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Straight answer on EMG

Posted by Mike Kephem on 11/21/01 at 09:23 (065047)

Why is it so hard to get someone to give an accurate description of what their emg experience was like? I think it would be very helpful to those who read this site to know exactly what to expect, for me anyhow, its the not knowing that is hard. Instead of saying they stick a needle in you in several places, please be more specific, (bottom of foot in arch, at ankle, top of foot). Where do they stick the needle in the legs and how far up the leg do they check? I realize not every emg is the same, but by telling about your own experience that would help. Tell how painful you thought the test was on a scale of 1 to 10. Pain thresholds vary but maybe theres a usual range. We won't know and understand until we compare. And if telling the whole story helps others who need this test and are frightened by the aspect of needles helps them some then that is my point. Thanks. and please post your experience.

Re: Straight answer on EMG

Laurie R on 11/21/01 at 10:39 (065049)

Hi Mike , I will try to answer your questions the best I can . I will tell you my spelling sucks . Wendy could help more then I . I remember posting a question before my RNG test. I was so scared to have it done . Wendyn answered it and was to the T how is was going to be.

I will tell you the truth . I hated it . It was very painful for me . Plus I was in so much pain the day I had it done . And I did not care for the Nuerologist that did the study ..

He had me lay on my back and all I felt was Zapping going through my foot and leg. He started on my feet then up my legs . Then he did the needles . As I remember the needles were very fast . They don't put the needles all the way in your foot ,well at least this doctor did not . It is a pretty fast test. I won't lie and you wanted it straight .I cried through most of it . I did not like the Zaps ....

Now Mike , not every doctor does the needle part from what I have heard . Some jus tdo the zapping ... It feels really weird .... You maybe for you it won't be a big deal . We all can have the same test and you will see all kinds of out comes .

Are you in a lot of pain now ?? For me is was a 10 + day for pain , I think that is why it was so hard for me .....

Maybe Wendyn will jump in here and give you her advise ... She can explain it better then I .

This is probably not what you wanted to hear. But I wanted to answer your question....

When are you scheduled to go have the EMG done?? And why are you going ? Do they think you have TTS , or do you have TTS?

My best , Laurie R

Re: straight complete answer takes a lot of time

elliott on 11/21/01 at 11:12 (065052)

I've posted what the experience was like several times, the latest just a week or so ago, right before the forums went kaput. You can't expect the same person to keep typing it out every time a newbie enters the board and asks the same thing again. I got a day job here. Unfortunately, I can't dig out my old post using the Search mode, so, since you're so persuasive, here's the experience, in more detail than I've ever given before:

First, the NCV (nerve conduction velocity) test: Some kind of cream is applied to a two-pronged shocker, which is then placed on your skin, and you receive an electric shock. Knowing what they're doing and why helps. What they're doing is not so mysterious: it's measuring the time it takes for the nerve being tested to conduct the electricity from shocker to where it's recorded by the metal disc placed lower down on your foot. If there is nerve entrapment and the test picks it up, the time it takes to get from one end to the other--called distal latency--will be slower than normal (if you see the tester write down a number in the single digits plus one decimal place of around 7.0 or higher, start worrying). The shocks are focused on the nerves of interest, so can vary depending on the patient's targeted problem. Mehodology can vary from tester to tester too; mine is very well respected. For TTS, they concentrate on the conductivity of the medial and lateral plantar nerves, but they usually quickly test the main nerves on the other side of the foot too. The shocker is placed most of the time on your middle and lower calf/shin area, both medially and laterally (I don't recall any shocks, or needles for that matter, placed directly on or in the ankle). The shocker may be placed higher up, i.e. on the thigh, for a few shocks, especially if it is suspected that the thigh or back might be involved. I think there were around 20 shocks in all. All but the last few are no big deal at all. The last few in each series, when they seem to turn up the volume, will make your leg jump a bit and will feel somewhat more uncomfortable than the rest. But each shock is felt just for a second or so. In fact, consider it to be around 20 shocks x 1.5 seconds/shock = 30 total seconds of 'pain', with the pain neither continuous nor of the same severity. If you insist on your pain scale, on a scale of 1 to 10, I'd rate the worst few shocks a 7, but overall the test gets perhaps a 4. Again, the 'pain' is so short that it's not a big deal, and I'm tempted to lower that number further because of this.

