what a good doctor should be

    • Anonymous
      August 14, 2009 at 11:39 pm

      I saw the Doc again. is this guy a gift from god? to put it obsequiously. I have seen doctors who tripple book every 15 minutes and this guy single books every half hour. he said my EMG wasnt completely normal but the doctor who did it is notorious for rushing (he spent 3 minutes on my EMG) so this doc is going to spend 40 minutes. he wants to do this one more test before beginning IVIG. I asked him if the test doesnt yeild satisfactory results will the Ins. co. still pay and he said ” they will if I tell them they should” ” I cant see this being anything else but CIDP”.
      At the end he asked how I was doing emotionally.

      vegas is notorious for its crappy medical care. it grew soo fast in such a short time period that it lacks a pool of anything but mediocraty when it comes to its professionals. it also lacks any prominant universities. so if you are from Vegas, you can appreciate what a find this Doctor is.

    • Anonymous
      August 15, 2009 at 12:38 am


      When I had my EMG, and NVC (Nerve Velocity Conduction or something like that), it took over 2 hours. I had them done in 1989 first, it took 4 hours , in 1995, I had a limited EMG done 1 hour, in 1999 I had both done 2 hours. Same in 2003 and 2008.

      What they do is first establish a baseline, and then try to see what is functioning and what is not. They will test nerve pathways and conduction speeds from the ankle to toes, from calf to toes, from different places to different endings. Many times they will do a hand/arm as well. One of the reasons they take so long is the set-up. They will measure from point A to point B, and everywhere in between. All of this gets entered into a computer. If you are too cold, you need to be warmed up to get to the right temp. The whole thing needs to be controlled and measured, otherwise the results have no meaning.

      Then they work the nerve/muscle function. They insert a long needle and root around until they get the right spot and then ask you to flex your muscle. they test for muscle “recruitment”. Can you get other muscle fibers to respond to a nerve “command”. They poke and poke all over your calf and thigh muscles. Above and below the knee. If you have hand/arm involvement, they need to do these as well.

      I’ know it took longer than 3 minutes to write this. I just can’t believe that they could do anything for you, call it an EMG and get it done in 3 minutes. If that is indeed what happened, you need to inform your insurance company, because it would be complete fraud. Ask for the test results. YOU ARE ENTITLED TO THEM. Your Dr. should not balk at providing them to you. I always asked, and was always given all test results. You are paying for them, you should get them.

      By itself, an EMG/NVC usually is not a complete diagnostic tool. Combined with everything else, it can eliminate many other neuropathies and get closer to the diagnosis. IVIG is very costly, make sure they are sure. Make sure you have insurance confirmation. You can call your Dr before the infusion. They should make sure it is pre-approved. Costs can vary from 5 to 10,000 dollars, maybe more, it has been a long time since I have seen pricing. I would hate to see that come out of your pocket.

      Be careful
      Dick S

    • Anonymous
      August 15, 2009 at 2:04 am

      hmm yeah that first jerk stuck the needle in and out about three times on each leg and about the same on my arm and no exageration because I asked the technician who was doing the ncv how much longer it was going to take and he said the next test will take the doctor about three min and sure enough it did. My new doctor said that he was going to petition the insurance for another test based on unsatisifactory testing procedures. I can tell that he dislikes the other doctor and said ” yeah doctor Germin has a tendency to rush things and not spend any time with his patients”. he also warned me that the doctor has difficulty releasing records but that it is my right by law to request them. but that is very interesting about the time it takes. I think that the 40 min the new doctor is going to take is on top of the time for a new NCV as well. I will definately complain to my insurance company. this doctor is not taking IVIG and its costs lightly I have already had 4 MRIs, 4 lps, 2 cts, 1 VEP, 1 EMG/NCV and an array of blood tests over the past 7 years (with all those letters and nothing has spelled DX). its just that with my GBS background and the symptoms match nothing else the way it matches CIDP ( symetrical weakness, arms and legs going numb, horrible pain in the neck that radiates and burns in my arms and legs, tremors, everything keeps falling asleep, yada yada yada). he also told me that if it came down to nerve biopsy, no one in Vegas is really qualified and that I would have to go to UCLA. I am going to rename this post

