Back pain after EMG

[Lim Yuan Hai]

I am sorry that I post it under your topic without asking your permission. I query here because you guys seem knowledgeable about MRI and/or spine.

1) What is a MRI cost for spine in Bangkok and, which hospital and spine specialist is recommendable?

My back especially around mid-back has been very tired, ached, pressured and uncomfortable even sometimes very early in the morning, for about 8 weeks (since around 5 October 2017) even when my usual sitting and standing.

It is coincidence with EMG testing (a needle was inserted on 3 different area on my back) that was done on 3 October 2017.
2) Is it whether this EMG testing was related to my back’s tiredness? It is because a needle was inserted around the edge of or so close to my spinal cord when the simultaneous simulation of some back muscle’s movement by a nurse that might further cause some impact on the inserted needle and, its surroundings and underneath that might be a bone or nerve.
3) Is this persistent tiredness and ache of my back related to my spine?

Brown mark is where EMG's needle mark and finger point to my spine.

 
Thank You,

Merry Christmas and Happy New Year.

[Sheryl]

IMO "tired, ached, pressured and uncomfortable" middle of the back does not sound likely to be a spinal issue.

 

Please explain why an  EMG was done. The  EMG has not caused this - but the condition or suspected condition for which the EMG was done, might be the cause.

[Lim Yuan Hai]

I greatly appreciate, Sheryl. I felt some relieve because of your IMO. I suspected it was a side effect of the EMG needles test because they were very coincident, my mid back problems just after EMG test. I do not have any back problems until this EMG test.

May I respectfully ask some questions so that I can focus on other possible causes and if possible, rule out it is not my spinal issue:
1) Why did you think it is not a spinal issue?
2) I think EMG’s needle might hit my vertebra or spinal nerve (kindly see attachment below) according to the needle mark on my back (kindly refer to the image of my previous attachment) that might cause some damages on them that make me very disturbing and kept on worrying. Can you kindly advise?

To answer your question: EMG was done (advised by my doctor) to rule out prolong weakness in my left polio leg’s knee was not due to a post-polio syndrome. I am exercising some non-weight bearing exercises (for examples, using swiss ball and in the swing pool) to strengthen my left leg.

Brief medical history, I am 55 years old. I suffered polio on my left leg when I was 10 months old. I was able to walk independently until 2011. I fell and my left tight bone fractured and metal implanted on it in 2011.  Implanted metal was too long to reach up to my left knee. I had to use one crutch to walk until 2013. Now I have to use 2 crutches to walk after 2013.

Thank You and Kind Regards,

Merry Christmas and Very New Year.

[Sheryl]

4 hours ago, Lim Yuan Hai said:

I greatly appreciate, Sheryl. I felt some relieve because of your IMO. I suspected it was a side effect of the EMG needles test because they were very coincident, my mid back problems just after EMG test. I do not have any back problems until this EMG test.

May I respectfully ask some questions so that I can focus on other possible causes and if possible, rule out it is not my spinal issue:
1) Why did you think it is not a spinal issue?
2) I think EMG’s needle might hit my vertebra or spinal nerve (kindly see attachment below) according to the needle mark on my back (kindly refer to the image of my previous attachment) that might cause some damages on them that make me very disturbing and kept on worrying. Can you kindly advise?

To answer your question: EMG was done (advised by my doctor) to rule out prolong weakness in my left polio leg’s knee was not due to a post-polio syndrome. I am exercising some non-weight bearing exercises (for examples, using swiss ball and in the swing pool) to strengthen my left leg.

Brief medical history, I am 55 years old. I suffered polio on my left leg when I was 10 months old. I was able to walk independently until 2011. I fell and my left tight bone fractured and metal implanted on it in 2011.  Implanted metal was too long to reach up to my left knee. I had to use one crutch to walk until 2013. Now I have to use 2 crutches to walk after 2013.

Thank You and Kind Regards,

Merry Christmas and Very New Year.

 

It is almost inconceivable that an EMG needle would hit a spinal nerve or nerve root exiting the spine, would take massive incompetence plus a very skinny patient to achieve that and if it happened it would be immediately apparent as there would be excruiating pain radiating all the way down.

