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Old 12-09-2011, 02:19 AM #1
Poetist Poetist is offline
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Default Single Fiber EMG

Okay, I was here a while ago, but my head was spinning from the merry-go-around.

Anyway, I've seen many neurologist, who couldn't come up with a decision with me. Then, I get a call from my primary doctor, who said my whole work up was wrong. I have had every test under the sun. I failed a portion of my pulmonary function test, and I continue to complain about breathing when I lie flat.

Long story short, I have a 5.7 enlarge thymus (no tumor). Anyway, I was sent to the head of neurology. After that, an outside referral for a single fiber EMG was ordered to determined whether or not I have MG.

Since, MG is up in the air for me, I stopped taking my mestinon. I can feel the effects (legs feel heavy). However, I thought it was a good idea to stop taking the meds, so it would not interfere with testing.

Am I right, or should I do something else?

Plus, what should I expect? What areas will they perform the test?
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Old 12-09-2011, 02:37 PM #2
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Hi. It's great you're having a SFEMG. That should give the doctors a lot more information.

You are right to stop the Mestinon before the test. Often they'll tell you 12 or 24 hours, but there is a small study here: http://onlinelibrary.wiley.com/doi/1...20211/abstract
that shows that Mestinon in your system can affect the SFEMG results for longer than that.

When I had my SFEMGs (I've had three, because the first two we inconclusive) they put thin needles (very thin) in my arms and legs. I've heard that it's important to make sure you're warm while they're doing it (because a chilled muscle might yield a false negative). The needles themselves aren't bad unless the doctor hits a nerve, in which case you may ask him to move the needle. While the needle is in, the doctor will ask you to slightly clench the muscle and hold it like that. The whole thing takes about 45 minutes.

My third SFEMG got me a diagnosis, finally. The weird thing is that this one was done on the muscles of my face (around my eyes). Those aren't muscles that I've noticed any weakness in. The neurologist didn't seem to think that mattered. He also sent small pulses of electricity (painless) to make the muscles twitch instead of asking me to clench the muscles, but they tell me this is an unusual method to use.

I hope this helps. It's good to know what to expect. I hope you get clear answers!

Abby
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Old 12-11-2011, 01:23 AM #3
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Thanks, Abby.

If you had EMGs as well as SEMGs, can you tell me the difference in the two? Meaning procedure. I've had 3 EMGs in which I got the needle and the zap. I would like to know what is different. I know the SEMG are going to target one nerve at a time, but are they longer? You mentioned you had to clench your muscle. I don't remember being asked to do that for the EMG. Is there anything else? Do they test the whole body or just the reported area of weakness?
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Old 12-11-2011, 08:12 AM #4
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Quote:
Originally Posted by Poetist View Post
Thanks, Abby.

If you had EMGs as well as SEMGs, can you tell me the difference in the two? Meaning procedure. I've had 3 EMGs in which I got the needle and the zap. I would like to know what is different. I know the SEMG are going to target one nerve at a time, but are they longer? You mentioned you had to clench your muscle. I don't remember being asked to do that for the EMG. Is there anything else? Do they test the whole body or just the reported area of weakness?
No zaps with the SFEMG! But the needle stays in for a few minutes while they collect data. They will test different areas, probably on your arms and legs, but maybe on your face. I was diagnosed by the one on my face, even though I didn't notice any weakness there. The neurologist told me that the disease affects every muscle in the body, and that even though I wasn't noticing symptoms in the muscles he tested, it didn't matter. I'm not sure I believe that--it doesn't really make sense to me--but that's what he said.

Abby
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Old 12-12-2011, 12:02 AM #5
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Yay, I'm not going to be zapped. I was fearing that the most.

So, you didn't have weakness all over your body. I seem to be more affected on my right side and below the knee on the left.

Lately, I've been having trouble smiling.
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Old 12-18-2011, 11:36 PM #6
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Poetist, Did you have the test done?

I've had a few SFEMG's and EMG's. Maybe it's because I have nerve damage from a B12 deficiency but I thought they both hurt. Abby has had the SFEMG where you don't have to "participate" and contract a muscle group while the test is being done. Most doctors do it where you have to repeatedly contract a muscle.

You'll definitely feel it. Whether you think it hurts or not is often a matter of perception.

They normally do the forearm, shoulder or forehead. Some doctors do more than one muscle, some don't. They never do the chest wall muscles - too dangerous.

If you had it done, I hope it went well. And that you don't have to wait weeks for the results! It can take awhile.

Annie
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Old 12-21-2011, 03:41 AM #7
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No, I have the test next week. Yikes. Well, if they are anything like EMGs then, I'm used to them.

So, they only test arm, shoulder, and head? I was hoping the doctor could test the muscle surrounding my shoulder blade, which I think collapses when I sleep or lie on my back.

I do have another concern. I am taking some medicine for my stomach. It's my mother's medication (Pantoprazole) for acid reflux/stomach discomfort. I wonder will it interfere with my test results. My stomach hurt so bad, when I took the pill. It worked for what feels like heart burn, and I had taken some antacid, which didn't work.

Anyway, this stomach discomfort is something new, but I will try to avoid it. I hate to have gone months without Mestinon to screw up my testing for something like this, but honestly, I was keeled over in discomfort.
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Old 12-21-2011, 04:10 AM #8
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Well, first of all, you should not be using anyone else's prescription! You know better than that. If you are having stomach issues, you should see your doctor. When did you start having stomach issues? When you took Mestinon? When you stopped?

Did you know that you need acetylcholine to make stomach acid? The symptoms of not enough stomach acid and too much are very similar. You could try taking some apple cider vinegar with food to see if that helps. Or some Betaine HCL capsules. Those two would work if you didn't have enough stomach acid. I don't have any and take Solaray Betaine HCL. But I think you need to talk to your doctor first. Stomach pain is nothing to mess with and can be a variety of things from ulcers (H Pylori bacteria) to celiac disease to cancer.

I don't think that med will affect the test results. And you shouldn't have had to go off of Mestinon for months. A couple of weeks would've been long enough. Most doctors say 24 hours but a study done by Dr. Howard said that the effects can last anywhere from 2 days to 2 weeks.

If you have generalized MG, you "should" show increased jitter on the SFEMG in weak muscle areas. Just ask the doctor if he can test your deltoid muscle. They have to use muscle groups that they know the average jitters of for certain age groups.

Are you on any other meds? Even supplements?

Please call your primary doctor and see them about this, ok? Good luck on your test.

Annie
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Old 12-25-2011, 04:23 AM #9
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Annie,

Thanks for the info. You are a walking encyclopedia.

In regards to Mestinon, I had no intention of being off Mestinon for months, but waiting on the paperwork to clear between two HMOs took just that long. In regards to the stomach issue, my symptoms came about one month after I had every test in the book. So, that was part of the reason I didn't run to the doctor. Plus, I wanted to have a least one month off from going to the doctor's office.

Quote:
Did you know that you need acetylcholine to make stomach acid? The symptoms of not enough stomach acid and too much are very similar.
That's very interesting. I do know that whether I eat something or not, I will get this burning sensation. It's worse, when I don't eat anything. I will be seeing my primary doctor in January, so I figure I will tell her all of this, if this continues.
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