Month: March 2016

Medical Procedures: What It’s Like To Get An EMG (Electromyography)

Raise your hand if you’ve got a bad shoulder (badum ching!).  Yup, me too.  Although I had surgery to repair it a year ago, I’ve had some lingering problems.

Since physical therapy (PT) hasn’t resolved the functionality problems with that arm, my primary care manager (PCM) ordered some diagnostic medical procedures to try to determine what’s causing the problems.  One of the procedures that was ordered was an electromyography.

Electromyography (EMG) is a diagnostic procedure that assesses the health of muscles and the nerve cells that control them (motor neurons).  According to the Mayo Clinic,

“Motor neurons transmit electrical signals that cause muscles to contract. An EMG translates these signals into graphs, sounds or numerical values that a specialist interprets…EMG results can reveal nerve dysfunction, muscle dysfunction or problems with nerve-to-muscle signal transmission.”

In my case, they were trying to determine whether a pinched nerve in my neck was causing the problems with my arm.

Electromyography is an outpatient procedure that typically takes about an hour.  EMG is often done in conjunction with a nerve conduction study (NCS), which I also had.  NCS is the measurement of “the speed of conduction of an electrical impulse through a nerve. NCS can determine nerve damage and destruction” (Johns Hopkins).

According to WebMD,

“Nerve conduction studies are done before an EMG if both tests are being done. Nerve conduction tests may take from 15 minutes to 1 hour or more, depending on how many nerves and muscles are studied.”

Since they were going to need access to my arm and shoulder (and trapezius, as it turned out), I wore a track suit with a tank top underneath. They asked me to take off the track suit jacket and lie down on an examining table.

To prepare for the NCS, the person administering the torture procedure asked me to move my fingers, hand, and arm in several different directions so she could determine her targets.  These she marked on my arm with a marking pen.  She fastened several electrodes to my hand and fingers with tape (see picture below), and proceeded to zap me with a machine that looked like a taser (but used less voltage, obviously).

 

This is not a pleasant sensation.  It typically wasn’t too painful, except when she applied multiple shocks in the same location.  The second or third consecutive shock in the same spot became more and more painful.  For the most part, she told me what she was going to do before she did it, which helped me prepare.  When she told me she needed to do 10 shocks in the same place, I knew two things: 1) It was going to hurt like hell, and 2) I’d better do the stress management/relaxation breathing techniques I learned at the base Wellness Center.

Breathing techniques, whether learned through biofeedback training or as part of yoga or meditation can be very helpful for managing pain or stress.  I use them whenever I am having an uncomfortable/painful/stressful medical procedure.  Of course, in this case, relaxing was a bit more challenging, since my body was also jerking from the shocks.  For some of the shocks, only my hand/wrist twitched.  But for some of them, my opposite leg jumped.  Several times I got a cramp in my arm muscles, and toward the end, I got a cramp in the muscles in my lower back.

That was part one.  Part two was the EMG.  “During a needle EMG, a needle electrode inserted directly into a muscle records the electrical activity in that muscle” (Mayo Clinic).

The needle is inserted into various muscles.  It didn’t hurt most of the times it was inserted, since it is a very fine needle.  It did hurt when it was inserted into the trapezius muscle.  Once it is inserted, the doctor taps on the needle, and sometimes moves it around inside the muscle as she listens to the signal.  As you can imagine, this doesn’t feel very good.  Then she asks you to engage the muscle.  You can hear an increase in signal noise while you are engaging the muscle.  This also doesn’t feel very good, as the needle feels like it is stabbing you more.

These tests may be done only on one side of your body (one arm, one leg, etc.), or they may be done on both sides of your body in order to compare results.  In this case, they only tested the problematic arm, not both, and the doctors were able to give me my results at the end of the procedures.

The good news is they didn’t see any evidence that I have a pinched nerve in my neck.  The bad news is that these diagnostic procedures didn’t help determine the cause of the problems with my arm.

After the tests: I had one righteous bruise, and I was tired for the rest of the day.

According to WebMD:

“After the [EMG], you may be sore and have a tingling feeling in your muscles for up to 2 days. If your pain gets worse or you have swelling, tenderness, or pus at any of the needle sites, call your doctor.”

“If you still have pain after the [NCS]:

  • Put ice or a cold pack on the sore area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
  • Take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label.”

How NOT to Do It: Applying for VA Disability Years After Military Separation

Something slightly different today: I had the opportunity to write a guest post for The Military Guide.  Started by a Navy veteran who transitioned to an early retirement lifestyle after 20 years of military service, The Military Guide covers subjects such as financial independence and early retirement from a military perspective.  If you’re interested in ways to parlay military pay and benefits into savings, investments, and possibly a side hustle or two so that you, too, can avoid working or can work on your own terms after you separate from the military, head on over there and check it out.  Doug Nordman, the founder of The Military Guide, retired in his early forties and now surfs and supports veterans causes.  With some hard work and careful planning, that could be you!