 

What you describe (tired achy feeling) is more often muscular in origin than spinal. But it could also be due to post-polio syndrome, if you have that. Or you may have something else neuro-muscular going on. Not to scare you, but pain after an EMG sometimes is found with people who are in early stages of  multiple sclerosis or other neuro-muscular diseases.

 

I actually had something like what you seem to describe  -- particularly bad in the middle of the night and early morning -- which turned out to be muscular and resolved with physical therapy.

 

With a bad leg and using a crutch it is quite possible that you are straining some muscles while under-using other ones.

 

ASSOC. PROF. WICHARN YINGSAKMONGKOLis an excellent spinal specialist, you may see him if you want a definitive opinion.

 

https://www.bnhhospital.com/spine/team/

https://www.bch.in.th/en/doctor-th-4/surgery/item/696-doc31.html

 

The second hospital will cost less than at the first and if any scan is needed, the  place I mentioned in the post above this will cost less than a hospital

 

if he rules out a spinal issue he might refer you either to Physical therapy if he thinks it is a muscular issue or to a neurologist specializing in neuromuscular issues.

 

 

[Lim Yuan Hai]

Thank you, Sheryl. You are so kind for sharing your knowledge and experience.

I am glad to know that your muscular issue has been resolved with physical therapy, congratulations. Can you kindly share (because you said you had similar symptoms):
1) which physical therapist and his/her hospital or clinic are recommendable?
2) which of your muscle was a problem and what methods of physiotherapy you did?
Oh, by the way, “particularly bad in the middle of the night and early morning” quoted. I felt strange why at these particular timing, did you manage to find a reason?

I gladly agree with your 1^st paragraph. May I respectfully ask you how did you know it “there would be excruciating pain radiating all the way down”? I am asking this because I would like to rule out this possibility.

3) Is it possible that an EMG’s needle hit the edge of a vertebra and damaged it? If so, what would be a symptom?

4) Can you kindly enlighten me why pain after an EMG for those who are in early stages of multiple sclerosis or other neuro-muscular diseases and how such a pain correlated with an EMG or after an EMG? Where is a pain? I wish I am not the one.

Can I consult ASSOC. PROF. WICHARN YINGSAKMONGKOL for my weak polio knee issue (if I am not wrong some spine specialist also a good orthopedic for knee)? 
Can I visit 2^nd hospital because I am a Buddhist and it is a Christian Hospital?

Kind Regards and have a wonderful day.

 

[Lim Yuan Hai]

21 hours ago, Sheryl said:

It is almost inconceivable that an EMG needle would hit a spinal nerve or nerve root exiting the spine, would take massive incompetence plus a very skinny patient to achieve that and if it happened it would be immediately apparent as there would be excruiating pain radiating all the way down.

 

What you describe (tired achy feeling) is more often muscular in origin than spinal. But it could also be due to post-polio syndrome, if you have that. Or you may have something else neuro-muscular going on. Not to scare you, but pain after an EMG sometimes is found with people who are in early stages of  multiple sclerosis or other neuro-muscular diseases.

 

I actually had something like what you seem to describe  -- particularly bad in the middle of the night and early morning -- which turned out to be muscular and resolved with physical therapy.

 

With a bad leg and using a crutch it is quite possible that you are straining some muscles while under-using other ones.

 

ASSOC. PROF. WICHARN YINGSAKMONGKOLis an excellent spinal specialist, you may see him if you want a definitive opinion.

 

https://www.bnhhospital.com/spine/team/

https://www.bch.in.th/en/doctor-th-4/surgery/item/696-doc31.html

 

The second hospital will cost less than at the first and if any scan is needed, the  place I mentioned in the post above this will cost less than a hospital

 

if he rules out a spinal issue he might refer you either to Physical therapy if he thinks it is a muscular issue or to a neurologist specializing in neuromuscular issues.

 

 

Sorry, I forget to quote you in my post above.
Kindly advise.


Thank you, 

[Sheryl]

There is absolutely no problem to be a Buddhist and go to Bangkok Christian Hospital. The vast majority of their patients and doctors are Buddhist.

