Confused by Normal EMG Results

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Ghandiks

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Hi All, I had my my neuro follow up yesterday and I feel lost. This is my first post telling my story and how this all started: I had an EMG, MRI, and blood work. She said my EMG was "normal," and that they don't know what is causing my symptoms so we'll just have to take a wait and see approach. The normal EMG confused me since the neuro that actually did my EMG said I have nerve root irritation shown by increased insertional activity which may show up prior to denervation, sharps, and fibs on an EMG. I told my neuro this and she said that increased insertional activity is an abnormal finding but by itself doesn't tell them anything. So with that information that can't diagnose ALS but they also can't rule out ALS. Also that increased insertional activity by itself is not indicative of ALS. She said I might be in the early stages of some disorder (not just ALS) and so tests may not show anything at this stage. She wants to do another EMG in December to see if it shows anything and until then she said try to live a normal life. EASIER SAID THAN DONE! I just feel so lost and hopeless. Also, what bothers me is how she considered my EMG to be normal even with the increased insertional activity. If the other neuro hadn't told me it was an abnormal finding my neuro would have sent me on my way with a diagnosis of BFS, a clean EMG, a clean MRI, and a clean MRI exam. Only because I asked about the abnormal finding did she admit that it was not 100% normal. So it makes me wonder how many neuros out there tell their patients they have a normal EMG when there was at least one abnormal finding? I am definitely not trying to scare anyone or make them doubt their results, I just wonder if there are others that did have increased insertional activity but it was considered a normal EMG? I hope some of you will ask on your next visit to the neuro to get a copy of your EMG report. I just want to see if others have this on their EMG report as well, that will definitely make me feel better and allow others to see that this finding is common for BFSers. I also was wondering if some of you have small, mild twitches? I've never had big thumper twitches. I only have small, soft, mild ones. I think they evolve at times though. Some are like pops, some waves or vibrations. I know people get different kinds of twitches but just wondering if anyone only had these kind as well? I have also started to have mild cramps in my left foot and calfs as well. I had a small cramp in my foot and what seems like almost cramps in my calfs. Pain in muscles as well usually lower legs and feet. It also feels like my left side is weaker but I can still function normally. So yes I'd just like to hear from some of you that have heard this from your neuro, about not being able to rule out ALS and the kinds of twitches you've experienced. Thank you.--Helen
 
You don't need a doctor to rule ALS out. All that really matters is that you rule it out. If you look into the OCD patterns of health anxiety you'll notice the underlying trend where people constantly look for reassurance from external sources to know that they are OK. Multiple clean EMG's and neuro opinions never seem to satisfy them. That's because health anxiety is a trap of the ego. No matter what the appetite of the ego, whether it be greed for money and power, a need for attention, or a consuming fear that cannot be extinguished... It's like a black hole. The solution? Rise above the ego and know in your heart that you're fine now and always will be fine. Your mind can be your own worst enemy when you let it run lose with the ego behind the wheel. Put your heart behind the wheel and you'll be a much happier, calmer person. I hope this makes sense...
 
Yes, my neuro said the same thing. She couldn't rule out MND based on the fact that my symptoms came and went. It took me great courage to straight out ask her. It was really a disservice to my psyche at the time. But it doesn't matter. I have no clinical weakness so I am ok. They even called to reschedule my followup and push it way back in the summer. Maybe it interferes with her vacation time, lol. So I know they don't see me as a priority and aren't worried about me. I don't plan on going back... to her at least. I don't see the point other than to get some... any.. diagnosis. As far as the EMG results, I don't see the point in digging that deep. If there was something there I really needed to know about, I trust they would have let me know. I've had all the twitches (mild and thumpers), buzzing, tremors, etc... that anyone can have... in every part of my body just about. They don't really mean anything to me other than a conversation topic now. Am I 100% worry free? No. There is always something in the back of my mind whenever my hands cramp up, the twitching flares, or I feel weak walking up stairs. That something is the unknown. I think with BFS and the related disorders, it will always be there to some extent. But it's not deadly. Mark
 
Increased insertional activity is a sign of hyperexciteable nerve. BFS is nerve hyperexciteability. So it is not a surprise. It also occurs especially in young people for just no reason. The problem is: you want someone to rule it out 100%. This just WON'T happen. The more you ask your doctor about definite answers, the more he will feel the need to cover his butt. Especially in a country where some people make a living on sueing doctors. And even IF some doctor gives people the 100%, their mind finds a way to just ignore it and keeps on worrying anyway. This is part of the nature of health anxiety. I can totally tell you, that I know that my doctor would not waste one thought on a clean EMG with just increased insertional activity. The actual problem is now, to get your mind to accept that it can only get the 99,99999 instead of 100%. This sounds so easy, but is actually one basic underlying problem of most BFSers. The worst way to handle this is searching for external reassurance. This will not work. People with BFS are not pushed into the depths of the medical system that usually has no answers for diseases like BFS, they decide to jump. Over and over again, and hit the floor bad, when they do not get the answers they want. This is a VERY self destructive way. The mind will not be the answer in this case. Our nerve system and mind are totally affected by BFS, the hyper nervous state and and anxiety allow us no normal and healthy view on this situation. So you have to find a way to find your inner balance again, and to trust and to believe in the fact that you are healthy. There are many ways you can try to solve this mind problem. One is for sure to distract yourself with positive things. Another may be a therapy for health anxiety, meditation or religion. Trust yourself you are OK, or trust in god if you are religious. In any way, you have to find a way to fill yourselve with the conviction of not dying, because the controlled mind is not very helpful at this point. Just DO something, stay active. Go on with your life an do not allow your mind to make you sit in your home and play tricks on you. Most BFSers are rather clever and have a very analytical and scientific mind. So with the good experiences we made with it so far, we have learned to trust our brains. Now in this situation, where our mind is so screwed up, it can turn into our worst enemy. So we have to find a way to calm down this voice. I know that this is WAY easier said than done.
 
