Friendly Message from an SLP

[voicespeechie]

Hi everyone.

I feel kind of silly posting here, but I need to do something to calm myself as I wait my Sunday out. I will be calling a neurologist's office tomorrow morning.

I'm a new Speech Pathologist who works primarily with voice and swallowing disorders. To that end, please feel free to message me if anyone would like information on the swallowing process or on swallowing strategies that SLPs recommend commonly. I perform MBSS regularly as part of my job and complete bedside dysphagia evaluations. I have immense respect for everyone here and would be glad to answer any questions on any other forum here that I can.

Anyway, I noticed about two months ago that my right bicep was twitching constantly. I ignored it and chalked it up to BFS, with which I'm quite familiar. The twitching spread after a couple of weeks to my left arm, and later to my abdomen, back, buttocks, thighs, calves, feet, lips, tongue, neck, and chin. I decided to just roll with it for awhile. After all, I had noticed the original twitch and began to think about it. I knew that I could be causing the twitches to move around due to anxiety and psychosomatic focus. My thumbs in both hands began cramping and burning easily, but I continued to attribute this to anxiety about ALS. I know ALS is a motor disease, and that sensations don't really mean much. I am equipped to assess swallowing, though probably not on myself, but I really have no idea how to assess clinical weakness. I sometimes perceive that my hands cramp or feel too weak to do something, or that my ankle in one foot isn't raising the way it should be when I walk.

The main thing that really has scared me and will send me running to the neuro is that last night, I suddenly felt that I was unable to swallow. I was eating and began to cough, but then tried to wash it down and began to cough some more. I have been coughing or clearing my throat every single time I even attempt to swallow saliva for the last 12 hours. I was fine yesterday, but now I'm terrified to eat or drink anything at all. Granted, I am recovering from an upper respiratory infection/laryngitis.. so I'm not sure if mucus could be a factor in this. I haven't had any slurring of my speech, and my oral-motor movements still appear to be functional. I still see laryngeal elevation when I swallow, but I wonder if I could still have dysfunction of the epiglottis without knowing it.

SO tl;dr:

- Did anyone here have swallowing issues without ever having speech issues first?
-And what gives with this, I always read that weakness must precede fasciculations - but I have seen a few testimonials here where PALS state that fasciculations came first for them (I've read this for both Bulbar and Limb-Onset PALS). I've seen that it can begin proximally or distally or in random ways sans rhyme or reason. Is it really this variable?

Anyway, I am just hoping that praying that a doctor will take me seriously enough to allow me an EMG, and not laugh me away because of my age (26). Thank you all for listening. <3

 

[gooseberry]

Als is different in every person. Since you have had a respiratory infection, I would see an ent to be sure it has cleared.

 

[Atsugi]

Yeah, Voice, it really is that variable, as the Queen noted.

You know, I have to say that over the years I feel I've gotten kind of an ESP about posters who ask "Do I Have ALS." My Spidey Sense isn't alarming on your post. If I understand you right, you're twitching and sometimes choking a little, so you went to ALS?

The hallmark of ALS is a paralyzed muscle--real weakness. This "weakness" is because a nerve in the brain is not sending a "go" signal to its corresponding muscle. Therefore, the muscle doesn't contract. How's your tongue? How's your swallowing muscles?

Another thing about ALS is that it's permanent. Once a nerve is destroyed, it doesn't come back. So once you get that weakness in a muscle, it will not be better the next day--or ever.

I hope that helps.

 

[lgelb]

It is extremely unlikely that the constellation of sx you describe over a mere two-month period are pathognomonic of ALS or anything else. As I'm sure you learned in your SLP program, the mind is a powerful thing.

Best,
Laurie