 

Dr Wicharn is specifically a spinal specialist, for knee problem you would need to see someone else.

 

The best knee specialist in Thailand is this doctor at Bumrungrad. It is an expensive hospital but he is worth it. If you have any previous  Xrays you can bring with you, that may help cut costs.

 

https://www.bumrungrad.com/doctors/Panya-Wongpatimachai

 

( I am not sure however that your knee problem is orthopedic in nature, it may be neurologic or nueromuscular - but see what Dr. Panya thinks).

 

My particular back ache was on either side of the spine in the lumbar area, a dull ache and due to tightness and strain of the lateral; femoral muscles and piriformis muscles, which is what the PT addressed. I got the PT in Cambodia, not Thailand so that is no help to you unless you will be traveling there (in which case there are excellent, American, physiotherapists in Phnom Penh).  In any case your pain is in a different region of the back as I understand it so will not be the same muscles. See the spine and knee specialists and let them  refer you if they think  PT is indicated.

 

It is extraordinarily unlikely that the EMG needles hit bone and if they did (1) the nurse would immediately feel it and (2) it would not be able to damage the bone and (3) could not be causing the pain you have now.

 

Hitting a nerve root coming off  the spine always causes excrutiating pain which will radiate all the way down the leg, this is simple physiology. And as said, it is extremely unlikely that would occur.

 

I can't tell you why some people in early stages if MS have pain after an EMG, but it is reported in the literature that this sometimes occurs. MS is thought to be autoimimmune in nature so probably the irritation form the needles aggravates the autoimmune response.

 

It is thought that there might p[ossibly be an automimmune aspect to post-polio syndrome also, though it is not known for sure.

 

In both MS and PPS the EMG can often be normal.

 

 

[VocalNeal]

18 hours ago, Sheryl said:

There is absolutely no problem to be a Buddhist and go to Bangkok Christian Hospital.

Ha, ha, ha. The prettiest nurse by far when I was in there was Muslim!  All the other nurses who came in used to smile and taunt me with "Islam!"  There is a good Neurologist there as well  Well i was happy and am still here.

 

Bangkok Christian is or was the third best hospital in Bangkok.

 

For MRI once on my knee I was sent by the late English sports medicine guy ( sorry name escapes me at present) to Urupong Medical Clinic.

[Lim Yuan Hai]

On ‎12‎/‎27‎/‎2017 at 7:02 PM, Sheryl said:

There is absolutely no problem to be a Buddhist and go to Bangkok Christian Hospital. The vast majority of their patients and doctors are Buddhist.

 

Dr Wicharn is specifically a spinal specialist, for knee problem you would need to see someone else.

 

The best knee specialist in Thailand is this doctor at Bumrungrad. It is an expensive hospital but he is worth it. If you have any previous  Xrays you can bring with you, that may help cut costs.

 

https://www.bumrungrad.com/doctors/Panya-Wongpatimachai

 

( I am not sure however that your knee problem is orthopedic in nature, it may be neurologic or nueromuscular - but see what Dr. Panya thinks).

 

My particular back ache was on either side of the spine in the lumbar area, a dull ache and due to tightness and strain of the lateral; femoral muscles and piriformis muscles, which is what the PT addressed. I got the PT in Cambodia, not Thailand so that is no help to you unless you will be traveling there (in which case there are excellent, American, physiotherapists in Phnom Penh).  In any case your pain is in a different region of the back as I understand it so will not be the same muscles. See the spine and knee specialists and let them  refer you if they think  PT is indicated.

 

It is extraordinarily unlikely that the EMG needles hit bone and if they did (1) the nurse would immediately feel it and (2) it would not be able to damage the bone and (3) could not be causing the pain you have now.

 

Hitting a nerve root coming off  the spine always causes excrutiating pain which will radiate all the way down the leg, this is simple physiology. And as said, it is extremely unlikely that would occur.

 

I can't tell you why some people in early stages if MS have pain after an EMG, but it is reported in the literature that this sometimes occurs. MS is thought to be autoimimmune in nature so probably the irritation form the needles aggravates the autoimmune response.

