Speech and Swallowing Trouble

I am a 49 year old male. About a year ago, I noticing that I was starting to have slurred speech and difficulty swallowing.  Since the problem did not improve, I went to see my primary care doctor.  He thought I may have had a stroke and sent me to the emergency room. While in the hospital, they did several blood tests including AIDS, Heavy Metals, and Lime Disease.  They also did a CAT Scan, MRI, Carotid Artery Test.  All tests came up negative.  Other symptoms I have are tongue fasciculations, very thick saliva. I get winded quite easily with moderate exercise like walking up a flight of stairs.  I also have occasional muscle spasms in my arms and legs.
A few months after I was released from the hospital, my neurologist did and EMG and an NCV test.  Both tests came back negative.  The doctors first thought - Bulbar ALS; but, the EMG and NCV did not support this diagnosis.
In 12 months I have lost about 25 pounds (190 down to 165), mostly, I think, because I eat so slow and also because I have cut so many foods from my diet (Aspertame, and anything with MSG).  I'm eating a lot of natural foods.
My speech and swallowing problems have remained similar over the past six months. I have noticed that the speech and swallowing problems get worse around 2-6 pm; but, improve in the evening and morning.
Does anyone had any suggestion on what type of doctor I should see to diagnos the problem?

[Kevin Pho, MD]

ALS itself can lead to significant speech and swallowing problems.  I agree that another neurological opinion should be sought, preferably at a major academic medical center.

Regarding the swallowing problems, a modified barium swallow can be done, in conjunction with a speech therapist.  Anatomical abnormalities can be determined with an upper endoscopy.  Depending on what is found on the test, referrals can be made to either an ENT or GI physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[hbp702]

Try to get a referral to a Neurologist.

[hbp702]

(not the one you went to - another opinion, perhaps even the Mayo clinic if you can't get help locally).

[PedsSLP]

IN ADDITION TO to the medical referrals have you considered a referral to a Speech Pathologist (SLP). Speech difficulties present differently for various neurological diagnosis, for example people with ALS typically have difficulty with maintaining speech for the duration of a longer sentence or conversation where as persons who are post stroke or injury to the motor areas may have difficulty throughout the conversation but it doesn't necessarily become harder as the conversation continues. Techniques can be taught to strengthen the muscles for those with a dysarthria (muscle weakness)or to conserve energy for those with ALS.

Pending the results of a modified barium study (MBS) (aka, Cookie Study) a SLP could help with position and techniques that assist a safe swallow. The MBS will inform you of safe consistencies for eating (which you might have already figured out some of the easier foods if you have been going through this for a year...)

Good luck!