The post I wrote for The Military Guide covers my experience of filing for VA disability well *after* I separated from the military.  Hopefully it will be a cautionary tale of what NOT to do, if you are still on active duty. Or, perhaps, it will give you the motivation to go ahead and apply for VA disability benefits, even if it’s been *years* since you separated from the military.  Check it out and let me know what you think.

Becoming a Critical Consumer of Health Information

“Everything we hear is an opinion, not a fact.  Everything we see is a perspective, not the truth.” – Marcus Aurelius

It is increasingly difficult to distinguish between signal and noise these days.  Information sources tend more toward being the first to release information (“getting the scoop”), and less toward fact-checking before distribution.  They also tend more toward hyperbole, and less toward sober, objective reporting.  When you add cognitive biases such as confirmation bias to the pressure to draw high ratings or optimize traffic to your site, the signal can become very hard to detect.

In other words, how do you know if health information is accurate or effective?  As of 2009, alternative medicine was a $34 billion-a-year business.  How do you know you’re not spending your hard-earned money on modern-day snake oil?

One place to start is here.  This article, provided by the National Institutes of Health (NIH), gives an overview on how to evaluate health information.

And this article in The Guardian explains a few of the reasons we can get it wrong: cognitive biases.  As one scientist in the article explains, “As a health condition degrades and there become fewer and fewer treatment options, the tendency to try anything rises. The confounding part of this equation is the concept of human hope – and that, unfortunately, is what undermines science every time. We hope that something will work, we believe that something will work.”

When I was healthy, I thought going to the doctor was like going to a car mechanic: you tell them what’s wrong and they fix it.  But when I developed a chronic health condition, I learned that doctors don’t always know how to “fix it”.  I also learned that they often don’t want to admit that they don’t know how to fix it.  I have a great deal of respect for the one and only doctor who told me, “You know more about your condition than I do.  You’re talking over my head, and I’m just going to refer you to a specialist because this is way beyond my areas of expertise.”  I have a great deal of contempt for the multiple doctors who have been unwilling to admit (perhaps even to themselves) that this is a case that *should* be referred to a specialist, and insist on trying to treat it themselves even though it is obvious to me that they have insufficient knowledge of or experience with this condition.

So, yes, when traditional medicine failed to heal me and my quality of life decreased to the point where I could hardly work and rarely left the house, I started exploring alternative medicine.  I want to believe that I will find ways to manage my condition and live a satisfying life.  Part of that has to do with hope, but a bigger part has to do with trying to regain a sense of control.  So, I’m willing to explore alternatives – but I’m also a frugal skeptic who doesn’t want to throw away money on things that don’t work.  I’m used to providing evidence to support my statements, and I expect others to do the same.

What I am finding is that it’s difficult to find empirical evidence for alternative treatments.  Many of them have not been scientifically studied, or the number of studies or number of participants are small.  So we don’t really know whether they work or not.  There are a growing number of blogs and websites that recommend various alternative treatments, but I am hesitant to endorse any of them because I find that they cite each other as support for their statements, but I can’t find scientific evidence for their claims.  That doesn’t necessarily mean that what they are saying is wrong – I just can’t prove they’re right.

It’s human nature to believe something we hear from someone we trust.  If a treatment “worked” for our friend, or someone they know, we’re often willing to try it ourselves.  The problem is that we don’t know for sure *if* it worked or *why* it worked.  Thus, we don’t really know whether it will work for us.  And we often don’t know if there are any potential side-effects or interactions with treatments, medications, or supplements we’re already trying.  We’ve all done it – but it’s a game of roulette, really.

So how can you become more informed about alternative treatments?  I have found a few information sources that have been very helpful for me.  For learning more about vitamins, minerals, supplements, and nutrition, I go to Examine.com, a site run by editors who examine primary peer-reviewed research on these topics, or to the Mayo Clinic’s website.  For a skeptical, science-based analysis of various alternative treatments, I turn to The SkepDoc, written by Harriet A. Hall, MD, a retired family physician and former Air Force flight surgeon. She writes about “medicine, so-called complementary and alternative medicine, science, quackery, and critical thinking”. She also is one of the editors for Science-based Medicine, a website that tackles “issues and controversies in science & medicine”.  There are also some very thought-provoking articles at A Breath of Reason, which is run by a skeptical cystic fibrosis patient.  In her own words: “I started this blog as a way to offer science-based refutations for other CF patients and their loved ones to refer to when swimming through the sea of misinformation flowing around the internet, TV media, bookshelves and health stores claiming to better your health in one way or another.”

I’ll add to this list as I discover new resources, and be sure to check out the Resources page.  Finally, always ask yourself: what does this person, website, company, or organization have to gain by promoting this treatment or product?  What is their motive for providing this information?  What evidence can I find to support (or refute) their claims?

If you know of other sources of scientifically tested health information, please share them with us.  Knowledge is Power!