 

It is thought that there might p[ossibly be an automimmune aspect to post-polio syndrome also, though it is not known for sure.

 

In both MS and PPS the EMG can often be normal.

 

 

Thank you, Sheryl for sharing. You are kind and knowledgeable.

You said:
1) “some people in early stages of MS have pain after an EMG, but it is reported in the literature that this sometimes occurs”.
Kindly share some of these literatures that are easy to understand.
Now I am very worry that I might have Multiple sclerosis.

2) “MS is thought to be autoimmune in nature so probably the irritation from the needles aggravates the autoimmune response”
Can you please enlighten me which part of the body needles probably irritated? Is it muscles or nerves or bones?
How can needles probably irritate?

3) “It is thought that there might possibly be an autoimmune aspect to post-polio syndrome also”.
I do not understand what you mean.
Does it mean autoimmune might possibly be a part of PPS?
Does autoimmune relate to persistent tiredness, ache, pressure and uncomfortable of my mid back since 5^th Oct 2017?
Which part of our body is a root cause for autoimmune?

My EMG testing was done at the Bumrungrad hospital. It is very strange that they did not recommend me to Dr Panya instead they recommend me to see other orthopedist who I think is just average.
I greatly appreciate that you recommend Dr. Panya of Bumrungrad the best knee specialist in Thailand. I will consult with him for my weak knee. By the way, would you mind sharing how do you know he is the best knee specialist here because seeing the best will save my time and benefit the most to my health? I wish we always meet with the best.  

A Neurologist at Bumrungrad ruled out the weakness of my left polio knee is not due to post-polio syndrome by referencing to the part of the following paragraph:
“Right lower extremity muscles were sampled. There was no abnormal spontaneous discharge noted. Chronic     neurogenic change was seen in proximal muscles.”.

I was told that there was spontaneous discharge if weakness is due to PPS. Can you please advise?

 

[Lim Yuan Hai]

On ‎12‎/‎27‎/‎2017 at 7:02 PM, Sheryl said:

There is absolutely no problem to be a Buddhist and go to Bangkok Christian Hospital. The vast majority of their patients and doctors are Buddhist.

 

Dr Wicharn is specifically a spinal specialist, for knee problem you would need to see someone else.

 

The best knee specialist in Thailand is this doctor at Bumrungrad. It is an expensive hospital but he is worth it. If you have any previous  Xrays you can bring with you, that may help cut costs.

 

https://www.bumrungrad.com/doctors/Panya-Wongpatimachai

 

( I am not sure however that your knee problem is orthopedic in nature, it may be neurologic or nueromuscular - but see what Dr. Panya thinks).

 

My particular back ache was on either side of the spine in the lumbar area, a dull ache and due to tightness and strain of the lateral; femoral muscles and piriformis muscles, which is what the PT addressed. I got the PT in Cambodia, not Thailand so that is no help to you unless you will be traveling there (in which case there are excellent, American, physiotherapists in Phnom Penh).  In any case your pain is in a different region of the back as I understand it so will not be the same muscles. See the spine and knee specialists and let them  refer you if they think  PT is indicated.

 

It is extraordinarily unlikely that the EMG needles hit bone and if they did (1) the nurse would immediately feel it and (2) it would not be able to damage the bone and (3) could not be causing the pain you have now.

 

Hitting a nerve root coming off  the spine always causes excrutiating pain which will radiate all the way down the leg, this is simple physiology. And as said, it is extremely unlikely that would occur.

 

I can't tell you why some people in early stages if MS have pain after an EMG, but it is reported in the literature that this sometimes occurs. MS is thought to be autoimimmune in nature so probably the irritation form the needles aggravates the autoimmune response.

 

It is thought that there might p[ossibly be an automimmune aspect to post-polio syndrome also, though it is not known for sure.

 

In both MS and PPS the EMG can often be normal.

 

 

Dear Sheryl,

I am anxiously waiting your invaluable comment about my post dated on 2nd Dec (Tuesday). Thank you.

[Sheryl]

These posts have been split off from original thread where they were itnerspersed with unrelated discussion.

