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LordJohn

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Hi, this is my second thread/question/symptom
Have had swallowing issues since January. Sensation front right side of throat (pharynx - Adams apple area) of constriction or tightened muscle, with soreness and pain when area is pressed. Always swallow to left hand side. Sometimes when swallowing water have sense of "fullness" and have to swallow twice. Frequently cough after swallowing, this is worse when have cold but is nearly always there. Had throat endoscopy in March, showed no blockages. Can swallow food ok and water ok when sip at a time, but with sensation that something is there. I dont think there are any tongue issues, have asymmetric tongue, but of long standing, bruxism when young man caused tongue damage to rhs. No wavy fasiculations, tongue does not look to have signs of atrophy.
once again many thanks for your time.
 
Have tried for a simple solution such as trying some Pepcid AC in case it is refux? It's worth a try.
Laurel
 
hi lord john.
i get the exact one sided pain sometimes,i do have gerd and i am prone to throat infections(had severe tonsilitis as a child and had them out at 12yrs )
this symptom is not a bulbar als symptom so you can relax.
i do cough or choke a little on liquids,especially finding more so on saliva which is increased.
honestly you would not be having bulbar symptoms so soon with limb onset if it were als related.
i have had pls 12yrs and started with bulbar symptoms about 5yrs ago but progression is minimal.
hate to be the barer of bad news but you have a long way down the diagnosis road with many tests along the way..........answers can be slow in coming.
 
What did the doctor that did the throat endoscopy say was causing your problem and what did he/she recommend that you do about it?

And, since you are into looking up medical stuff on the Internet, try searching for the term "globus" in relation to your swallowing problems.

The typical first symptom of bulbar ALS is slurred speech, not swallowing problems. If nobody is accusing you of being intoxicated when you haven't been drinking, then you needs not worry further about bulbar ALS.
 
Thankyou for your replies. Dr who did the endoscopy was ent specialist who said no serious obstruction! Not terribly helpful. And yes I do know about globus.. I am not that lousy a Google searcher! The GERD possibility will be followed up with GP
Best wishes
 
And, you reject globus as an explanation for your swallowing difficulty -- why? The ENT says that there is no physical obstruction.

What exactly about the nature of your swallowing difficulties suggests muscle paralysis in your throat -- a paralysis so subtle that it escaped the notice of a trained ENT specialist? That's how ALS works, you know. Muscles become paralyzed and stop working. And, because the muscles are paralyzed, they don't work all the time, which means that the person has difficulty swallowing all the time, not just occasionally.
 
trfogey
Globus for 6 months, through good and bad times, I dont think so? However your last point is a very good one indeed .. hopefully others with similar concerns will also read it -- you are a good gatekeeper.
As a well known UK comedian said at the end of each of his TV programmes
May your God go with you.
 
dave allen:wink:...........nice one lordjohn:D
 
trfogey
Globus for 6 months, through good and bad times, I dont think so?

Go to the a b o u t B F S dot c o m website. People there have had globus for years, so six months is just getting started.

And, if your symptoms had been caused by bulbar MND, you would have noticed some progression of those symptoms. That's the nature of MND -- it progresses and it usually does so quickly. The place where it first presents continues to get worse and it spreads out into the rest of the body.

If you think that having globus for six months is far-fetched, please note that six months of bulbar MND with no progression is equally far-fetched, if not more so.

However your last point is a very good one indeed .. hopefully others with similar concerns will also read it -- you are a good gatekeeper.

No, I'm not a gatekeeper. Just a PALS with some free time on his hands trying to spread the word about how ALS works and how unreliable most of the information about ALS on the Internet search engines really is.

By the way, you do know that the primary symptom of GERD is chronic heartburn, and not swallowing difficulties, don't you?
 
As the wife of a GERD guy, with GERD you can have excess saliva, which can lead to coughing and sputtering and even choking on the saliva, weak sounding voice from all the acid irritating the throat--all things that could make one query something more serious. Since my husband has CIDP and had a differential of A L S when he started with all the GERD symptoms I was quite worried. The symptoms settled nicely with treatment for the GERD.
Laurel
 
when is a symptom that of mnd or something else?
at the neuro rehab clinic any symptom they check for a cause first before putting it down as secondary to neurological.

intresting laurel about the excess saliva,i did not know that and will mention it to my gp.
however i still have bulbar involvement,my first symptom being slurred speech and throat/lower facial muscle spasms.

yes trfogey,having pls/mnd you do and i have had 6mths and more with little progression as to bulbar symptoms.........while my legs the point of onset continue to fail.
 
Not sure why you think (and state in almost every thread) that ALS symptoms must go very quickly from nothing to full-time paralysis. This very rarely happens. Instead, initial symptoms are often subtle and/or intermittent in the beginning -- esp. any bulbar symptoms. Ask any neurologist, read any number of personal accounts from bulbar onset patients, or read a neurology text. People don't go from not choking at all to choking on everything overnight.

