Pain in the esophagus, lump in the throat

[moon]

Hello, I'm 39 years old. I've been undergoing neurological diagnosis since the beginning of the year, but I still don't know what's wrong with me. I had many sensory symptoms initially, but in May, fasciculations and muscle tremors began. A week ago, I felt something in my throat that causes discomfort when swallowing. Every day I feel like it's getting worse. Today, I feel significant pain and pressure in my esophagus, lump in the throat when swallowing and I feel like my tongue is stiffer, especially at the back. I can swallow, but with pain, and I often have to focus on it. Sometimes I find it harder to breathe, while other times it's normal. I don't have any weakness and still have strength in my limbs, but I suffer greatly because of the esophagus and pain.

Sorry for my english, I hope you understand.

1. Can bulbar ALS start with a lump and pressure with pain in the esophagus?
2. Does bulbar ALS progress so quickly in the beginning that it gets worse day by day, and can this be felt? After week I have a big problem with esophagus and pain.
3. Can muscle atrophy occur in places where I feel stabbing, burning sensations? Or muscle atrophy is painless in the initial phase?

 

[lgelb]

No, no, and no. I would see an ENT.

 

[moon]

Thank you for your response. I've scheduled an appointment with an ENT specialist for tomorrow.

My condition is getting worse hour by hour When I wrote the previous message, it was still better, but now it's harder for me to breathe and swallow. I've also suddenly started producing saliva excessively.
1. Could it be possible that ALS has attacked my larynx so rapidly? (My voice hasn’t changed.)
2. Is it possible that this could be ALS and that it’s progressing this quickly?
3. Is it possible to start producing so much saliva so suddenly, and after a week since I first noticed the symptoms?

 

[lgelb]

No/no/no. ALS does not progress as rapidly or in the manner you describe. But some conditions do, a good reason to see an ENT.

 

[moon]

Thank you, my condition is getting worse

1. Could it be that ALS initially attacks the epiglottis, and the symptoms are such as a sensation of a foreign body in the throat, as if something is touching the walls of the throat at rest ? The tongue is functioning correctly.
2. Could all of this happen within about a week, from the moment of feeling something in the throat to the point where it becomes harder to swallow, and I have the impression that I am choking because the food isn't going where it should?

 

[Nikki J]

What did the ent say and plan? This doesn’t sound like any als I have ever heard of

 

[moon]

I have supported your work, you are doing a great job, and thank you for answering my questions!

I visited two laryngologists, and no one detected any problems, but no one examined the behavior of my epiglottis, which I suspect.

In recent days, I felt a significant pressure in the area of my larynx, the pain has subsided, but other symptoms persist and are getting worse...

I have some questions, what do you think about this?

1. If ALS were to affect my epiglottis, would I feel a lump in my throat while at rest, but more like a tickling sensation, as if a piece of skin has come loose and is tickling me, and sometimes pressing? I've started to feel this more and more while eating.
2. Is it possible that it is progressing this quickly? A week ago, I didn't feel anything there, and today it's harder for me to swallow.
3. On Monday, I have a follow-up EMG + EMG of the tongue. If my epiglottis is indeed damaged, will the EMG of the tongue show abnormalities?
4. If I am indeed at the stage of bulbar ALS, will the EMG of the limb muscles also show abnormalities?
5. When I sleep on my back, after some time I wake up due to a lack of oxygen because something is blocking my throat (a falling epiglottis?). Is it possible?

 

[Nikki J]

1it doesn’t sound like als still
2ditto
3 and 4. If you have als the emg would show. When it doesn’t your next stop should be a gastroenterologist
5 anything is possible. Doesn’t sound like als.

Let us know when you have emg results

 

[moon]

I have already seen a gastroenterologist, had a gastroscopy, and I have a hiatal hernia, reflux, and Helicobacter pylori (which I am currently treating). The upper and middle part of the esophagus is fine.

 

[moon]

I no longer feel pain in my throat, but I feel something like "popping" or "clicking" in that area when I swallow... Another thing is that I see a visible hollow on the inner part of my left hand, near the base of the thumb, but more toward the center of the hand (flexor pollicis brevis?). And constantly I feel a slight "pulling" sensation in that area, whereas earlier I felt a mild burning. Could this be muscle atrophy, and that's what I'm feeling?

Thank you, I will get in touch after the EMG.

 

[lgelb]

With a hiatal hernia, H. pylori and reflux, you can hardly expect your GI sensations to exactly accord with the esophageal segments that you say are normal. Swallowing is like sailing down a channel, with offshoots along the way. So your current treatments may well improve these sensations.

For the same reason, if you are waking up due to perceived breathlessness, you could track your sleep with a wearable (including your O2, pulse, and sleep stages) and if the data suggest apneic or atypical movement events, that could lead to a sleep study. Bear in mind especially in warm weather and given your GI history, it's very important to maintain an environment that is cool and quiet enough for sound sleep.