 

Sorry for the delay, I was frankly a bit deterred by your asking "how" I know things whenever I provide information or a doctor referral - so please let us take care of that once and for all. Everything I know is the result of a combination of professional education, years of professional experience, years of using Thai medical facilities (for myself and a large extended Cambodian family -- and many of their friends as well) and many years moderating the health forum on TV, in the course of which I get a lot of feedback from people.  

 

An EMG stimulates the motor neurons, these are the nerve cells that stimulate muscle. The stimulated motor neuron in turn stimulates muscle. So if it had an effect it could have been on the wither the   motor nerves or the muscle(s) those nerves ennervate.  Definitely not bone. 

 

Normally the stimulation of an EMG does not create any irritation, but it is conceivable that if there was an inflammatory and/or automimmune process already present, the stimulation might have aggravated it.  It has been my experience with people with allergic/ auto immune problems that once these reactions are in progress the body becomes hypersensitive and will react to things it normally would not. It is also possible the temporal connection to the EMG is pure coincidence, but you seem quite convinced that the EMG set off the aching pain in the mid back, so I am just explaining how this might  possibly have occurred, if it is not in fact pure coincidence.

 

The cause of PPS is not well understood. It has been hypothesized that there might be an autoimmune component but it is not sure. Totally aside from PPS, there are other autoimmune diseases in which muscle weakness and/or aching occurs, such as fibromylagia, MS, and others.

 

To my understanding, there will not always be abnormal EMG findings in PPS.

 

"The criteria for PPS [3] according to Halstead are confirmed history of polio, partial or fairly complete neurological and functional recovery after the acute episode followed by a period of at least 15 years with neurological and functional stability with two or more of the following health problems occurring after the stable period: Extensive fatigue, muscle and/or joint pain, new weakness in muscles previously affected or unaffected, new muscle atrophy, functional loss and cold intolerance. Also no other medical explanation should be found. PPS is an exclusion diagnosis."

http://www.mjdrdypu.org/article.asp?issn=0975-2870;year=2015;volume=8;issue=1;spage=57;epage=60;aulast=Sheth

 

So unless the test results were consistent with something else I am not sure that the lack of spontaneous discharge rules out PPS.  But I am not a neurologist and have no prior experience with patients with PPS, just going by what I read.

 

It would help to have a full history i.e. when your symptoms began and what they originally were, I believe the "persistent tiredness, ache, pressure and uncomfortable of my mid back since 5th Oct 2017" refers back to the date of the EMB+G but obviously you had problems before then, bad enough to warrant an EMG. Was the increased knee weakness the only symptom prior to the EMG or were their others?

 

Also what if any diagnosis did the neurologist suggest? If you have a written report, black out your name and hospital number  then scan and post here.  Surely it said more than "Chronic     neurogenic change". Also which neurologist did you see?

 

The more information you can give me, the better able I will be to suggest an appropriate specialist. This is sounding less and less like an orthopedic problem.

 

It would also help to know your ethnicity and country of origin.  MS is rare in Asians and especially rare in Southeast Asia, it is mainly a disease found in temperate climates.

 

[Sheryl]

Please reply soon as I will be mostly offline from Monday onward for 12 dys

[Sheryl]

As I have not heard back rom you and will have limited internet access in the next 10-12 days:

 

From ythe very limited information provided it sounds like you morel ikely have a neuromuscular issue than an orthopedic one.  One of the best neurologist for PPS and other neuromuscular problems is Prof Kanokwan

 

https://www.bumrungrad.com/doctors/Kanokwan-Boonyapisit

 

Can also be seen at Siriraj's private wing   http://www.siphhospital.com/th/splash

 

She is US trained and board certified, did a fellowship at the world renowned Cleveland Clinic and is on faculty at the nation's leading medical college.

 

 

[Lim Yuan Hai]

On ‎1‎/‎5‎/‎2018 at 10:31 PM, Sheryl said:

These posts have been split off from original thread where they were itnerspersed with unrelated discussion.

 

Sorry for the delay, I was frankly a bit deterred by your asking "how" I know things whenever I provide information or a doctor referral - so please let us take care of that once and for all. Everything I know is the result of a combination of professional education, years of professional experience, years of using Thai medical facilities (for myself and a large extended Cambodian family -- and many of their friends as well) and many years moderating the health forum on TV, in the course of which I get a lot of feedback from people.  

