Does this sound like Bulbar onset?

[jkenne25]

Hello

Over the past 3 months I seem to have developed a cough that tends to come on after eating or drinking. It is intermittent in that it doesnt happen at every meal, every drink, but regular enough that it happens at some point most days.

Most of the time the cough is dry, but at times I produce green phlegm as well. I don't choke or gag, but it often feels like something has 'gone down the wrong way' despite not choking or sputtering. I usually feel an irritation and then start coughing 5-10 minutes later, the severity of cough also intermittent.

I also feel a burning feel on occasion when eating and drinking in the soft palate area/nasopharynx area, but nothing has yet actually come out my nose. That area and my throat feels constantly full of mucus, and I need to clear my throat a lot.

When researching symptoms I came across neurogenic dysphagia, and that one cause is ALS. I am now concerned that I have bulbar onset, and have an appointment to see a neurologist.

I understand that it is very rare at my age, I'm 31, and that it is fairly fast progressing - I haven't had any progression since it started, but I know everyone's presentation is different and was maybe wondering if i could have some opinions on whether this sounds like what others have experienced.

I don't have any problems with speech, as far as I can tell anyway, and my tongue feels normal.

I appreciate any insight, thank you.


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[KarenNWendyn]

There are many reasons why you might have a cough with eating or drinking. Neurogenic dysphagia would not be the first thing to pop into my mind. More common reasons would include gastroesophageal reflux and sinus problems, to name a couple. Some people develop localized anatomical problems with their sinuses, pharynx, or esophagus that can cause the symptoms you report.

You have to realize that ALS is really rare and common things are common. Bulbar onset to ALS more commonly starts with slurred speech that others notice. The burning sensation in your soft palate area and the mucus point away from ALS. I’m sure your visit to the neurologist will be reassuring.

Meanwhile, you might consider seeing an ENT physician.

 

[jkenne25]

Thank you for your reply Karen.

I guess I had a moment of panic when I looked at Google, but I guess that's how a lot of people end up here.

I do have a history of both acid reflux and sinus problems, they just never have caused a cough for this long before so didnt consider them. My acid reflux has been bad during this time too, but like I said I didnt think it would cause a cough.

I'll speak to my GP about seeing an ENT, thanks for your advice in that regard. I know that ALS is rare, especially at my age, but I became worried that my productive cough was due to bouts of aspiration pneumonia and that led me to the whole dysphagia worry. I guess even aspiration pneumonia would present with more than just a productive cough though.

I will reply again when I have seen the neurologist, thanks again.

 

[jkenne25]

Hello again

I have my neurologist appointment on Friday, and have a few questions for those who have seen one if I may.

As my concerns are in my throat/bulbar region, will he likely just listen to what I have to say or will he test anything? I know I won't get an EMG on Friday, but am unsure what he would do with respect to bulbar concerns and a clincial exam.

I also read that choking on liquids is the first swallowing problem noticed with bulbar ALS. I have the feeling that some liquids 'go down the wrong way' frequently, but I don't gag or choke, it mainly feels like an irritation that sometimes leads to a bit of a cough and throat clearing. Does this sound like the 'choking' that is described early on?

Many Thanks

 

[jkenne25]

Thank you for your reply, I guess it will be something similar that I will experience.

I'm still hoping that the general findings of bulbar starting with slurred speech and my age will mean it is out of the question, but will just need to wait and see I guess.

 

[KarenNWendyn]

Hi there. We ask undiagnosed persons to stay in their own thread, so they won’t be answering you here. I believe you can send each other visitor messages by going through your profiles.

To answer your questions, slurred speech is generally the first symptom of bulbar. The neurologist can tell if your speech is a concern.

An EMG on the limbs can still check for bulbar, because abnormalities will be widespread if it is ALS. If they specifically want to do an EMG on bulbar muscles, the areas tested are the tongue, sternocleidomastoids, or submandibular muscles.

 

[jkenne25]

I saw the neurologist today and he completed a full clincial exam and said he did not see any sign of a neurological disease. He feels that my issues are more a mix of anxiety and gastro and does not think any further tests are required. I will now leave the forum as I am not going to waste anyone's time, I just wanted to update since some people were kind enough to reply to my original post. I wish everyone all the very best.

 

[lgelb]

Thanks for checking back in, with best wishes for your health.

Best,
Laurie