Next, the EMG: This is the needle part of the test, which is searching for muscle atrophy as connected to nerve entrapment. I was stuck me with a very small needle (no permanent marks) maybe 6 times. Locations I recall were bottom of big toe, maybe fourth toe, top of foot, and shin (the last probably sightly 'worse' than the others, I think due to the feeling of it pressing on your bone). You barely feel the prick, although you get this slightly uncomfortable feeling while it's in there that you've lost range of motion. It's kept in for a few, call it 3, seconds. Total duration of 'pain' is 6 x 3 = 18 seconds. On a scale of 1 to 10, this test gets a 1.

Total duration of 'pain' for entire exam is 30 + 18 = 48 seconds, not all continuous. The total test, with the pain levels appropriately weighted by pain time, gets a 3. Elapsed time for entire test (including dead time, but not including pre-test interview) is around 35 minutes. Hope this is enough detail for you.

Now I've got in trouble before here for allegedly not being sensitive enough to everyone's fears for this test. I'm not insensitive. I'm often near tears when I read some people's stories here, about how they're in constant TTS agony, overdosing on medication just to make it through the day. It could be me or anyone else here. But context is important. I think this whole fear about this test's pain, all 48 noncontinuous seconds of it, is way overblown, especially in the context of why you're getting the test. It almost makes me laugh. Sure, people are curious and a little apprehensive about what they're going to face (I was a little the first time too--I've had it three times). Yes, some have lower pain thresholds than others. But if you need the test, get it, and that's it. Knowing the test may help with proper diagnosis and treatment, and possibly avoiding the wrong surgery as well, is a strong mitigating mental factor for any short-lived pain. Getting a certain TTS diagnosis can be so tricky, TTS itself can be so debilitating, can cause so much prolonged suffering, people's lives can be so ruined forever, that any test that can help avoid lifetime suffering or the wrong surgery should just be taken, and the pain lasting a few seconds is totally insignificant. I think this is worth emphasizing. When posters say they're afraid, and ask for an exact ranking of the test's pain, given the motivations behind the question, to me the better answer than a pain ranking is that the whole test is about 48 seconds of non-continuous pain, the test may really help your case, so just go in with a good attitude, joke around with the tester, and it will be over before you know it. Emphasize that and the asker won't be so nervous about taking the test. Just my humble opinion. Insensitive?

-------

Re: Straight answer on EMG

Megan C on 11/21/01 at 18:39 (065069)

My emg experience wasn't so bad. I went in expecting the worse. I was so afraid of how much it was going to hurt, but it wasn't as bad as I expected. On me, they first did the shocks. That wasn't so bad. Then after that, they use one needle and stuck me about 6 times. I think I had 3 on the top of my foot, one place was kind of between my big toe. Then higher up my leg, including around my knee. The needle that hurt the worst was on the inside of my lower foot, where the arch is. The pain though can be compared to that of getting a blood test. Don't worry though, it doesn't last too long. Good luck!

Megan

Re: Straight answer on EMG

wendyn on 11/21/01 at 23:38 (065075)

The universal opinion seems to be that there is NO universal opinion. Some people experience more pain than others. I would imagine that it may depend a lot on what is wrong in the first place.

In Laurie's case, I'm sure that the fact she has RSD caused her to experience far more pain that what most people would go through.

In addition, the type of testing, equipment, skill of the tech, pain level of the patient, and anxiety level of the patient all seem to factor in.

Re: Straight answer on EMG

Laurie R on 11/22/01 at 09:36 (065079)

Dear Wendy, Thank you so much for this post...Now I am not sure if I had RSD when I had the EMG , but what you said made a lot of sence... Oh boy was my anxiety up that day I had the test...Which always makes things worse for me. I would like to share with you and everyone else. Since I started my much needed anxiety meds I am doing so much better....Plus I started Bio-feedback, what a BIG difference it has made... It has been a long foot road for me ,but I am trying so hard to get it under control.

I know some can have the EMG , well I should say most can have the test and it does not bother them at all.

To me the worse ever test was the MRI ..I think the reason was I had to keep my foot in the coil for 1.5 hours .Oh the pain was terrible ... The Tech did stop to let me move my foot .. Everyone is different ..

