Jagdish Vishnoi, MD Please give final thoughts!

[needhonesthelp]

Thanks for your reply.  When you say weightlifting can cause some EMG abnormalities, are there specific changes commonly seen.

My report says I have some Normal, some brief duration, and increased percentage of polyphasic motor unit action potentials.  The muscle involved were triceps, supraspinatus, gluteus medius, and peroneus longus.  What concerns me is that my EMG from 2+ yrs ago was normal and the peroneus longus was tested.  I'm not sure if you can see some changes based on who is doing the test or the specific area of the muscle tested, etc.  And the NCS was normal.  By the way, I did not lift for a week before the EMG test.  Not sure if this means anything but I didn't want to have sore muscle before getting tested to throw it off...Also, when I asked the MD that ran the test if being a weightlifter can cause these findings, he said wieghtlifter do not have different EMGs??  He is a Physical Medicine and Rehab Doc..

I do feel some shakiness in some of the muscles that seem to be abnormal when I lift sometimes...during the contraction or when I hold the muscle in a contracted position for a few seconds.  Maybe this is normal and I just never noticed it before.  It is as if my muscle feel buzzy or shaky after workouts or yard work...arms seem a little shaky.  I don't know if there is a lot of weakness associated, but what could possible cause this sensation.  Of course, I am getting a little older too and maybe this is part of aging??

Your final thoughts based on the specific of my EMG report and symptoms is greatly appreciated!  I'm not sure why I ache so much unless stress can causes these types of problems?

Again, it means so much to hear your expert opinion with all the details of my situation.  I promise this is my final post as I know you are interested in helping others too.

Kind Regards,

[lilplum]

Can very low platelets cause fluid retention?  I have RSD and I know (now) that some side effects of this disorder can be fluid retention.  But I also have a report regarding  my platelets and they are 1/2 the low normal "score."  I also wanted to ask if there was anything used other than Lasix and Bumex that would help with getting this fluid off of me!!  It's so painful.  It's so difficult to walk.  I know they are missing some rare diagnosis with me.  I fall into so many diagnois' but when you take all my symptoms and try to make one diagnosis, it seems to me that something could be done to help me.  Yes, I have RSD, and I have Arachnoiditis.  I also have a very low platelet count, a 7 mm lesion in the middle of my liver (yet to be determined as to what it is.  They want to wait another 10 weeks for some reason), I get these sores that look like little spider bites but they don't go away.  I have 3 on my right now.  I put bandaids over them so I couldn't scratch them at night.  I took off the bandaids this morning and one was sort of "weeping."  My triglicerides are thru the roof....600.  I barely eat anything, and I'm not kidding when I say that.  My husband worries that I'm anorexic.  I flip  out when I get on the scale because the fluid has put 15 lbs. on me, and my normal weight for my entire adult  life has been 125 lbs!!  I know putting 15 lbs. on doesn't make me heavy, and I don't look heavy.  People laugh when I try to tell them I'm worried about this fluid!  No one will pay attention to the fact that this edema  HURTS !!!  Yes, I've had 2 cardiac workups......I only have mitral valve regurgitation and P.A.T.  I have severe pain right under my rib cage on the left.  Today it was so bad it made me throw up.  Sorry.......but it's true.  The common bile duct is dilated much larger than it was on my last scan.  I don't have a clue what all this means.  I ask my doctor and he says "When I start to worry, then you can worry"  My family is full of diabetics.  My glucose has gone from 90 to 120.  I know that's not a high number but it has changed from before.  I just want this fluid off of me.  I'll deal with the pain.  I just hate to feel like I'm buzzing everywhere I go, and I feel at times when I'm standing that my ankles and feet are just "pooling" with fluid.  Any advice as to what tests I should have??

[needhonesthelp]

i hope you read all  my responses and give some further insights.  I'm not a troll, just very worried.

I think the main symptom lately that seem odd (of course, the odd aches are strange) is the fact that I get a buzzy or shaking-type feeling in my arms/hands/delts/etc...it seems to be worse when I work these muscles (lifting, yard work), but I do notice at other times too.  Do you have any explanation for this?  Is it related to my abnormal EMG that we have been discussing.

