More good news for Erik!!!

For the second time now the EMG showed improvement and my surgery was postponed for yet another month!

Posterior view of the axillary nerve innervating the deltoid muscle.

Last month my tricep was noticeably improving prior to the EMG, but the surprising good news was that my suprascapular nerve was also showing subtle signs of improvement.  I have been "exercising" my left shoulder even though it doesn't actually move, hoping that it will continue to heal.  Well, this EMG showed some improvement in the tricep even since last time, but not much difference in the supraspinatus or infraspinatus muscles.  However, the good news this time is that there appeared to be a single motor unit firing in my posterior deltoid for the first time.  This does make sense as the first sign of improvement since the axillary nerve innervates the deltoid muscle posteriorly and extends anteriorly.  Unfortunately, it's difficult to know what the significance of a single motor unit is.  On one hand, it is something that was present this time and hasn't ever been there in the past, but it is also only ONE motor unit.  Could it have been hiding from the previous physicians performing the EMGs and is actually not new?  Could the needle have been positioned incorrectly this time and it was picking up my tricep activity or some other muscle?  Or is it actually healing but at too slow of a rate?  Apparently, there have even been instances where a nerve is completely severed and this sort of activity is still seen on EMG, so could my results just been an errant false positive?  Who really knows.

My surgeon was very straight forward about his ambivalence to operate tomorrow, which I really appreciated.  He noted this wasn't a black-and-white case as my injury is somewhat unique in the distribution of disability with three separate nerves involved (really two locations of injury, most likely) and while the text book answer is to operate now, at the six month mark, he couldn't recommend that as the "right" answer for me.  He actually said he dictated a letter on Thursday for a different patient encouraging the patient to pursue a surgery the patient declined because he sincerely believed he could help that patient.  (He also said it was something that he rarely ever does.)  He was saying that he would give his honest professional recommendation to me if he thought surgery now was the best option, but that there really isn't a definite best option in this case.

Even before my appointment on Friday I was somewhat surprised that we scheduled the EMG for only 3.5 weeks after the last one considering it took six months to see the first sign of improvement.  Whether the new finding on EMG is real doesn't really matter because without knowing the significance, I say there is something on EMG that wasn't there before.  In looking at the 10-year plan, healing without surgery would probably be better, but the longer we wait for surgery, the chances for good outcome go down.  That's the dilemma I've discussed in previous posts (wow - maybe I am becoming a "blogger").  We also discussed that the studies showing surgery at or prior to 6 months as having the best results didn't salami slice the 6th, 7th, 8th months, etc.  The studies were looking at 3 months vs. 6 months vs. 12 months.  So, operating at 6 months is better than 12 months, but is it really much different than 7 months?  In saying that, we agreed that unless there was significant improvement in the deltoid after another 4 weeks we would go to the OR and take a look.  Two or three motor units on the next EMG doesn't really constitute significant improvement  With the relative improvements in my tricep, supraspinatus, and infraspinatus, he said they wouldn't do the nerve transfers for the radial and suprascapular nerves, but would likely only do a graft to the axillary nerve with the anticipation that the others would continue to heal on their own.  More good news!

For now, we wait another four weeks, less than a week after the youngest little Scharrer boy is here.  Skogen had his tonsils and adenoids out last week and has been resting, so one down, two to go.  :)

Thank you so much for your support and please keep praying for continued healing and good results in the long run!