Asymmetrical Tongue and Twitching

[Missing7]

25 male here. For the past few months I've been experiencing muscle twitches in various places (calves, thighs, buttocks, triceps, abdomen, ribs, back, shoulders, and even tongue). The twitching has decreased in frequency. However, I still experience them pretty much every day in my right leg and upper back/shoulder area. My right calf is also constantly tight. I also started having problems swallowing, especially small bits of food. I went to an ENT who told me he could see acid reflux damage in my esophagus. He attributed my swallowing problems to GERD. My swallowing has gotten better. However, I often feel like my swallow is incomplete or like something is stuck on the base of my tongue around where it anchors.

The swallowing problems and tongue twitches eventually led me to examining my mouth on my own. That was when I noticed that I had an indent in my tongue about 1/2 and inch from the tip. This indent does not go away even if I leave my tongue hanging out of my mouth. So, I know it is not an imprint from my teeth. The area around the indent also appears to be pale. I then noticed that the left side of the tip on my tongue sticks out farther than the right and that the right side of my tongue looks thicker than the left. I also noticed that my tongue, even at rest, seems to be sitting entirely off center in my month to the left.

Should I be worried? I do have a follow up appointment with my neuro in a week for a follow up on migraines that I was having. But I'm a little anxious and thinking about trying to get an appointment this week. I know there is a condition called BFS, which I decided was the cause of my twitches until I noticed the asymmetry of my tongue.

I have been chewing exclusively on the right side of my mouth for a couple of years now. I started doing it when I had a problem with one of my teeth on the left side and it just became habit. Could this explain the asymmetry? What about the indent and paleness?

[Missing7]

Thank you for the response.

I am currently taking omeprazole for GERD. I did have my B12 levels checked, which were found to be at the very bottom of the normal range. So, good job on picking up on that. I also recently had an MRI and just got the results back today: perfectly normal. The twitching has decreased in frequency. I am taking B12, Iron, and magnesium supplements as well as doing my best to stay hydrated. I'm still a little worried about ALS. I know the odds are slim, but I have a nasty habit of focusing on the worst case scenarios. Fortunately, I have an appointment with my neuro this Friday. I will bring up my symptoms with him then. Hopefully he can put my mind at ease. My tongue being crooked is still a little disconcerting to me. Did you have any thoughts on that?

[Dr. Kokil Mathur]

Hi!
Your problems can be a combination of bad gastric reflux and vitamin B 12 or electrolyte deficiency. Hence, it is important to get serum electrolytes and vitamin B12 levels checked.
The gastric reflux can cause chemical burn of the tongue caused by acid from the stomach. The symptoms could be exacerbation of the GERD or gastric reflux.  It could also be hiatal hernia. Treatment is a combination of drugs to reduce the acid and lifestyle changes. You will need to take a combination of medications (under medical supervision) like a proton pump inhibitor such as omeprazole, lansoprazole or pantoprazole empty stomach in the morning and an antacid gel after meals or H-2 blocker such as ranitidine for complete relief. Possibility of H pylori infection too should be looked into by a carbon urea breath test and a combination antibiotic tried. Many a times a persisting H pylori infection can be the cause behind acidity not responding to treatment.
Life style changes that will help include: Drink cold milk. Avoid heavy meals and eat frequent small meals. Avoid too much of caffeine, tea, smoking, fried food and drinks both alcoholic and non alcoholic fuzzy ones. Avoid heavy exercises within 4 hours of a heavy meal. Raise the head end of the bed by pillows to 30 degrees. Avoid lying down for least 2 hours after food. Take a late night snack. Maybe these tips will help you.
Since a confirmed diagnosis cannot be given on net please consult your doctor regarding this. You should ideally consult a GI doctor or gastroenterologist for this. Hope this helps. Take care!

The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.