And finally, what would cause any abnormal potentials on EMG and be benign...this just confuses me...i worry that there must be some disease process with all my weird symptoms and EMG and yet I pray so hard I'm healthy and normal.

[needhonesthelp]

As I do more research it just becomes a bit more confusing for me.  I'm not sure how I could have some of the abnormal findings on an EMG and not have something wrong with me...even though I am really hoping I'm fine.

It just seems odd that there would be any polyphasic or short duration potentials.  I wonder if I have normal potentials mixed in becuase it is in the early phase of a disease process or my body has just changed a little or time now my EMG reads some abnormalities but it may be benign.  

I suppose a muscle biopsy would be the most telling way to find out.  You know, I did hear that weight lifters can sometimes have abnormal EMGs and yet I don't knwo specifically would look abnormal and why some muscles may be normal while others abnormal  when all of them are used in lifting.  ANy further insights you can provide based on my last few comments would be great.

[needhonesthelp]

By the way, do you need to have a really high CPK to have a myopathy or can it be normal...or even slightly elevated.  I have read different things.

I do not know what kind of muscle disease I could have because I'm not aware of any family related diseasse...maybe something inflammatory but my Rheum doesn't think inclusive body myositis is likely based on my age (30) and the other effect proximal muscles.  It seems like my EMG should some abnormalities in proximal and distal muscles.  

ANy further thoughts based on the adiitional info I have provided would be great.

[needhonesthelp]

As I mentioned, my CK level was back down to 137 with 1 week of no lifting and rest.  This was just before my EMG.  My AST was normal before and Aldolase was 6...normal.  Sed rate normal, etc.  This was really encouraging, yet my EMG was abnormal is some muscles.  I guess it is odd that some muscle were normal and others abnormal when I lift with all of them...
Do my symptoms seem suggestive of myopathy?  Buzzy muscles or mild shakness after workouts even if my strength is reasonable.  I don't know if this is a benign feeling or some process going on in my body.

Just so I understand you correctly, if there are normal action potentials along with abnormal, it is more likely a benign finding.  I don't know how many polyphasic action potentials I had.  The report states mixture of normal, brief duration, and increased % of polyphasic.  I worry this is abnormal because it is early in a disease process.  I pray so much this is a benign finding and the odd sensations I get are related to nerves or just benign in nature.

I really do not want to have a biopsy but is scheduled for early July.

[Jagdish Vishnoi, MD]

Hi,
Polyphasic muscle action potentials recruited in excessive numbers for a given degree of voluntary muscle(triceps,supraspinatus,gluteus medius and peronius longus in your case) suggest myopathy especially if such polyphasic action potentials are small and of short duration.In your case it is associated with some normal action potential which does not favour the other findings.In my opinion you take a rest of 2-3 weeks and then go for CPK,LDH and AST enzyme levels(EMG electrode/needle stimulation also increases these enzyme levels upto 1-2 weeks) and if high then again with rest repeat EMG.For further clarification(if needed)please give detailed findings of all EMG tests.
Best wishes,
Regards,

[needhonesthelp]

will you please let me know your final thoughts based on a few of my comments.  Thank you so much

[needhonesthelp]

Any doc please read my response to the original post I had...regarding muscle disease...listed under "Dr.Kalra-here is my situation".thx

[needhonesthelp]

I also want to ask, you mentioned on your previous reply that these EMG may be due to lifting.  Why would some muscles be normal on EMG and others abnormal.  I use my deltoids, biceps, quads, etc a lot in lifting too but they had normal EMG readings.

I certainly hope you are correct, but I just want to educate myself and piece this puzzle together a bit.  I'm being asked to get a muscle biopsy because the EMG suggests a muscle disease and yet they don't know what it could be???

OK, that is truly my final thoughts.  I'm actually leaving for job training in a day and just want some thoughts to calm myself down I hope...Thanks!