 

An EMG stimulates the motor neurons, these are the nerve cells that stimulate muscle. The stimulated motor neuron in turn stimulates muscle. So if it had an effect it could have been on the wither the   motor nerves or the muscle(s) those nerves ennervate.  Definitely not bone. 

 

Normally the stimulation of an EMG does not create any irritation, but it is conceivable that if there was an inflammatory and/or automimmune process already present, the stimulation might have aggravated it.  It has been my experience with people with allergic/ auto immune problems that once these reactions are in progress the body becomes hypersensitive and will react to things it normally would not. It is also possible the temporal connection to the EMG is pure coincidence, but you seem quite convinced that the EMG set off the aching pain in the mid back, so I am just explaining how this might  possibly have occurred, if it is not in fact pure coincidence.

 

The cause of PPS is not well understood. It has been hypothesized that there might be an autoimmune component but it is not sure. Totally aside from PPS, there are other autoimmune diseases in which muscle weakness and/or aching occurs, such as fibromylagia, MS, and others.

 

To my understanding, there will not always be abnormal EMG findings in PPS.

 

"The criteria for PPS [3] according to Halstead are confirmed history of polio, partial or fairly complete neurological and functional recovery after the acute episode followed by a period of at least 15 years with neurological and functional stability with two or more of the following health problems occurring after the stable period: Extensive fatigue, muscle and/or joint pain, new weakness in muscles previously affected or unaffected, new muscle atrophy, functional loss and cold intolerance. Also no other medical explanation should be found. PPS is an exclusion diagnosis."

http://www.mjdrdypu.org/article.asp?issn=0975-2870;year=2015;volume=8;issue=1;spage=57;epage=60;aulast=Sheth

 

So unless the test results were consistent with something else I am not sure that the lack of spontaneous discharge rules out PPS.  But I am not a neurologist and have no prior experience with patients with PPS, just going by what I read.

 

It would help to have a full history i.e. when your symptoms began and what they originally were, I believe the "persistent tiredness, ache, pressure and uncomfortable of my mid back since 5th Oct 2017" refers back to the date of the EMB+G but obviously you had problems before then, bad enough to warrant an EMG. Was the increased knee weakness the only symptom prior to the EMG or were their others?

 

Also what if any diagnosis did the neurologist suggest? If you have a written report, black out your name and hospital number  then scan and post here.  Surely it said more than "Chronic     neurogenic change". Also which neurologist did you see?

 

The more information you can give me, the better able I will be to suggest an appropriate specialist. This is sounding less and less like an orthopedic problem.

 

It would also help to know your ethnicity and country of origin.  MS is rare in Asians and especially rare in Southeast Asia, it is mainly a disease found in temperate climates.

 

Dear Sheryl,

I am very sorry that you were a bit deterred by some of my questions. Actually, I like and appreciate the best specialist/the best and information you provided because he/she is the right specialist or doctor to find the root cause to eliminate it and I would like to double confirm and assure the information/referral by asking where they came from. Anyway, again I am very sorry.

Thank you for explaining how you got your professional knowledge and experience. I think only a professional person who has a sound knowledge and experience know the best person in her field. I greatly appreciate you are one of them.

You said (I quoted because I respect and value what you said):
1) “An EMG stimulates the motor neurons”.
Can you please enlighten me on where (muscle or neuron or nerve) an EMG needle was inserted to stimulate the motor neurons?  

2.a) “….but obviously you had problems before then, bad enough to warrant an EMG. Was the increased knee weakness the only symptom prior to the EMG or were their others?”
My knee weakness is the only symptom to see Dr Sasitorn Siritho (to be exact my left knee is not strong enough to straighten and hold when I walk, but no pain).
There is only one more problem that was a bit swollen on my foots that was handled by another specialist and doctor who recommended blood test, ultrasound and heart package test. I did not mention this because I do not think that a blood test and ultrasound could cause back problems. It was likely due to my limited mobility and all the tests (blood test, ultrasound and heart package medical check-up) were good.
2.b) “PPS is an exclusion diagnosis”.
I respectfully agreed with you.

