C & P Today

[Bound4heaven]

Greetings to all,

My wife and I took an elderly man to a C&P exam today. It appears the exam went as expected, however the MD who did the exam now wants another C&P exam (Nerve exam) in regards to his Median Nerve. What is a Median Nerve? and what type of nerve test can be done? The doctor was not specific and refered to an nerve exam called EMG or something like that. Does anyone know what this man is headed for and can help with how to prepare for this type of exam. He is extremely stressed and full of anoxiety in regards to this matter. I will pray for protection. Can anyone help? Thank you and God bless you all.

Bound4Heaven

[Josephine]

Bound4Heaven,

If I remember correctly, isn't this veteran 74 years of age? Why in the world does this doctor want to put him through this test?

I am assuming that a Neurologist or Psychiatrist will be doing the examination.

I had one done and it is painful and I am a heck of a lot younger than this poor guy.

I was like 48 when I had it done and what can they do to help when they are finished?

I am sure that there are other vets that have had it done and can go into more detail.

I would have to make sure that there is a sound reason for putting him through it.

This will tell you all about the test from the internet:

What are some problems for which EMGs are ordered?

EMGs are usually ordered when patients are having problems with their muscles or nerves. They test the nerves and muscles of the body’s extremities, looking for a problem in either one of these areas. An EMG may be ordered to see if you have a pinched nerve in the back or the neck. If you have tingling or numbness in your arms or legs, an EMG may show if you have a nerve entrapment somewhere or a nerve injury. Weakness of the muscles or “fatigue” (tiredness) may be indicative of nerve or muscle disease and require an EMG. There are many other medical problems that might suggest the need for an EMG. If you have any doubts as to why you need this test, ask your doctor.

What happens during an EMG?

During this test, you will be lying on an examination table, next to an EMG machine (which looks like a desktop or laptop computer). The test consists of two parts, though at times one may be done without the other. The first part is called Nerve Conduction Studies. In this part some brief electrical shocks are delivered to your arm or leg in an effort to determine how fast or slowly your nerves are conducting the electrical current and therefore in what state of health or disease they may be. You see, a nerve works something like an electrical wire. If you want to see if the wire is functioning properly, the easiest thing to do is to run electricity through it. If there are any problems along its length, you will know it by a failure of the current to go through. To do this, the doctor will attach small recording electrodes to the surface of one part of your limb, and will touch your skin at another point with a pair of electrodes delivering the shock. When this happens, you will feel a tingling sensation that may or may not be painful. Between the brief shocks you will not feel pain. As there are several nerves in each extremity which need to be tested, the procedure is repeated 3 or 4 times or more per extremity studied. The amount of current delivered is always kept at a safe level. Patients wearing pacemakers or other electrical devices need not worry since this current will rarely interfere with such devices. During the nerve conduction study, the doctor or the technician performing the study will occasionally be pausing to make calculations and measurements.

The second part of the test is called Needle Examination and as the name implies, involves some needle sticking. The needles used are thin, fine and about one and a quarter inches long. This part tests the muscle to see if there has been any damage to it as a result of the nerve problem or if the disease involves the muscle itself rather than the nerve. Usually 5 to 6 muscles are sampled in one extremity, but occasionally, if you have problems in more than one area, additional muscles may need to be studied. The needle is usually inserted in the relaxed muscle and moved inside gently in order to record the muscle activity. When this is done, you will be able to hear the sound of the muscle activity amplified by the EMG machine; it will sound something like radio static. The painful part of this section is when the needle is first inserted through the skin since all of the pain receptors are located in this area. Once inside the muscle, the sensation is usually perceived as discomfort or pressure rather than pain. During the needle exam, no electrical shocks are delivered. Also, since the needle probe is used here only as a recording device, no injections are given through the needle into the muscle. On the average, a muscle can be sampled in 2 to 5 minutes though this may vary with the type of problem being investigated.

How long does an EMG take?

The nerve conduction part of the test usually takes longer than the needle exam because one needs to make calculations and measurements during it. On average, if one extremity is studied, the nerve conductions take anywhere between 15 and 30 minutes. The needle exam for one extremity usually takes 15 to 20 minutes. You can count on being in the examination room for about one hour if only one extremity is requested; longer if more extremities need to be tested.

