The New Year of 1998 brought many new doctor's visits with it. I started off at the Chattanooga Neurology Associates. Dr. David Rankine saw me on January 9, 1998.
At this point, I was 16 years old and 8 months into my medical journey. I had gotten progressively worse to the point that I had no exercise tolerance and I could not stand for long periods of time. I could only manage steps one at a time.
During the physical examination, Dr. Rankine described me as a pleasant female in no apparent distress. :-) The motor portion of the examination revealed decreased bulk throughout my body. My physical abilities tested between 4- and 5. A manual muscle test is something that is frequently performed. The scale runs from 0 to 5 with + and - along the way. A 5 is considered to be normal muscle strength and is general assessed when the patient contracts the muscle and the test giver cannot 'break' the contraction. (If the patient straightens their knee and the test giver applies resistance below the knee but can't apply enough force to bend the knee.) A 4 is when the patient can complete full range of motion and accept some but not maximal resistance from the test giver. A 3 means the patient can move through full range of motion against gravity but is unable to hold against any resistance. (The patient can straighten their knee all the way while sitting up right but is unable to hold it there when give resistance.) A 2 is when the patient can move the joint through a full range of motion with gravity eliminated. (The patient can bend/straighten their knee while lying on their side, patient is not lifting against gravity.) A 1 is when the test giver can feel the patient's muscle contract but no actual movement occurs around the joint. A 0 means there is no muscle contraction felt by the test giver when the patient tries to contract the muscle.
After a thorough examination, Dr. Rankine's clinical opinion was that I had polymyositis. This conclusion was reached due to my elevated CPK count of over 10,000.
The next course of action was to recheck my CPK level, as well as, do an EMG to see if there was any electrodiagnostic evidence. Electromyography (EMG) is a technique for evaluating and recording the electrical activity produced by skeletal muscles. An EMG is preformed using an instrument called an electromyography, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by the muscle cells when these cells are electrically or neurologically activated. The signals can be analyzed to detect medical abnormalities, activation level, recruitment order, or to analyze the bio mechanics of human or animal movement. (Wikipedia) If there was electrodiagnostic evidence, I would be required to have a muscle biopsy to confirm a diagnosis of polymyositis.
I don't remember the exact date of the EMG. All I remember is how PAINFUL the test was. The best I can remember, needles were placed at different points all over my body. It felt like there was some sort of electric shock that came through the needles. I would like to think I am a pretty tough girl, but I was crying before the end of the EMG. By far the EMG was the worst test I have had preformed on my body.
I still don't think I was really scared about my future at this point. I was merely going through the motions as the doctors tried to give me a solid diagnosis. I guess I was still thinking it might be an easy fix, like I needed to exercise more or eat different foods. It wasn't going to turn into anything major. There would be a pill I could take or something simple along those lines. All the 'bad' stuff always happens to someone else. Or so you think.
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