Dr Sasitorn Siritho said she wanted to do EMG test just to rule out PPS. I am wondering if the EMG test can’t rule out PPS or not bad enough to warrant an EMG, then why she recommended the EMG test.

3) “So unless the test results were consistent with something else”
She said my weak knee was not due to PPS because a) my polio leg has no pain my polio leg could feel when tough c) specifically mentioned “There was no abnormal spontaneous discharge noted” on my EMG result.

Are they the ones that you mentioned “consistent with something else”

To further answer your questions:

I am a Chinese, born in Yangon (Myanmar) and resident of Singapore since 1991. Currently living in Bangkok for around 2 years.

I have seen GP (Dr Yaowarat) to recommend a suitable specialist to solve my weak polio left leg. She recommended to see Dr Sasitorn Siritho who recommended me to do an EMG test. I was very desperate to walk independently like before (before 2 fall down, kindly refer to my post dated on ‎12‎/‎26‎/‎2017 at 3:19 PM) without two crutches and trusted the Bumrungrad hospital hence, I was dumb enough to think or ask questions about usefulness or suitability of an EMG test. I saw Dr Prinyarat Burusnukul name on my EMG test result I do not know whether she was the one who personally performed the EMG test on me. I have upload the reports (4 more graph pages left. Please let me know if you want me to upload it) as per your request. I appreciate your request and awaiting your invaluable comment.

My regret is I would have known you earlier on this forum.

My symptoms only began after the EMG test. I do not know what they originally were I only know around mid-back. No pain when I pressed my spine or back. My symptoms like stress on lower back, feel mid back is very heavy (new symptoms), persistent tiredness, ache, pressure and uncomfortable of my mid back are no pain but felt very bad and hard to tolerate them hence, badly effect my daily routine.

There are these back problems when sitting or standing. There are no symptoms when walking or lying down on the bed. Worst time is just before finishing dinner time. Around 3 months ago, I felt symptoms even early in the morning, now much better in the early morning.

Could you please advise how can I completely rule out my back symptoms are not my spine related and not a result of the EMG test? I suspected the EMG test because I do not have such symptoms before the EMG test and I felt quite sharp pain when an EMG needle inserted near or the edge of my spine (kindly refer to the image I posted on 25^th December 2017), no pain after that.

My another problem is the weak knee of my polio leg. Can you recommend the best physiotherapist or physical doctor or any suitable one?

Kind Regards,

[Lim Yuan Hai]

On ‎1‎/‎7‎/‎2018 at 7:58 PM, Sheryl said:

As I have not heard back rom you and will have limited internet access in the next 10-12 days:

 

From ythe very limited information provided it sounds like you morel ikely have a neuromuscular issue than an orthopedic one.  One of the best neurologist for PPS and other neuromuscular problems is Prof Kanokwan

 

https://www.bumrungrad.com/doctors/Kanokwan-Boonyapisit

 

Can also be seen at Siriraj's private wing   http://www.siphhospital.com/th/splash

 

She is US trained and board certified, did a fellowship at the world renowned Cleveland Clinic and is on faculty at the nation's leading medical college.

 

 

Dear Sheryl,

Thank you for recommendation. Is it for my weak knee or back problems? Dr Sasitorn Siritho ruled out PPS.
What is a difference between neuromuscular issue and an orthopedic one?

I have uploaded the result of my blood test here. There is one more page, please let me know if you want me to upload it.

Kind Regards,

[Sheryl]

The recommendation is for both problems as they might both be neuromuscular in nature.

 

Neuromuscular problem = the cause is either in the nerves or muscles. Orthopedic = the problem is in the bone or adjacent structures and is structural rather than functional in nature.

 

The knee and spine specialists previously mentioned will be relevant only if the problem is orthopedic. From the EMG results you mentioned previously it seems likely there is a neuromuscular issue.

 

Your blood tests are normal.

 

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

 

 

 

 

[Lim Yuan Hai]

On ‎1‎/‎5‎/‎2018 at 10:31 PM, Sheryl said:

These posts have been split off from original thread where they were itnerspersed with unrelated discussion.

