You are asking an interesting question, the one that I ask myself a lot, what would my EMG show now? No, I did not have a follow up EMG, for a very simple reason: it is unlikely that my HMO would allow a referral to EMG if the patient is claiming not having any symptoms anymore. They are not a research facility, they are clinic.
However, if this can help, I can tell you about my encounter with EMG and a very experienced neurologist, with close to 40 years of practice under his belt. My original diagnosis was carpal tunnel syndrome and it was confirmed by at least 3 doctors that I saw at the time. It ended up being something else (CRPS), which ended up being irrelevant because both were TMS. However, I did not know that at the time, since I had not heard of Dr. Sarno back then.
I apologize, but to save my time I am giving you a straight quote from the book I published about my recovery, so please don't be annoyed by me going off the subject at hand, but pay attention to the last paragraph:
He concluded that signal degradation in both my hands indicated definite nerve damage and recommended that I undergo a steroid injection and, if that did not help, surgery. At that point, I asked him whether either of the two procedures would fix my curled fingers. He did his best to avoid the answer. He could see that I was very skeptical about the CTS diagnosis, that I was upset that it took so long for The Clinic to have me scheduled for the procedure, and, despite my allocated time being only 30 minutes, he offered to give me a consultation beyond the basic EMG procedure. I was floored. I was finally seeing a doctor who was willing to discuss my illness. Unlike Dr B, he did not repeatedly state that I had CTS and because I had CTS and that I had to go through steroid injections because that’s what was recommended for CTS.
Dr. W was a nice man. He definitely loved his craft. He walked out of the room and came back with a big, heavy book on neurology. He also brought a brochure on CTS, written and published sometime in the ‘40s or ‘50s. He told me that to him this brochure was still the best material on CTS because it was so clearly written. He started with the explanation of why he chose neurology some 40 years ago. He was a very analytical person and when he was in medical school at UCLA, he found nerves to be very logical. He showed me the diagrams and drawings in the book. The electrical signals that power our nervous system either exist or not. That’s why it is so logical – here he got excited. You see – he pointed at my chart – both of your hands show significant degradation in the strength of electrical signal. That’s why you feel the pain, numbness, and tingling because there is simply not enough electricity to feed the tendons.
That’s when I asked him again about my curled fingers. How does the degradation of electrical signal explain the fact that I can’t straighten out my fingers? How confident are you in the CTS diagnosis? - I asked. He said, 75%. I asked him, what about the other 25%? He insisted that 75 was still greater than 25. To that, I had to agree – his math sounded very logical.
Leaving the logic of the other 25% aside, I asked him about the effectiveness of the steroid injection procedure and the rate of success. He looked puzzled. You know – he said – I used to run a clinic with my partner, a hand surgeon. When I referred people to my partner, they would come back to me and I would evaluate them after the procedure. But that was a long time ago. Now at The Clinic, I just refer people out, but I don’t see them after the treatment. They go for the follow-up to their primary doctors. That was a good question, he said.
As we progressed into our conversation about the logical nature of the nervous system, he remembered a patient who he’d seen some years back. The patient had a bad case of CTS in one hand, but Dr. W did EMG on both hands. The hand with no pain at all had a much deeper degradation of electrical signals. I can’t recall where the conversation went after that point. I think I quickly agreed that nerves were very logical and got ready to leave.
As someone with mathematical/scientific professional background, I readily agree with you ahead of time that my single case is not a statistic or even more so a scientific fact; yet, it could serve as an indication of how unsettled the world of clinical medicine is. It changed it's course so many times over the past couple centuries, maybe we should be more critical of the standard treatments of the day when it comes to brain: neuroscience has just come out of a crib only 10-15 years ago. I also would like to encourage you to read works of Dr. Norman Doidge who I credit for building up my own confidence that my brain could be re-wired successfully.
I absolutely do not want to make an impression that I am trying to convince you that you did not try hard enough in your TMS journey, but sometimes a simple change of angle may be helpful in our outlook and respective outcomes. I deeply sympathize with your pain and suffering and I wholeheartedly wish to see your success story on this forum.
TG
