Feeling Blue - EMG Results

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simonw00

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Hi allI am having a 'woe is me' day today and thought I'd post to get it off my chest. Hope you don't mind.I had an EMG a couple of weeks ago which was normal in three of my limbs but showed 'evidence of mild chronic partial denervation with reinnervation' in my left quads. The technician said that a neuropathy or a lumbar disc could cause this and that he did not think that ALS was likely from this EMG but was careful to point out that it was the neurologists job to assess this. I see her on Saturday coming and, as you can imagine, my anxiety levels have been building up as the appointment approaches.I have a good friend with advanced ALS and he very kindly emailed me today to ask how my EMG went. I told him (as above) and he replied with 'I had the same technician and he told me that he doubted I had ALS too.' Needless to say this hasn't made me feel any better!My friend however had weakness in his right hand when he went for his EMG and the neurologist picked up the diagnosis straight away after examining him. I on the other hand have had fasciculation (and latterly cramps) but no other symptoms and have previously had two normal neurological examinations.So the logical part of me thinks it is all going to be ok but the non-logical part of me is making me scared out of my wits today. Thanks for listening!RegardsSimon
 
Strange thing for your friend to say, if you don't mind my saying.What your techincian said about the most likely explanation seems exactly right - that is by far the most plausible scenario, based on other people's experiences.Add to that the fact you have a 'clean' neuro exam and the odds are even better.Perhaps the technician once made a highly improbable mistake. The odds of making two are astronomical - even before you consider the fact your neuro exam was normal. (Most cases of suspected *** are picked up through the exam, not the EMG, which only serves to confirm what the neuro already knows.)All in all - don't let your mind play tricks on you. Life is a game of chance, and your chances look very good.
 
Hey Simon,I am sorry you are feeling so bad today :( My twitching has been pretty bad lately too... although I don't go back for a check-up until September 10th...I too, find it a highly unusual thing for your friend to say. I cannot imagine what he must be going through, but I doubt that was what you needed to hear from your friend. I imagine that the technician sees a lot of slightly abnormal EMGs that mean absolutely nothing, which is why he told you he didn't think you had anything serious. I am sure your neurologist is going to tell you something similar. Keep your head up, have a glass of wine and a bath and get a good nights' rest if you can! You're gonna be just fine my friend!Megan
 
Simon, chin up mate. You're having the typical pre-exam jitters. Ask Bfshopeful about this. He had it a few weeks ago prior to getting cleared by his neuro. I have it everytime I go to a doc for something that's been bothering me. I get seriously anxious in the day or two leading up to the appointment, even if I know in my heart of hearts the symptom is nothing terrible. Its still the impending visit/exam that sets the BP up above normal. You'll be relieved when the neuro clears you saturday, mark it down. Don't waste 5 or 6 perfectly good and precious days stressing or feeling down about it. You're a medical doctor. You're career is built on logical, science and reasoning. Those three things should tell you that you've got nothing close to ALS. You've got BFS + Health Anxiety. PS- The fact that you get worried about this makes me think us non-doctors should be a bit more worried, and that's not a good thing with the level of anxiety most of us already have here.
 
Hi TJM - I appreciate the encouragement.Just to respond to what you said about doctors and worrying - when it comes to health anxiety, us doctors are absolutely no different from anyone else and are prone to the same illogical fears as the next person!RegardsSimon
 
Good point Megan!I have always wondered whether I am more prone to health anxiety because of my profession or whether I was more likely to become a doctor because I worried about health! Probably a bit of both!At Med School I was taught and I teach my own students that, for every patient seen, you should ask yourself "What it is most likely to be?" (BFS in our case) and "What don't you want it to be?" (ALS in our case). By working this out, a student/ doc should be able to work out what questions to ask each patient, what examination to do and what tests to order. But the downside of this is that, when I myself get a symptom I apply the same thought process to myself and decide that my heartburn could be angina, that my headache could be a brain tumour or that my twitching could be ALS.I guess the other thing about being a doc is that I do get to see first hand all sorts of nasty things happen to people and so I guess I am sensitised to this. Thanks all for your support.RegardsSimon
 
Look, we are all guilty of having a pity party from one time or another. Wouldn't you prefer a fun party instead? Life is short even if you don't have a dreaded disease - don't waste it. I just found out today that a work friend died (cancer) - but she lived life with positive determination asking always where is the solution and how can we make this better - and I plan to follow her form.
 