    • August 15, 2009 at 7:51 am

      Hi Tara,
      I agree about Las Vegas Doctors. I believe you are seeing Dr. Lee.
      My Doctor Farrow dx me Last Oct. 2008 with Cidp. This dx came after many blood tests, an emg, a muscle test with needles. Then A Dr. Kaplan did a nerve and muscle biopsy which was sent to Salt Lake City for a second opinion.
      I think Dr. Farrow dx me correctly and started me on 20 mg of prednisone which he reduced now to l0mg. on day and 5mg. the next.
      My energy level is good the fatigue is gone. I still use my walker when I go outside and I walk for 3 hours every other day.. On real hot days I go to the clubhouse gym and exercise on the bike or on the treadmilll. Around the house I walk without support. As long as I have a level unobstructed surface I won’t lose my balance. Outside I have a fear of falling so I take the walker.
      I don’ trust a cane right now.
      My feet are still numb and so are my shins. Some sensation seems to be returning and I am feeling stronger after l0 months on the prednisone.
      I suspect I could have some residual damage, but I don’t know. Nerves take a long time to heal.
      I am 7l years old and had to leave my job a year ago, because I kept falling down, getting weaker and weaker and could not even drive my stick shift.
      I think I could drive now but I sold my stick shift vehicle and would now only drive an automatic and possibly get hand controls. I can manuever my four-wheel walker on and off the city busses here, because they have kneelers, ramps and lifts whatever a motorized wheelchair, regular wheelchair or a walker needs. I Don’t even need the ramp. This is a blessing.
      I have medicare (Senior Dimensions)
      and if I needed a second opinion then I would see Dr Richard Lee or even try to change my insurance coverage if I needed a good doctor, because I know a good neurologist here in Vegas is hard to find.
      My Dr. Farrow is a consultant on Senior Dimensions and I was lucky to get to keep him. I started out with him on Culinary and now I need a referral to see him which is an inconvenience. If he ever left or retired I would need to get immediate care from someone like Doctor Lee who is said to know all the ins and outs of CIDP.
      The IVIG or PP may not even be covered on my plan, but I will question my doctor and check out the donut hole that exists in other plans.
      Right now the prednisone seems to be keeping thing under control and I have not needed anything for pain since last December. In l0 months I feel like I have come a long way. I don’t know if my case is going to relapse or if I will progressively get worse.
      I am also diabetic with excellent sugar control and I eat a healthy diet as well as take vitamins, minerals and Omega 3’s.
      I was diagnosed with diabetes about 6 months before CIDP reared its ugly head.
      I was going to get a shingles vaccination until I started reading the posts here and will not get any vaccinations.
      I hope we are on the right track Tara and I know the neurological association recommends Dr. Richard Lee. Most neurologists have never seen this disease in their lifetime. My neuro has 33 years of expericence and he has helped me with thorough tests and a cheap effective treatment.
      My best wishes and prayers to you and your family.

    • Anonymous
      August 15, 2009 at 5:38 pm

      Hi Tara,
      With my doctor, who is VERY good, who deals with rare neuro diseases, and neuro-muscular diseases, he is also Chief of Neurology at the local Medical Center. But his office that he works out of, is called, “The Neurology Center of Southern California”, and has a team of 10 Neurologists there, with each Neuro. specializing in one neuro problem. This office also does research on different neuro problems. They have three offices in north San Diego County, and they have a website: [url]www.neurocenter.com[/url]
      My doctor is Dr. Gregory Sahagian. He has been my neuro for the past few years, and is the kind of doctor you can really talk with, and is very caring.

      I remember those tests years ago. But my doctor would trust only himself when it came to those important tests, and he would do them himself. Though, to come up with my final diagnosis years ago, because I had a rare variant, he had sent me to his teacher way back when he was in med. school, who teaches at UCSD, and ONLY deals with very rare diseases. I liked that alot of my doctor, in that when he was stumped, he sent me to one of the top neurologists in the county. But I remember those tests taking 45minutes to an hour. My doctor has one day per week, where he only does testing of patients all day, as the tests take a long period to do.

      So, Tara, if your insurance would cover going to another state, grab a cheap flight on Southwest Airlines, and come on over. San Diego County is known as a leader in health research.
      Good luck finding a good neuro.