 

Sorry for the delay, I was frankly a bit deterred by your asking "how" I know things whenever I provide information or a doctor referral - so please let us take care of that once and for all. Everything I know is the result of a combination of professional education, years of professional experience, years of using Thai medical facilities (for myself and a large extended Cambodian family -- and many of their friends as well) and many years moderating the health forum on TV, in the course of which I get a lot of feedback from people.  

 

An EMG stimulates the motor neurons, these are the nerve cells that stimulate muscle. The stimulated motor neuron in turn stimulates muscle. So if it had an effect it could have been on the wither the   motor nerves or the muscle(s) those nerves ennervate.  Definitely not bone. 

 

Normally the stimulation of an EMG does not create any irritation, but it is conceivable that if there was an inflammatory and/or automimmune process already present, the stimulation might have aggravated it.  It has been my experience with people with allergic/ auto immune problems that once these reactions are in progress the body becomes hypersensitive and will react to things it normally would not. It is also possible the temporal connection to the EMG is pure coincidence, but you seem quite convinced that the EMG set off the aching pain in the mid back, so I am just explaining how this might  possibly have occurred, if it is not in fact pure coincidence.

 

The cause of PPS is not well understood. It has been hypothesized that there might be an autoimmune component but it is not sure. Totally aside from PPS, there are other autoimmune diseases in which muscle weakness and/or aching occurs, such as fibromylagia, MS, and others.

 

To my understanding, there will not always be abnormal EMG findings in PPS.

 

"The criteria for PPS [3] according to Halstead are confirmed history of polio, partial or fairly complete neurological and functional recovery after the acute episode followed by a period of at least 15 years with neurological and functional stability with two or more of the following health problems occurring after the stable period: Extensive fatigue, muscle and/or joint pain, new weakness in muscles previously affected or unaffected, new muscle atrophy, functional loss and cold intolerance. Also no other medical explanation should be found. PPS is an exclusion diagnosis."

http://www.mjdrdypu.org/article.asp?issn=0975-2870;year=2015;volume=8;issue=1;spage=57;epage=60;aulast=Sheth

 

So unless the test results were consistent with something else I am not sure that the lack of spontaneous discharge rules out PPS.  But I am not a neurologist and have no prior experience with patients with PPS, just going by what I read.

 

It would help to have a full history i.e. when your symptoms began and what they originally were, I believe the "persistent tiredness, ache, pressure and uncomfortable of my mid back since 5th Oct 2017" refers back to the date of the EMB+G but obviously you had problems before then, bad enough to warrant an EMG. Was the increased knee weakness the only symptom prior to the EMG or were their others?

 

Also what if any diagnosis did the neurologist suggest? If you have a written report, black out your name and hospital number  then scan and post here.  Surely it said more than "Chronic     neurogenic change". Also which neurologist did you see?

 

The more information you can give me, the better able I will be to suggest an appropriate specialist. This is sounding less and less like an orthopedic problem.

 

It would also help to know your ethnicity and country of origin.  MS is rare in Asians and especially rare in Southeast Asia, it is mainly a disease found in temperate climates.

 

290118
Dear Sheryl,

You might overlook my reply to your request including test result of the EMG due to your busy schedule. I appreciate each and every of your comments/advise. Kindly advise.

Thank you,

[Sheryl]

We are going in circles here and you are referring to old replies.

I have seen your EMG report. It seems suggestive of a neuromuscular problem. The reported onset of pain after the EMG likewise is probably neuromuscular in nature. I have suggested a specialist in neuromuscular problems. There is no more I can do.

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[Lim Yuan Hai]

22 minutes ago, Sheryl said:

We are going in circles here and you are referring to old replies.

I have seen your EMG report. It seems suggestive of a neuromuscular problem. The reported onset of pain after the EMG likewise is probably neuromuscular in nature. I have suggested a specialist in neuromuscular problems. There is no more I can do.

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Thank you very much.

[Sheryl]

Already replied by PM but for the benefit of others:

Medconsult Asia handles tbis sort of thing.

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