 

[moon]

Lgelb, you might be right, and my throat and swallowing issues could be related to gastric problems. So far, my throat is gradually improving slightly, so I won't panic about it anymore.

I would like to learn more about muscle atrophy, and I promise that after this, I'll wait for the EMG and only then come back here.

1. Can muscle atrophy in the hand (from the inside) be felt in some way? Earlier, I often felt a slight burning sensation in one spot, and now I feel a kind of tingling/stinging/pulling sensation, and exactly in that place where I feel it, I also have a visible atrophy that wasn't there a few months ago.
2. Is it possible that I don't feel a loss of strength in my thumb, but I have progressive atrophy? I think it's the short flexor muscle of the thumb.

 

[lgelb]

Neither (1) nor (2) would happen if related to ALS. Atrophy and loss of function walk hand in hand in ALS since it is the death of motor neurons that leads to both.

But lots of littler things can seem more serious than they are once "ALS" enters your vocab. For example, many of us have a weak or flabby thumb, for many reasons. And no one reading this has not had some kind of weird hand feelings that meant absolutely nothing.

 

[moon]

Thank you very much for the explanation. I'll get back to you on Monday with the emg results, hopefully good ones.

 

[moon]

Hi, I am still having problems with my esophagus, I still have the sensation of a foreign body when swallowing (for about a month now), especially when I lie on my side, it becomes more noticeable. The laryngologist and gastroenterologist don't see any problems. The muscles in my limbs are much less resilient and tire more quickly than usual. I also feel strange localized numbness/pulling/tightening of muscles in different parts of my body, particularly in my hands and feet.

I have just now received the results of my EMG, which I am attaching below.

(this is the translation of the document into English)
Electromyographic examination:

• Left Biceps:
  • Duration: 9.5 ms
  • Amplitude: 515 µV
  • Area: 556 ms*µV
  • Size Index (S.I.): 0.44
  • Polyphasic potentials: 8.0%
• Left Extensor Digitorum Communis:
  • Duration: 9.1 ms
  • Amplitude: 410 µV
  • Area: 431 ms*µV
  • Size Index (S.I.): 0.29
  • Polyphasic potentials: 11.5%
• Left Glossus:
  • Duration: 7.4 ms
  • Amplitude: 777 µV
  • Area: 866 ms*µV
  • Size Index (S.I.): 0.75
  • Polyphasic potentials: 19.2%
• Left Tibialis Anterior:
  • Duration: 8.4 ms
  • Amplitude: 644 µV
  • Area: 674 ms*µV
  • Size Index (S.I.): 0.67
  • Polyphasic potentials: 35.0%
• Left Vastus Lateralis:
  • Duration: 10.2 ms
  • Amplitude: 1416 µV
  • Area: 1666 ms*µV
  • Size Index (S.I.): 1.44
  • Polyphasic potentials: 26.9%
    
• Effort recording from the biceps muscle of the left arm: Rich in amplitude, 1.5-2.5 mV. During slight effort, action potentials of motor units of medium amplitude, duration, and SI index were registered as normal. At rest, electrical silence.
• Effort recording from the extensor muscle of the left fingers: Rich in amplitude, 1-2 mV. During slight effort, action potentials of motor units of medium amplitude, duration, and SI index were registered as normal. At rest, electrical silence.
• Effort recording from the vastus lateralis muscle of the left thigh: Rich in amplitude, 2-3 mV. During slight effort, action potentials of motor units of medium amplitude, duration, and SI index were registered as normal, with no significantly increased amplitude. At rest, electrical silence.
• Effort recording from the anterior tibial muscle of the left leg: Rich in amplitude, 1-2.5 mV. During slight effort, action potentials of motor units of medium amplitude, normal duration, and a reduced SI index were registered. At rest, electrical silence.
• Effort recording from the muscle of the tongue on the left side: Rich in amplitude, 2-3 mV. During slight effort, action potentials of motor units of medium amplitude, duration, and SI index were within normal range. At rest, electrical silence.

Conclusion: In the EMG recording from the anterior tibial muscle of the left leg, there is a suspicion of minor myogenic damage, without any pathological activity. The EMG recording from the other examined muscles was within normal limits.


By the way, I also did the ischemic test, and it came out positive.
Ischemic test:
The ischemic test was performed by applying an elastic band to the left arm for 10 minutes, with additional hyperventilation in the last 2 minutes. In the second minute after releasing the pressure, multiple discharges lasting from 6 to 8 minutes occurred in the dorsal interosseous muscle and the left muscle.

Conclusion: Positive ischemic test, indicating neuromuscular junction hyperexcitability.


Questions:
1. Could my symptoms and the EMG results in any way indicate ALS?
2. Is it possible that I have bulbar ALS starting in muscles that were not tested during the EMG, and that's why it wasn't detected?
3. If it's not ALS, do you have any idea what disease could cause similar muscle symptoms that match mine?