Nerve Conduction Velocity Test...

Today, 22^nd January 2020 was my scheduled follow-up visit to the neurologist at Apollo hospital after the first one on 6^th January 2020.

Although my condition of the sensation in the toe region has marginally improved with medication and Yoga, I am unable to state which one had a more pronounced effect, at this time. I reported this to the neurologist and he immediately suggested that I proceed for an NCV Test. It stands for Nerve Conduction Velocity test. This test is used to assess nerve damage and dysfunction. Also known as a nerve conduction study, the procedure measures how quickly electrical signals move through our peripheral nerves. I also understood from the technician that NCV can determine nerve damage and or destruction.

It is a 45 minutes shocking (pun intended) procedure.  During the test, the nerve is stimulated, usually with surface electrode patches attached to the skin. Two electrodes are placed on the skin over the nerve. One electrode stimulates the nerve with a very mild electrical impulse and the other electrode records it. When I asked the neurologist for some additional details about the process, he dismissed it simply stating that a mild electrical impulse is given at various points. Not having heard about it before, I went in bravely to the EEG department which has a separate enclosure at Apollo to get this test done. To my surprise there was not a single patient in ‘Q’ – a hospital where every faculty has loads of people standing in a row for getting themselves tested, it did strike odd to me, but then I dismissed it as perhaps my luck that I did not have to wait in a ‘Q’.

It struck me only midway during the test about the absence of any patients in this unit. You don’t pay to be given shocks…as such we get enough from all quarters daily! Believe me, they aren’t mild! The technician started the test with my left hand and gave the shock impulses at various positions. To divert my mind from the shocking impulses, I started mentally counting the number of times the technician was administering. It turned out to be 50, ranging from a mild one, which just tickled the nerve to a strong one which made my arm lift up involuntarily and settle back with a thud. On the left foot however, the number was less at 25, but the intensity range of the shocks were identical. I heaved a sigh of relief when she said it was done and as I got up to step down and walk out, she said, Sir only 50% has been completed. It’s time to commence on your right side. Quite reluctantly I went back to the flat bed and summoned enough courage to receive the shocks once again. But now that I was familiar with the procedure, I started looking forward to the shocks and in my mind I started comparing which was worse, the left side or the right side…The count was identical and the intensity identical, but, I felt that the right side was less shocking! The games a mind can play!

By the time the experiment on me was completed, I had been given close to 150 shocks…my quota of a lifetime, I thought to myself and swore that I would not subject myself to this test ever again.

No wonder people never willingly accept to take this test and it explained why the count was zero at the waiting ‘Q’.

It may be useful to explain a few terms/terminology to help understand a little about this problem. All of us have heard of Sciatica nerve problem and pain. Sciatica is a condition that affects the sciatic nerve, which is the largest nerve running in the human body. The sciatic nerve extends from the lower back and down both sides of the hips, buttocks, legs and feet. Sciatic nerve pain is related to herniated discs in the low back and low spine. When discs in the lower spine and back slip out of position or bulge, the rubber cushions or discs stop acting as an expansion joint (in engineering parlance), and                 the nearby nerves can cause irritation, pain, weakness and numbness in legs and feet (lumbar) and arms and neck (cervical).

An NCV test can help diagnose compression or damage in the sciatic nerve and it can also detect any problem in the nerve itself. The peripheral nerves are responsible for sending information from the brain and spinal cord to the rest of the body and vice versa. When these peripheral nerves are damaged, people may feel weakness, numbness and pain in their hands and feet. Most of the time the symptoms can improve with treatment, especially if caused by underlying conditions such as vitamin deficiency, diabetes, other autoimmune deficiency or simply a bulge (inflammation) around the discs.

While medication can be very helpful when the sciatic nerve pain is on account of inflammation of the herniated discs, it is Yoga and its finely controlled stretches alongside breathing technique that will restore the gap between the discs and release the pressure on the nerves. The best part is, once the pressure is released, the nerve ends can become active and re-establish connections with the brain.

Incidentally, this is the only department within EEG Cell of a hospital where the technician doesn’t offer any interpretation of the test results – the neurologist has to write them down after scanning through the report. When I went finally back to the neurologist armed with the reports, he said everything was normal, considering my age and with time and a daily dose of one tablet “Maxmala” I should be okay within a month. He just acknowledged when I informed him that I had joined Therapy Yoga to overcome my backache problem. He asked me to continue with it to the best of my ability and not undermine the importance of a daily walk. My cardiologist had set me a target of 10,000 steps each day, but so far I have been able to manage an average figure of only 5,000. My efforts have to double…

Finally, Nerve Conduction Velocity (NCV) of 50 to 60 meters per second is normal. In my case it varied between 40 to 60 meters per second. In layman’s term, If I hurt my small toe in either of my legs, information flow to the brain will be delayed and corrective instruction from the brain to the toe will also be delayed…I may not be aware that my toe hurts…     

Medical Complexities - Is a Holistic Approach Possible?

My story in the last three months:

Three months back, I suffered from palpitation and high blood pressure in spite of my medication for hypertension. My mom's cardiologist, who was willing to study my case history, suggested I get an echo-cardiogram and TMT (Tread Mill Test) done. He observed variations in my TMT graph and suggested that I get an angiogram done. During this period, I had also developed a lower back pain (lumber region) + occasional pain at the base of my neck. While these aches and pains are common for people above 60, what worried me was the numbness and tingling sensation in the toe region of my right foot.