Thanks again Wendy ...Laurie R

Re: Straight answer on EMG

wendyn on 11/22/01 at 22:22 (065097)

Laurie I hope that you (and all the rest of the Americans on the board) havd a very good Thanksgiving.

Re: straight complete answer takes a lot of time

Mike on 11/23/01 at 10:16 (065110)

Thank you, this was very helpful. I appreciate your taking the time to go into this a bit further. Trust me, I really do appreciate it.

Re: Straight answer on EMG

Laurie R on 11/21/01 at 10:39 (065049)

Hi Mike , I will try to answer your questions the best I can . I will tell you my spelling sucks . Wendy could help more then I . I remember posting a question before my RNG test. I was so scared to have it done . Wendyn answered it and was to the T how is was going to be.

I will tell you the truth . I hated it . It was very painful for me . Plus I was in so much pain the day I had it done . And I did not care for the Nuerologist that did the study ..

He had me lay on my back and all I felt was Zapping going through my foot and leg. He started on my feet then up my legs . Then he did the needles . As I remember the needles were very fast . They don't put the needles all the way in your foot ,well at least this doctor did not . It is a pretty fast test. I won't lie and you wanted it straight .I cried through most of it . I did not like the Zaps ....

Now Mike , not every doctor does the needle part from what I have heard . Some jus tdo the zapping ... It feels really weird .... You maybe for you it won't be a big deal . We all can have the same test and you will see all kinds of out comes .

Are you in a lot of pain now ?? For me is was a 10 + day for pain , I think that is why it was so hard for me .....

Maybe Wendyn will jump in here and give you her advise ... She can explain it better then I .

This is probably not what you wanted to hear. But I wanted to answer your question....

When are you scheduled to go have the EMG done?? And why are you going ? Do they think you have TTS , or do you have TTS?

My best , Laurie R

Re: straight complete answer takes a lot of time

elliott on 11/21/01 at 11:12 (065052)

I've posted what the experience was like several times, the latest just a week or so ago, right before the forums went kaput. You can't expect the same person to keep typing it out every time a newbie enters the board and asks the same thing again. I got a day job here. Unfortunately, I can't dig out my old post using the Search mode, so, since you're so persuasive, here's the experience, in more detail than I've ever given before:

First, the NCV (nerve conduction velocity) test: Some kind of cream is applied to a two-pronged shocker, which is then placed on your skin, and you receive an electric shock. Knowing what they're doing and why helps. What they're doing is not so mysterious: it's measuring the time it takes for the nerve being tested to conduct the electricity from shocker to where it's recorded by the metal disc placed lower down on your foot. If there is nerve entrapment and the test picks it up, the time it takes to get from one end to the other--called distal latency--will be slower than normal (if you see the tester write down a number in the single digits plus one decimal place of around 7.0 or higher, start worrying). The shocks are focused on the nerves of interest, so can vary depending on the patient's targeted problem. Mehodology can vary from tester to tester too; mine is very well respected. For TTS, they concentrate on the conductivity of the medial and lateral plantar nerves, but they usually quickly test the main nerves on the other side of the foot too. The shocker is placed most of the time on your middle and lower calf/shin area, both medially and laterally (I don't recall any shocks, or needles for that matter, placed directly on or in the ankle). The shocker may be placed higher up, i.e. on the thigh, for a few shocks, especially if it is suspected that the thigh or back might be involved. I think there were around 20 shocks in all. All but the last few are no big deal at all. The last few in each series, when they seem to turn up the volume, will make your leg jump a bit and will feel somewhat more uncomfortable than the rest. But each shock is felt just for a second or so. In fact, consider it to be around 20 shocks x 1.5 seconds/shock = 30 total seconds of 'pain', with the pain neither continuous nor of the same severity. If you insist on your pain scale, on a scale of 1 to 10, I'd rate the worst few shocks a 7, but overall the test gets perhaps a 4. Again, the 'pain' is so short that it's not a big deal, and I'm tempted to lower that number further because of this.

Next, the EMG: This is the needle part of the test, which is searching for muscle atrophy as connected to nerve entrapment. I was stuck me with a very small needle (no permanent marks) maybe 6 times. Locations I recall were bottom of big toe, maybe fourth toe, top of foot, and shin (the last probably sightly 'worse' than the others, I think due to the feeling of it pressing on your bone). You barely feel the prick, although you get this slightly uncomfortable feeling while it's in there that you've lost range of motion. It's kept in for a few, call it 3, seconds. Total duration of 'pain' is 6 x 3 = 18 seconds. On a scale of 1 to 10, this test gets a 1.

