Does this EMG and other tests reflect ALS/BULBAR?

Resolved question:
does this EMG and other tests reflect of ALS/Bulbar?

I have seen 10 neurologists for total of 13 visits.  

I had a clean emg on january 13th 2015

The emg was done on both arms and legs 
The needle was inserted on 4 spots on the right leg, 3 spots on left leg, 3 spots on right arm and 5 spots on left arm.  Everything was normal.  
Than i did what any insane person would do and i googled more and came to these forums and learned about Bulbar onset.  Since than i have not been able to get this thing out of my head.
Had a normal barium swallow test(JANUARY)
had a normal egd(IN APRIL 2015)
had a normal ent scope study to check back of throat(normal)(MARCH-APRIL 2015)
None of the neurologists i seen were als specialists. but almost all of them had 25 years plus experience and some had over 40 years of experience.  

they all said if i had bulbar that some part of my emg would have caught it even on limbs.  they also all said that bulbar is very easy to diagnose even by just looking at my tongue,jaw jerk and my throat muscles.  they all said its very hard to miss on a clinical, and they said i have seen so many that it would be hard for everyone to miss it
SO THAT BRINGS US TO TODAY'S EMG WHICH WAS ALSO DONE BY A NEURO PHYSICIAN IN PAKISTAN, MAKING IT MY 9TH NEUROLOGIST.  THE NEURO WAS 2 HOURS LATE, AND HE REALLY HURT ME DURING THE ENG, HE KIND OF STABBED ME VERY VERY HARD.  IT HURT SO BADLY AND IN SOME SPOTS WHERE HE INSERTED THE NEEDLE WERE SWOLLEN AFTER THE EMG
I DON'T KNOW IF IT'S NORMAL BUT HE DIDN'T CHANGE THE NEEDLE, HE KEEP INSERTING THE SAME NEEDLE IN DIFFERENT SPOTS AND HE INSERTED THE SAME ONE UNDER MY CHIN.  I THOUGHT THE BULBAR STUDY NEEDED A SINGLE FIBER EMG?

EMG STUDY:
1. right tibialis anterior-no spontaneous activity:
moderate-marked reduction of recruitment patterns with motor units of high amplitude up to 4.16 mv, recruited at normal firing rate  
2.left gastrocnemius-no spontaneous activity:
moderate-marked reduction of recruitment patterns with motor units of high amplitude up to 3.2 mv, recruited at normal firing rate  
3. right rectus femoris-no spontaneous activity:
moderate-marked reduction of recruitment patterns with motor units of high amplitude up to 6.26 mv, recruited at normal firing rate  
4.right biceps-no spontaneous activity:
moderate-marked reduction of recruitment patterns with motor units of high amplitude up to 3.06 mv, recruited at normal firing rate  
5.right thoracic para spinal-no spontaneous activity:
moderate-marked reduction of recruitment patterns with motor units of high amplitude& normal duration, recruited at normal firing rate
6.right ganioglossus-no spontaneous activity:
moderate-marked reduction of recruitment patterns with motor units of high amplitude up to 4.3 mv, recruited at normal firing rate 
REPORT:
NEEDLE EXAMINATION REVEALS REDUCED RECRUITMENT PATTERN IN THE TESTED MUSCLES OF LIMBS, THORACIC PARA SPINAL&GENIOGLOSSUS MUSCLES 
comments:
THE ELECTROPHYSIOLOGICAL STUDY IS SUGGESTIVE OF ANTERIOR HORN CELL DISEASE.

my questions are:

1.could all those doctors miss diagnose me?

2.why would my emg be normal in january and dirty 4 months later? 

3.after my emg i saw another neurologist in lahore who did a very extensive clinical exam and said i show no signs of anything neurological.  He said we usually do a clinical exam than if we see something we do an emg, he said a clinical exam is more important than an emg  

he also told me that in Punjabi pakistan there is only one lady who is a certified emg specialist, he said rest just can not be trusted 

he said a dirty emg could be cause of having low power, or person doing it didn't know what they were doing or the machine itself could have had faults 

4.can als/bulbar start at the same time? i have been told over and over that both can not start at the same time.  by my emg shows abnormalities on different limbs

5. i had a perfectly clean physical a day after my dirty emg?

so can i take this emg and say ok this is the one i can trust or can i trust the one done in usa among other tests like barium swallow study, ent scope study and gi doctor did a egd

i am very confused.  this doctor who did the emg didn't do a physical, i went to him and he without even looking at me said let's do an emg?

if someone like me walks in to your office would you order an emg without doing a clinical? 

the doctor in lahore at doctors hospital which i saw the day after my emg, tore my reports and threw them away saying they were no good compared to my usa emg.  

in february a neurologist in multan also told me to not get an emg from pakistan.  he said if you get one they will fine something because they don't know what they are doing 

my emg was very very painful

it felt like the doctor was stabbing me 

also he used the same needle on my arms,legs,back and chin.  Is it normal to use the same needle?  i thought during an emg doctors change needles few times? 

my tricep has a big purple color bruise and its been almost a week since my emg

I would really appreciate your feedback

Thanks.  Can i disregard this emg and just move on or do i need to perform more test.  I have seen so many neurologist and i even asked you for your opinion twice

you yourself said that a clinical is very telling especially when it comes to bulbar.  I seen 10 neurologist and 9 of them did very extensive clinical 

one last thing that doctor told me in lahore.

he said bulbar starts out with very elderly he said it usually starts with slurring , he said to start with swallowing issues is rare and the swallowing issues usually are liquids 

but i feel like having trouble with thick foods.  nothing has ever get stuck or i haven't choked on anything 

he said you have better odds of being hit by lightening than getting bulbar at age 31, and to start with swallowing issues which are not liquids but thick foods

Thank you 

Submitted: 4 Days
Category: Neurologist, Medical

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