“Courage is very important. Like a muscle, it is strengthened by use.” Ruth Gordon
“Commitment is a muscle. The more you use it, the stronger it gets.” Chalene Johnson
Introduction: Along the way to receiving the diagnosis of Parkinson’s, you may have to undergo several different kinds of tests/procedures to help your physician(s) learn what is going on with your physiological and neurological networks. Remember, there is neither a blood test nor a genetic marker evaluation to diagnose Parkinson’s. Therefore, the exams I’m getting ready to describe are sometimes done to implicate or exclude other disorders before even considering Parkinson’s. However, my Neurologist says the actual patient interview is the most helpful. The interview (History and Physical) is crucial since most people with Parkinson’s have a characteristic set of signs and symptoms.
These posts on procedures are purely descriptive/informational. Still, they are valuable to describe because they can be kind of intimidating and nerve-racking to undergo (just in case any of these tests are suggested by your physician team). Let me be clear: I am not recommending any of these procedures for you (I’m a basic scientist, not a physician). Interestingly, my Neurologist was involved only in the MRI and sleep studies, which were both done after my diagnosis of Parkinson’s. The other procedures were done before my diagnosis as another group of talented physicians tried to determine what was wrong. These are the procedures:
Part 1 described the Barium Swallow test (click here for this post);
Part 2 gave an overview of Magnetic Resonance Imaging (MRI) (click here for this post);
Part 3 highlighted Polysomnography, which is a sleep study (click here for this post);
Part 4 presents Electromyography (EMG), which measures nerve/muscle interactions;
Part 5 will characterize Transradial Cardiac Catheterization and Angiography.
“Great ideas originate in the muscles.” Thomas A. Edison
Electromyography (EMG): The EMG is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons). Motor neurons transmit electrical signals that cause muscles to contract. Before Parkinson’s was diagnosed, my group of physicians wondered whether or not it could be either peripheral nerve damage or muscle dysfunction. The EMG can be used for determining both defects.
A Neurologist presided over the total procedure but doing most of the evaluation process was a Senior Resident Physician in the Department of Physical Medicine and Rehabilitation. Some medical school faculty do not want to be treated at the hospital where the students they teach are being trained/working. I never bought into that philosophy; for almost 40 years, it was my medical school and my hospital, and I was okay with going there to be treated. I quickly discovered that I had taught this Resident Physician in medical school. She had good memories of the Hematology Block (where I was the co-Block Director), which made me smile and relax. I learned that the Residents of this program were expected to perform so many EMGs, and my EMG was her last required one.
“Practice puts brains in your muscles.” Sam Snead
The First Part of the Procedure is Nerve Conduction, and the Second Part of the Procedure is EMG: The nerve study measures how well and fast a signal travels down a nerve. They used things resembling little calipers, which come with a light buzz or tingling sensation when activated but are not painful. The EMG is a tiny diameter needle, which I imagined was much longer than it was. The needle is inserted into a muscle, and then you are asked to contract that muscle. Sound is transmitted linked to muscle-nerve interaction, and a measurement is made.
It took about 2 hours. The first part was the slight buzz, the second part a little needle prick, but neither process was painful, just a nuisance. Kind of like when a mosquito lands on your arm; you know it’s there. The Resident Physician did a great job summarizing what she was doing and what to expect. You can’t be shy because you have muscles and nerves everywhere, and her focus was on my back, arms, legs, and neck.
“It is necessary to relax your muscles when you can. Relaxing your brain is fatal.” Stirling Moss
Thankfully, it Was Not ALS: The Neurologist had to do the final test for whether or not I had ALS. It was an uncomfortable few minutes. He had me put the back of my head on a pillow, and he inserted the electrode (needle) into the lower part of the chin, directly into the muscle of the tongue. He then told me to drive my tongue to the roof of my mouth. He repeated the process on the other side of my tongue. He gently sat me up and, with the most sincere tone I have ever heard, said that I do not have ALS. The needle in the base of your tongue did not hurt. It was, again, more of a sense of feeling it. And driving my tongue to the roof of my mouth, I did with vigor. While the ultimate diagnosis of Parkinson’s was still months away, it was good to know that it was not ALS.
It is not by muscle, speed, or physical dexterity that great things are achieved, but by reflection, force of character, and judgment.” Marcus Tullius Cicero
The Path to Parkinson’s: I have been slowly composing these post. It truly has taken years to get to the 4th procedure. Since we reach the diagnosis of Parkinson’s with different health care providers and with a vast array of symptoms and signs, these procedures may impact none of you. However, if someone is undergoing one of these procedures and these blog posts offer some description and solace to cope with them beforehand, all is well.
“Life is a series of natural and spontaneous changes. Don’t resist them; that only creates sorrow. Let reality be reality. Let things flow naturally forward in whatever way they like.” Laozi
Cover image credit: http://dpictures.com/pic/napa-valley-grapes.jpg