Monday, September 17, 2012

It's a needle-y kind of day: EMG's, Nerve studies, and Botox

Another day of fun, just to much fun..

I wasnt sure the best way to send the actual x-ray order  and request from my Pain dr regarding her wanting flexion/extension Xrays of full spine (to nrsgn)  to have them done by my neurosurgeon (have nrsgn order them) and so I scanned it in to the computer and emailed it last night (is that odd? Do other chronic dx pts do this kind of thing?) and her nurse who I had also cc'd responded back this morning that the order was in and I could do it after the MRIs but before the actual appt on thurs.   I often wonder as I email or scan in to send via email various med records to some providers if its something thats requested or wanted is this out of the ordinary? A couple of my providers dont use email (they'll use their mychart systes) but the majority of my providers will communicate via email if its a non-urgent question or if sharing information from say another appt with them. I personally think if the pt is ok with it (as in my case) and doesnt mind the 'un-secure' records things then it shouldnt be that big of a deal to send a med record through email. Typically i'll try to remember to black out my MR number (but often forget) and tend to just think if it makes something work better then is the reward better than waiting for snail mail or fax? I do have a fax machine on my scanner/printer but dont use a home phone and in all honesty if someone intercepts the email under some small chance is it really that interesting really? A bunch of medical crap? I tend not to think so..  I know its a personal decision and dont care what others chose just for me I dont see a problem with sending via this means..

This morning I had the EMG done at Dean St.Mary's Hospital which was the usual loads of fun although I got the sense the Neurologist doing the needle part was a wee bit unhappy as that part progressed as he couldnt get clear answers.. (after 2 different releases on each hand and the tendon transfer I wouldnt expect personally for the EMG to come back with simple yes or no 'there's nerve damage/compression' issues going on..,) Maybe he doesnt deal with re-occurences of it that much?  Outside of MPS its not that common to re-occur I guess? He seemed a bit on the younger side so who knows maybe less experience w this sort of thing.. I should add he wasnt rude or anything and explained his concerns but you can kind of tell someone's personality (feelings) in these kinds of situations!  As far as what he all looked at and tested it ranged from the more 'routine' carpal tunnel compression to compression in the elbow (normal I think) on up to his concern was there lower c-spine nerve root compression below my previous surgery (C2-4) around C5-6 but he said this was fairly normal or atleast no significant issues from what I gathered from him? We know there is a very narrowed area in my upper thoracic or lower c-spine area (in the area near where the lumbar-to-thoracic shunt catheter sits which is in T8-9 or T9-10 I think right off hand.)  and although I dont know alot about that narrowed area its an area my nrsgn has had concerns about I think regarding the lumbar-to-thoracic catheter being below it. Thurs's MRIs if nothing else should help rule out the spine as cause of these carpal tunnel like symptoms or give us clearer answers although that isnt why its being done. (Nrsgn ordered it to get an idea where the shunt catheter is now sitting as that could also be the cause of the other nerve and spine symptoms I have if sitting against a easily irritated area.) Some of the symptoms my Pain dr was concerned about where short episodes of dizziness though havent been w/movement (so Pain dr didnt think autonomic) the leg symptoms with these being  'tired' when standing, legs falling asleep and painful when sitting, and other also on/off symptoms.
My prior hand surgeon who I saw back in April I think (before our insur switch)  and who did the more significant of the hand surgeries had said he didnt think an EMG would give totally clear answers so I didnt really expect to learn much from this.
The worst part of the EMG may have been when the same Neurologist was trying to get a reading of the nerve signal/muscle in the thenar area (base of thumb) which is where I had the tendon transfer done 2 yrs ago and which the muscle was pretty wasted before even this. He kept having to take out and move the needle and then wiggle it in deeper to try and find a signal but after about 5 mins couldnt get a good reading (im not sure if he got any) - YOUCH! I can take alot and can pretty well just bite my lip and not say anything and sometimes even still hold a conversation but this one I think the nurse thought I was going to pass out (I was laying down semi-propped up already which is hard enough in and of itself!) as she kept asking if I was ok and looking at me like she might pass out, lol.  Its over though and thats a good thing!
The Neurologist said he just couldnt gather enough info from either the nerve conduction part of the EMG itself and so couldnt say if it was carpal tunnel re-occuring through that alone but he presumed with the underlying visible damage, the symptoms/symptom pattern and same symptoms as previous CT issues he would write instead in his report what he didnt find and not what he thought of the overall testing. In other words he wasnt going to say it was carpal tunnel and he wasnt going to say it wasnt but that it wasnt clear it was from lower c-spine compression as he got better (if not perfect I guess) readings there than in hand but he presumed the Hand surgeon would assume as much given the history.