Total duration of 'pain' for entire exam is 30 + 18 = 48 seconds, not all continuous. The total test, with the pain levels appropriately weighted by pain time, gets a 3. Elapsed time for entire test (including dead time, but not including pre-test interview) is around 35 minutes. Hope this is enough detail for you.

Now I've got in trouble before here for allegedly not being sensitive enough to everyone's fears for this test. I'm not insensitive. I'm often near tears when I read some people's stories here, about how they're in constant TTS agony, overdosing on medication just to make it through the day. It could be me or anyone else here. But context is important. I think this whole fear about this test's pain, all 48 noncontinuous seconds of it, is way overblown, especially in the context of why you're getting the test. It almost makes me laugh. Sure, people are curious and a little apprehensive about what they're going to face (I was a little the first time too--I've had it three times). Yes, some have lower pain thresholds than others. But if you need the test, get it, and that's it. Knowing the test may help with proper diagnosis and treatment, and possibly avoiding the wrong surgery as well, is a strong mitigating mental factor for any short-lived pain. Getting a certain TTS diagnosis can be so tricky, TTS itself can be so debilitating, can cause so much prolonged suffering, people's lives can be so ruined forever, that any test that can help avoid lifetime suffering or the wrong surgery should just be taken, and the pain lasting a few seconds is totally insignificant. I think this is worth emphasizing. When posters say they're afraid, and ask for an exact ranking of the test's pain, given the motivations behind the question, to me the better answer than a pain ranking is that the whole test is about 48 seconds of non-continuous pain, the test may really help your case, so just go in with a good attitude, joke around with the tester, and it will be over before you know it. Emphasize that and the asker won't be so nervous about taking the test. Just my humble opinion. Insensitive?

-------

Re: Straight answer on EMG

Megan C on 11/21/01 at 18:39 (065069)

My emg experience wasn't so bad. I went in expecting the worse. I was so afraid of how much it was going to hurt, but it wasn't as bad as I expected. On me, they first did the shocks. That wasn't so bad. Then after that, they use one needle and stuck me about 6 times. I think I had 3 on the top of my foot, one place was kind of between my big toe. Then higher up my leg, including around my knee. The needle that hurt the worst was on the inside of my lower foot, where the arch is. The pain though can be compared to that of getting a blood test. Don't worry though, it doesn't last too long. Good luck!

Megan

Re: Straight answer on EMG

wendyn on 11/21/01 at 23:38 (065075)

The universal opinion seems to be that there is NO universal opinion. Some people experience more pain than others. I would imagine that it may depend a lot on what is wrong in the first place.

In Laurie's case, I'm sure that the fact she has RSD caused her to experience far more pain that what most people would go through.

In addition, the type of testing, equipment, skill of the tech, pain level of the patient, and anxiety level of the patient all seem to factor in.

Re: Straight answer on EMG

Laurie R on 11/22/01 at 09:36 (065079)

Dear Wendy, Thank you so much for this post...Now I am not sure if I had RSD when I had the EMG , but what you said made a lot of sence... Oh boy was my anxiety up that day I had the test...Which always makes things worse for me. I would like to share with you and everyone else. Since I started my much needed anxiety meds I am doing so much better....Plus I started Bio-feedback, what a BIG difference it has made... It has been a long foot road for me ,but I am trying so hard to get it under control.

I know some can have the EMG , well I should say most can have the test and it does not bother them at all.

To me the worse ever test was the MRI ..I think the reason was I had to keep my foot in the coil for 1.5 hours .Oh the pain was terrible ... The Tech did stop to let me move my foot .. Everyone is different ..

Thanks again Wendy ...Laurie R

Re: Straight answer on EMG

wendyn on 11/22/01 at 22:22 (065097)

Laurie I hope that you (and all the rest of the Americans on the board) havd a very good Thanksgiving.

Re: straight complete answer takes a lot of time

Mike on 11/23/01 at 10:16 (065110)

Thank you, this was very helpful. I appreciate your taking the time to go into this a bit further. Trust me, I really do appreciate it.