What kind of preparations are necessary for an EMG?

Few preparations are needed on the day you have an EMG. You do not need to fast, or eat any particular kinds of food before the test. You can drive yourself to and from the test, so you do not need to bring a friend or a relative with you, any more than you would say if you went to the dentist. You can count on resuming your regular activity after the test is completed. As for clothing, it is not as much what you wear as it is what you don’t wear. Since in a great majority of cases the low back and buttocks area may need to be studied or in cases of neck problems, the back of the neck and shoulder areas studied, it is best not to wear clothes which will interfere with access to these areas.

With few exceptions, you may continue taking medication prescribed by your physician as ordered without this interfering with the EMG. However, if you are taking a blood thinner, you should notify the Lab where your EMG is being done, since in that case the needle part of the test may cause bleeding inside the muscle. Also if you are on any medication for Myasthenia Gravis such as Mestinon or other, your medication may interfere with the test, so you should also notify the Lab. If you have any doubts about other medications you are taking, it is best to check with the Lab to be on the safe side.

Can I ask for some pain medication?

Different labs have different policies about pain medication. Some physicians may recommend you take two Aspirins or Tylenols before the test. Others may mail you a prescription drug to take an hour before the test. Sometimes you may be given an injection prior to the test. It is common however, that no sedation is given in any form since in most instances, patients wish to return to work or other regular activity after the test is completed. Another reason for not giving sedation is that you should always have someone accompany you to drive you home after receiving sedation and this is not always easy to arrange.

How soon will I find out the results?

Though the physician performing the test has a general idea of what the findings are during the test, the full results are only arrived at after more calculations and measurements are performed after the end of the test. The results are therefore usually not ready until later that day or even the next in complicated cases. They are usually not released directly to the patient. Instead they will be conveyed to the referring physician since he or she has to assess the results in light of the patient’s other findings.

God Bless,

Josephine

Edited September 26, 2006 by Josephine

[Guest jstacy]

Bound, The median nerve derived from the cervical spine at C5/C6. It runs through the shoulder down the arm and through the elbow and controls the thumb and forefinger. It also controls some muscles in the shoulder.

The main problem with the median nerve is CTS (Carpal Tunnel Syndrome)

To test the nerve, They can do several physical test, A pin prick test, sensory exam.

They can also do a nerve conduction study, The electrical shocking part is not too bad but the second part is extremly painful. They stick needles into the muscles effected by the nerve and see they are innervated.

[Josephine]

Jstacy,

Boy do I ever remember the needle test. I just hate to see the poor guy go through this unless it is absolutely necessary.

Believe me I have had it done and when all was said and done, they couldn't do a thing to help my balance.

Mine is plain inner ear with damage to the brain stem.

Josephine

[Guest jstacy]

I had 3 done last year. I have Left Median Neuropathy, Carpal Tunnel, Elevated shoulder, Paralysis in the left thumb and a Paralyzed left Diaphragm. The VA sent me to the University oif Kentucky and stuck the needle in my diaphragm. It still hurts. It is the only true test to tell nerve damage.

[Josephine]

Jstacy,

You are correct, it is the only true test for nerve damage.

Josephine

[Bound4heaven]

Greetings to all,

Thank you for those who responded. Yes this veteran is taking 4 meds for his high blood pressure and also taking a drug which I take called Etotolac which helps reduce the nerve pain. Two of the blood pressure meds are thinners. According to one of he posts here we should contact the clinic involved and inform them of the blood thinners, and maybe they wont give him the 2nd test. I am afraid this veteran who go into a panic attack if I tell him about the needles.

Another past refered to a Psychiatrist doing the exam. Why would a shrink do this exam? As many I am unsure of the VARO resoning behind this exam, but I have been questing the VARO reasoning for the past 10 years.

Let me ask this question. What if the veteran refuses the needle exam and only allows the 1st part of this exam? Thank you all for your help. God bless you.

Bound4Heaven