When the angiogram report was normal, I asked my cardiologist the reason for the numbness...by now it had spread to my left leg also. This condition did not hamper the normal functioning of both feet, but if the feelings aren't 100%, then it certainly felt very odd. Back of my mind I was scared that I would loose all sensation from ankle to toes and who knows it could spread in the reverse direction. Would I become wheelchair bound? These fears are real and can be extremely unnerving. The cardiologist in Apollo hospitals asked me not to worry and said it was as a result of the pinched nerves in the lumbar region which caused loss of feeling in the toes. He said it was as if I was walking on a bed of cotton. He was right; there couldn't be a better explanation of that feeling. Bed of Roses, I had heard, bed of thorns, I've lived it, but bed of cotton...this was a first!

I asked him if I need to worry about it and he categorically said 'No'.

While I stopped worrying for a few days, the nagging doubt persisted and I did the next best thing...I went online to see what the net had to teach. It said exactly as my cardiologist had diagnosed. Pain in the lumber region; the vertebrate sections pressing each other; pinched nerves and the resulting numbness in the region of the toes. It also said, possible Vitamin B12 deficiency. I understand this is the major cause of numbness + tingling sensation in most people. But I didn't come in that category of "Most People". Another reassuring fact was these nerve ends which had stopped sending signals to my brain which resulted in numbness, eventually regenerate once the pinched nerves are released free. The time taken to regenerate could be 3 to 4 months at the very least.

For the next two to three weeks I did some self medication of Vitamin B12, but that didn't help. Its funny, the same medicines, if prescribed by a doctor, Works, but self medication... Aha! They just don't obey the patients...

I waited for another two weeks, worried a lot more about my deteriorating condition and went back to Apollo to meet a Neurologist, as was suggested by my Cardiologist. By this time, I had also developed severe vertigo. The spinning sensation was so severe that I would close my eyes hoping for the spinning to stop, but it wouldn't. This feeling would also be present when lying on my back...indeed it was awfully scary.

The neurologist at Apollo turned out to be an empathetic listener (a very rare quality in most doctors, these days) and he patiently heard my full history before doing some basic checks with a hammer having a plastic head. He hammered all my joints to check if the nerve system was active. He found them to be in order. On his instructions I was able to walk forwards on my toes and on backwards on my heels. And this made him conclude that the case wasn't very serious requiring surgical intervention! The numbness could be because of either Vitamin B12 deficiency or pressed sections in the lumber region vertebrate column, pinching the nerve cables.

Regarding vertigo, he said it was related to my 'out of whack' inner ears that controls "stability" and would be come normal in three days with medication. Truly, it did disappear after 3 days of medicines. But for numbness, he suggested that I get my blood tested for CBC (Complete Blood Chemistry) + a test for Vitamin B12 count. For my lumber & neck, he suggested an MRI. Already in a panic mode and wanting to get to the bottom of the problem, I got both these done the same day at Raghav's and went back to the doctor the following morning armed with all reports that sounded gibberish to me. Vitamin B12 was certainly low, sitting at the lower point in the range.

The MRI report wasn't scary but for bulges in neck and lumber vertebrate sections. These apparently were pinching the nerves causing numbness. Neurologist suggested a course of medicine for reducing the bulge/swelling and walking + weekly injection of neurobion to build Vitamin B12 in the body.
I asked the neurologist if physiotherapy would help. He suggested walking for the time being, but I went to an acupressure specialist for a second opinion. After three sittings with him, I asked him if I could join a Yoga center...and would that help? He immediately endorsed the idea and suggested that I join the Therapy Yoga at Rashrottana Yoga Fitness Center at 5th block Jayanagar (behind BSNL telephone exchange). In fact my Homeopathic doctor had also recommended that I do Surya Namaskara on a daily basis as part of a holistic approach to wellness. She suggested Surya Namaskara, as this is a combination of 12 yoga postures done in a particular sequence and is tantamount to a complete body work out.

I did join this centre and have been working out in a 15 members batch in the age bracket 50 to 65 years. It is conducted 5 days a week (Monday to Friday) for a duration of 1 hour and 15 minutes.
Tomorrow, Monday will be my eighth day of Yoga workout, but I have begun to see some benefits, although it is a small baby step. I also firmly believe that the medicines are helping, but the fact that I am able to stretch and do the Surya Namaskara, (although imperfectly) has soared my positive spirits! 😅

The numbness isn't as bad and its like removing a heavy burden from my mind. I am now encouraged to do the Yogasanas in exactly the manner as the yoga instructor tells us. Breathing is the core of all yogasanas. The bending and stretching all revolve around the correct method of breathing. If done exactly as the instructor says, then I am certain that this will be extremely beneficial. But, for the full benefits to be felt or seen, this has to be a lifelong activity which means, a commitment to discipline. I am told that the present problem of mine, can only be corrected by Yogasanas and I should become normal within the next eight to twelve months time, if I am sincere about applying myself to do the yogasanas at least 5 days a week, if not on all seven.

For now, I am committed and hope this mood prevails in the days and limited years ahead!