopsy that shows dennervation/fiber type grouping and I have widespread fasciculations so I'm not sure why it doesn't show up on the EMG. - And I don't see how I can have a normal EMG 6 weeks ago & a myopathic EMG this week.

Go figure - there's my EMG rant.
 

Jamiet

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jimercat said:
Husband's EMG was covered by insurance. I have to say that we were very "lucky" to have been referred to a neurologist that was very precise and knew exactly what he was doing. But before the EMG, he asked us an open ended question regarding symptoms/diagnosed. We told him we feared ALS. He told us that was what he thought as well, but needed to run tests to make sure. He was very thorough and took a very long time with my husband on each visit and even allowed us to stay in his office privately to pull ourselves together. His office staff were very caring. This doctor went beyond what I've ever experienced in healthcare. He asked if my husband would like to continue seeing him or would he like to go to Emory. He explained that Emory would have all the specialists in one location and we would not have to travel around and make multiple appointments. He even took me on as a patient so he could prescribe an antidepressant to help me over the shock.

My husband recently dropped in on him to tell him thank you for his kindness. He graciously took the time out to speak with my husband.

I wish you all had the same experience while facing such a devastating possibility.


Wow, i hope you told this doctor he is one of few like him....what a special person...he deserves doctor of the year in my eyes...
 
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