The technician is obviously not someone who is charged with making neurological diagnoses and is probably ethically (maybe legally) forbidden to suggest that someone has one even if all the signs are there. He/she is probably frequently asked his/her opinion about ALS since many who have EMGs fear it. When he/she is asked this, he/she probably wants to be reassuring so he/she probably always says I don't think that is what you have. Given the odds, he/she is usually right. This practice seems the best approach to an awkward question for someone who cannot diagnosis people, since he/she gets to avoid saying anything conclusive and avoids provoking the patient's anxiety. If the technician said nothing to the question or even "I can't answer that," it would provoke anxiety so he/she has to say something. Now a neurologist obviously has to be more straight with a person since unlike a technician that is their moral and professional obligation. So bottom line, I think you just learned about a technician's standard response to a frequent question and that is the only relationship between your and your friend's experience. As far as the pre-visit anxiety, boy do I know that well. The fact that you have no weakness means that you will not hear what you fear. This is what I have learned from my experience with similar facts. So the way I look at it is you may get some reassuring info that points to a non-worrisome explanation or you get the bfs/idiopathic explanation. Either way, you are either better off than most of us because you may find the cause of your problem or you are in the same boat with dealing with the symptoms but no clear reason why except the assurance that without weakness it is benign.I am sure many people who have come in with a cough or headache and asked about cancer were told it is probably not that. But every now and then one of them is told wrong but the error is realized quickly from imaging showing the obvious tumor. When you don't have the progressive weakness, you simply don't have the key finding that is looked for. Until that key finding exists, the worst case scenario is that you are part of the masses (think peripheral neuropathy, bfs, fibromyalgia, restless leg) with unexplained neurological findings and/or symptoms.I hope my thinking helps you feel more confident going into your next appointment. These are the same thoughts I go through to help me get through the irrational fear that all of sudden despite the fact that every muscle still has normal strength I will be told something different than I was told before.I look forward to hearing about your reassuring visit.Krackersones
 
Hi Simon,Over 2 years ago I had a similar finding in my leg of reinnervation, deinnervation stuff as you. About 6 years ago I suffered a back injury and this is why I had this reading on my EMG. Ofcourse I didn't believe it at first, I was sure I had MND or MS. Like you I had anxiety issues but for me it was severe. The severity of my anxiety made me do something about it as I just couldn't live like that. I've now got that under control and I no longer twitch. Anyway I am deviating from what I originally wanted to say to you. My mum died from ALS not long ago. When she first was referred to a neurologist she said she never felt fasciculations and only had weakness. I would say at least a year before she saw a neuro there was weakness. You don't have weakness so don't make yourself sick with worry and the findings of the reinnervation etc put it out of your mind. Trust your neurologist.When I saw a neurologist 2 years ago I asked if that sort of finding is only specific to ALS and he said no. You must have weakness to have MND. Please please please try not to worry as you will only exacerbate your anxiety and anxiety can easily present symptoms similar to all sorts of diseases. I go on and on about anxiety but if that is all that is wrong with you then that is good as you have the ability to recover just like I did. I will just say that to recover from anxiety it is a 2 steps forward one step back recovery plus it takes time. It is when you have the one step backwards when it is most important to not give up. Even if you twitch and cramp for other reasons than anxiety I believe working on your anxiety will help you just go with the twitching and not let it bother you. Look at Eduardo he worked on his anxiety and he is doing well. I'm not the only one. Many of the old timers are doing well and it is because they no longer fear the "sensations" of twitching.Hope this helps even if just a little bitMaria
 
Don't forget there is a huge difference between you and your friend, muscle weakness. You do not have muscle weakness which is the defining feature of the disease you are worried about.
 
Yeah - docYou shouldnt worrry unless one or more bodyparts doesnt work. And even then, it could be something harmless with facics and all... All this internet stuff have given us self a lot of worries which didnt exist before. Look at your own buisness. In the good old days the doctors asked the following:Do you drink? noDo you smoke? noOk, you are fine. C ya.This hole stuff is so complicated nowadays, that we feed ourself with worries. Things were easier (and more deadly) back then. What happened to a good old gunshotwound in Tombstone? A bit of whiskey and a stick to bite in... How hard could that be? :LOL:
 
Simon,I'm 46. I've been twitching since I was 13. I wondered myself if I'd eventually fall apart.I'm still here, and at my last check up, my doctor told me I'd live to be 100.Hang tough.Roy
 

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