lyme/mnd symptoms

Age: 52
Sex: Male

Summer of 2005: began to develop mild hoarseness which slowly but steadiy became more serious.

Fall of 2005: developed pressure in lungs, shortness of breath upon mild activity. Some mild cough.
Congestion in lungs.  PCP found no evidence of infection but tried antibiotics (possible low-grade infection).
Failure of antibiotics resulted in trial of prednisone.  This brought the lung symptoms to a very minor
discomfort but did not completely clear the symptoms. PCP discovered that I wheeze and cough dramatically
when performing a forced complete exhalation from the lungs. This occurs at the end of the exhalation process.

April 2006: Visit with EMT for dx of continued hoarseness.  He found "atrophied vocal cords to a degree
far beyond what can be expected for someone of my age" and encouraged a visit with neurologist. His letter
to PCP suggested the possibility of ALS or other MND.

While awaiting appointment with neuro, began to have stiffness and muscle fatigue in both legs with stronger
manifestation of symptoms in right leg. I cannot do physical work on my feet for more than an hour or so without
feeling an overwhelming sense of muscle fatigue in my legs. Soles of both feet are always painful to step on,
at the ball and heel of the foot and the outer edge of the sole--essentially all areas that find pressure
when contacting the floor. Also developed pronounced increase in salivation such that I would have choking
episodes while lying on my back. This also results in drooling while sleeping on my side. It is *not* difficult
to swallow food or drink, but I can feel a lot of muscle strain in my throat when trying to "gulp" down the
excess saliva.

May 2006: Neurological exam shows no sign of any weakness in any limbs.  EMG normal. MRI normal.  All blood
tests normal (including MG and thyroid).  No antibodies for Lyme.  Neuro suspected bulbar palsy but could
not confirm with tests. PFT shows no abnormality even though the deep exhalation process still results in
a strong wheeze and cough at the end of the cycle.

June 2006: Began to have fasciculations in both legs and both arms. Fasciculations are frequently felt but are more
often seen rather than felt. They are frequent but of very short duration and tend to jump from leg to
leg and arms.  Still no weakness.  

July 2006: It is now difficult to project my voice.  I can speak loudly but it takes a lot of effort, such
that I do not wish to do so. I also run out of breath upon the string of two or three sentences in quick succession.
PCP sends me to rheumo to look for possibility of polymyositis. Rheumo does not feel that there are symptoms that
reflect a rheumatological condition.

At this point, I am awaiting a follow-up in September with neuro.

Thoughts?  I have three very specific questions.  

If this were Lyme disease, could it actually cause atrophied vocal cords?  

Does the atrophied vocal cords dx in itself define that there is some  neurological disorder, or is it
possible to develop out of some known benign condition?

Is there any kind of MND (or other neuro condition) that can manifest itself
*first* (with slow progression) as stiff and fatiguing muscles rather than weakness?

Thanking you very much in advance for your attention.

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.  The symptoms and history that you have provided is concerning for ALS with bulbar onset, but can also be seen in other disorders, such as Parkinson's disease, myasthenia gravis, vocal cord paralysis, polymyositis etc. The type of EMG that you need is called a Laryngeal EMG (Available in large academic centers).  This is an EMG (Electro Myography or "nerve-muscle test") of the thyroarytenoid and cricothyroid muscles (muscles in the larynx).  I would also recommend that you repeat the general EMG for signs of ALS since you are having a more systemic spread of your symptoms now, with stiffness and fatigue (these symptoms are non-specific but can be seen in a number of the disorders all ready on your list, such as ALS and Parkinson's).  You should seek out an expert in ALS (there are several around the country) and have them do the laryngeal EMG/general EMG, to take advantage of their ALS protocols for doing EMG and their interpretive skills (EMG is subjective and requires one know what they are looking for).
I hope this has been helpful.

[zny444]

Hi Dave,

I'm kind of in the same boat as you... many pains,stiffness in my right foot/calf (especially when I first get up in the morning). I have continous twitching in my right calf, a slight tremor of the jaw and SEVERE eye floaters and dark spots in my vision. It all started after two lumbar injections for sciatic pain I was having. I have no weakness, no atrophy... in fact I still jog and lift weights. I have had these symptoms since Jan of this year. I have been to multiple Doctors, Neuro's and an ALS clinic. All determined I did not need an EMG and that this is all Benign Fasiculation Syndrome (BFS). I don't know what to think anymore. I'm continuting with my PT/Chiro visits for my back pain and just going on with my life. I know how frustrated you are... but it's a good thing they haven't found any major thing wrong with us. Hang in there bro... your not alone.

[tiff423]

Hi!

I just wanted to let you know about a great website that has a tremendous amount of info about Lyme disease.  It's www.lymenet.com  I was clinically diagnosed w/Lyme this year.  I find many many answers to even the craziest of symptoms from their forums (On its home page click on "Flash Discussions" to get to the forums).  It's strickly people living w/Lyme, not DR's.  But, if you post your symptoms there, you may be surprised of the responses you'll get.  You may find others w/exactly the same problems.  Lyme can attack every part of the body if it wants to, and can very often mimic many other diseases.  Good luck, I hope you can find some answers on that site.  I know I do!  Take care!