I had increased insertional activity noted on my EMG in all my muscles tested. The Mayo clinic told me the same thing Chrissi said, its a sign of hyperexcited nerves. They told me that because I twitch all over, they would expect increased insertional activity. It's all benign. -Matt
 
I had my first (and hopefully, last) EMG yesterday. The neuro stuck the needle directly into muscles in my "problem" left leg and foot and a few other locations. At the end, he said he doesn't see anything indicative of anything serious. Probably just irritated nerves or something minor. So, even after he said that there was basically nothing going on to worry about from an EMG standpoint, I stupidly asked "So I can stop worrying about ALS?" He looked at me for a second and said "There is nothing in your testing or clinical exam to indicate anything serious, but I can't tell you won't develop ALS." Reading lots of experiences on here and other sites, that seems like a pretty standard response. The key is, don't focus on the wrong part of what the neuro said. Personally, I feel better than I've felt in months after yesterday. I'm still twitching and my left leg still feels weaker than my right, but for now, I don't have any clinical evidence of ALS. It sounds like you don't either. Let's celebrate.
 
Thank you all for your support and input. I've been feeling a lot better lately since I've been focused on other things, not good things, but other things. I've recently, yesterday to be exact, had another panic moment because a few days earlier I had found some spots on my legs and right arm that look like dents. Not really dents but more of a spot on my skin that is circular, dark, and flatter than the surrounding. When I feel it I can feel it dip in, kind of like those crater acne scars. Only its not really deep like a crater acne scar. I don't know what they are but they definitely haven't been there before. Just wondering if anyone knows if atrophy starts off like that in small tiny spots (like one muscle cell/fiber) then grows to encompass the whole muscle or if it starts in whole muscle groups. I have no weakness and from what I know weakness always precedes atrophy so I just wanted your guys' input on this.Ah, one more thing. The joints on my left side from head to toe, seem to crack more without me doing it on purpose. I mean this is from my ankle, to knee, shoulder, sometimes it doesn't even feel like a joint. Does anybody experience this or should I be worried? This doesn't happen on my right side. My left side is the side that gets intermittent weakness, pain, more twitches, and this cracking. Thanks.
 
Thanks Sue. Might be cellulite but might be not since two spots are on my shin where there is not much fat. Also found some horizontal lines across the front of my thighs. My new concern is this twitch between my thumb and pointer in my left hand. I didn't know I had it until today because I couldn't really feel it. I used a pen light to shine light over the area and I saw very fine twitches, like a pulse only it was very quick. Earlier in the day it was a strong twitch and made my thumb twitch with it. Now its not as strong and can only be seen with a light. This makes me really nervous. Are fine quick twitches a bad sign? I probably had it for a while only didn't notice it before. Has any one had small fine twitches they couldn't feel? I've read on here that some people had obvious twitches they could see and not feel but how about small fine twitches they couldn't feel and barely see? I can kind of feel this one sometimes but it doesn't feel like a regular twitch.
 
I have that right now actually, very fine twitches under my thumb in the thumbpad that can only be seen in certain lights. I made a post about it. Naturally I kind of freaked like you because you probably read the first post here and what it says about "fine twitching" and "special lights." At first it was moving my thumb as well but then they turned into very fine twitches. I find myself just searching them out and even tried to show someone who suspected I was seeing things, but they were definitely there. I have searched the forum more thoroughly and see that other people have had them, and frankly in my 5 years of this, I probably have had them before too. I try to calm myself by just realizing that if I wasn't seeking them out, would I know they were there? I can't believe I am back to "checking" again for twitches, strength and whatnot because of my stupid throat issues. BFS is a *beep*.
 
Here's the deal; I've been having a multiplicity of twitches for the past 8 months that range from mild, small, vibration, popcorn popping, types of feelings. And you bet it scared the bejesus out of me. I too went down that rabbit hole of tons of blood work, Ct's, MRIs, EMG, all to rule out/or diagnose anything and everything (in my mind ALS being the most destructive). Yes, the muscle cramps, and mind tricks of looking at yourself and wondering if you're starting to atrophy away...it sucks. I realized I was having muscle cramps as a result of my muscles twitching for hours at a time. Its quite the workout for them and so they are going to hurt. I purchased a product called "bio-freeze" from my chiro and this stuff really helps out with the cramping. As far as the twitching is concerned, I've learned to meinganage it with diet. I know its hard to "live a normal life" with ALS looming in your mind, I totally understand. We go to these professionals in search of some reassurance and words of comfort to help ease our anxiety, when often it ends up making things worse. Yes, it is easier said than done, but truly hang in there. Some days will be better than others, and capitalize upon the ones that are really good. I will leave you with a link to a physician's story about his own fears of being diagnosed with ALS. I felt much better after reading what he had to say and had discovered with his own symptoms. I hope this finds you well and in better spirits. Blessings your way.
 

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