Furthermore, choking on liquids is initially caused by muscle coordination issues, not weakness. The windpipe fails to seal in proper timing with the swallow. Strength issues present in the form of trouble with swallowing solids.

Early ALS does not equal paralysis. By the time a part of the body is paralyzed, ALS has been at work for quite some time. And by definition, anyone posting in this sub-forum is trying to assess whether he has early ALS -- not whether he has advanced ALS with rampant paralysis.


And, you reject globus as an explanation for your swallowing difficulty -- why? The ENT says that there is no physical obstruction.

What exactly about the nature of your swallowing difficulties suggests muscle paralysis in your throat -- a paralysis so subtle that it escaped the notice of a trained ENT specialist? That's how ALS works, you know. Muscles become paralyzed and stop working. And, because the muscles are paralyzed, they don't work all the time, which means that the person has difficulty swallowing all the time, not just occasionally.
 
Not sure why you think (and state in almost every thread) that ALS symptoms must go very quickly from nothing to full-time paralysis. This very rarely happens. Instead, initial symptoms are often subtle and/or intermittent in the beginning -- esp. any bulbar symptoms. Ask any neurologist, read any number of personal accounts from bulbar onset patients, or read a neurology text. People don't go from not choking at all to choking on everything overnight.

I hate to throw cold water on your little rant, but I've never said anything of that nature and I never will. Unlike your wild oversimplification of what you think I have said, I am careful to not make generalized statements like that.

ALS is a disease that kills motor neurons in the brain and spinal cord. Portions of a muscle (called fascicles, which are groups of muscle fibers) become denervated when their controlling motor neurons die. These fascicles can no longer contribute their share to the muscle's function, causing weakness and an accompanying loss of functionality proportionate to the percentage of total muscle fibers in the muscle that have been taken offline.

A denervated muscle fascicle stays in a state of paralysis unless and until it is reinnervated, which does occur in the earliest stages of ALS. This cycle of denervation and reinnervation causes changes in the "wiring" of the nerves and muscles -- fewer motor neurons controlling increasing percentages of the fibers in a given muscle (large MUPs, decreased recruitment, etc.) and it is these "wiring" changes that the EMG detects, even when the disease is still subclinical.

Eventually, the disease gets beyond the repair (reinnervation) capacity of the body and this is usually the stage when the clinical symptoms begin to appear. By the time ALS symptoms become clinically detectable, recognizable paralysis is occurring. The paralysis of the muscles is seen at the clinical level as clinical weakness, changes in muscle tone, altered responsiveness to reflex stimulation, and, eventually, muscle wasting. From that point forward, paralysis becomes greater and greater as more and more muscle fascicles are permanently denervated (paralyzed).

Furthermore, choking on liquids is initially caused by muscle coordination issues, not weakness. The windpipe fails to seal in proper timing with the swallow. Strength issues present in the form of trouble with swallowing solids.

Muscle coordination issues caused by what, exactly? What prevents the epiglottis from closing properly? What causes reduced laryngeal elevation or reduced pharyngeal contraction? Could it be denervated portions of muscles that can no longer play their assigned role in the action.

Early ALS does not equal paralysis. By the time a part of the body is paralyzed, ALS has been at work for quite some time. And by definition, anyone posting in this sub-forum is trying to assess whether he has early ALS -- not whether he has advanced ALS with rampant paralysis.

ALS, early or late, does equal paralysis. What differentiates the stages is simply the scale upon which the paralysis is detectable and measurable. Early ALS -- detectable by the EMG, subclinical. Intermediate (clinically detectable) ALS -- detectable by clinical examination as changes in the nature and quality of muscular contraction, muscle tone, and response to reflex stimulation. Late ALS -- total paralysis of a muscle and accompanying loss of bodily function, muscle wasting, easily seen by gross visual examination.

Don't know why you feel compelled to call me out, but setting fire to your own strawman really is only a Pyrrhic victory.
 
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In early ALS would nerve regeneration cause neuropathic pain that subsides as nerve destruction worsens?
 
In early ALS would nerve regeneration cause neuropathic pain that subsides as nerve destruction worsens?

The sensory nerves and the motor nerves are two separate systems. Sort of like the phone lines and the power lines in your house. They are each made up of conductive material, run alongside each other in the walls, and carry electrical currents, but the end uses for those currents are radically different.

Also, please note that it is the motor neurons in the spinal cord and brain that die in ALS, not the nerve fibers out on the periphery. The effect of motor neuron death is more like unplugging the appliance from the wall, rather than cutting the cord. The analogue for reinnervation (not regeneration) would then be plugging the cord into an extension cord run from a different outlet.

So, as far as I know and have experienced for myself in my journey with ALS, the answer to your question is no.
 
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