After this loveliness I went across the street to the out-patient center and saw the new Neurologist (a different one) who is taking over the botox injections previously done at FMLH by the PMR doc. She doesnt use EMG to do botox injections which just means she was able to use a smaller needle but not have as precise of knowledge where the worst spots where for over-active muscle issues. She was working off the previous PMR docs well laid out report so I think although she seemed to do less actual injections she likely did most of the same areas.
She seemed like she's probably nice and easy enough to talk to but you know how some providers you can quickly feel rapport with and feel like they are the ones you'd go to for any questions or to bounce a question off of even if the question is maybe not their specific area/field? I dont know about other people but I can usually pretty quickly figure out which drs will be the ones that are like this.  I think or tend to think a first appt sort of cements which side a provider will be and in reality out of about a dozen specialists I think only 2 or 3 are in the 'I think  I could ask you almost anything' category and further narrowed down I think only 1 (pain mngmt) is in the 100% trust for many more reasons than just this but even if I get irritated w her secretary on occassion she (the dr) has always believed and trusted me, stuck behind what she said and really gone out of her way to take on areas that needed someone to help with but no dr was really willing to fully manage. (before my nrsgn this dr did all the imaging and followed that stuff, did all the conference call coordinating (other than my Insur person), sent me to other drs if she thought they had something to offer she couldnt (botox for one, worked on the pre-cspine surgery stuff) and she un-failingly tried to help and (not that I expect ANY dr to do this!!!) she would call before surgeries or after surgeries to see how it went and if there was anything she could do and sometimes for no reason bc she was concerned about something that we had dealt w at a previous appt. She is the 2nd longest provider on my team at shy of 5 yrs, Cardiologist is 8 yrs now! Probably close behind her (but it would take alot to surpass her) :) would be my nrsgn who in just 15mo has endlessly been there to try and figure out on-going shunt issues, deal with after effects of some of the surgeries, coordinate care related to those secondary issues, answers any and all questions I have or admits if she may not know but tries to find out and if its some quick thing like re-setting one or both shunts she'll meet me in the lobby vs making me come in for an actual longer appt, does email and her staff is pretty AWESOME! :)  That aside I really do have many other good providers after many yrs of hiring, firing, adding and subtracting to the ones that did and didnt work or left. Its just some I guess get closer than others and sometimes I think its little things like they are interested in you as a person outside of "just their issue(s)" they treat/see you for, they see the big picture of whats going on (instead of just that area they treat) and (dont fall over) they want to help no matter how long 'that helping' lasts. :) I guess I got off the pt of this babbling though and was just that im not sure this time where this Neurologist will fall in the bigger picture. With my new PCP I sensed she would be interested in being more involved and helping and especially learned alot really quickly before I even saw her about the issues and seems to want to help wherever she can but in this case not sure how this chip will fall.. I will see the Neurologist every 3 mo for the botox (standard and insur approved 4 botox visits for the year so I imagine we'll get to know each other better in time it may just be a slower figuring out which is ok too!  If needed she apparently knows my nrsgn through a friend of hers (the neurologists friend) who sees my nrsgn too as she said to me she really liked Dr.Bragg and thought she was personable and good at what she does. Thats a good thing.

I'll try to update after thurs thoracic and c-spine MRIs, X-rays and appt with neurosurgery.
All for now, thanks for stopping by,

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