Wet voice after drinking, doctor is concerned

[TwitchyDoc]

I had a swallow study (not videofluoroscopy, just the esophaeogram) done a month ago which found slight motility problems. I went there because often when I drink, I feel pressure in my throat as if the liquid was stuck.
Unfortunately, I noticed lately after drinking, especially water, my voice is wet and I need to clear my throat. This is a bedside test with 97% sensitivity for aspiration so I am terribly scared. I do feel strange tickling in my trachea for the last two months but I still hope it is some kind of persistent viral infection. My neurologist, a neuromuscular specialist, for the first time expressed (slightly and carefully) some concerns...he wants me to undergo videofluoroscopy. I think I cannot do that, positive finding would literally kill me and I am not aware of any other reason for my problems.
I was hoping for GERD but the esophaeogram did not suggest that

[J4son]

Ok but why the panic? A couple of days ago i was reading an article about videofluoroscopy (coincidence?) where they said that it is used to diagnose neurological dysphagias. They also said that dysphagias caused by neurological disorders is a frequently encountered problem touching more than 16 million people in the U.S. So why are you jumping immediately to a doomed conclusion, am I missing something? Also Do you think there is one chance over one million that you might just be an anxious person like all of us here?

[TwitchyDoc]

Yes, you are missing the key point - tongue fasciculations, widespread fasciculations and neurogennic dysphagia. My neurologist, who was always so sure what I have is benign, is now a bit concerned. If you know about any other cause (except for strokes, which account for majority of cases of these 16 million, some are RS, some ALS, some SMA...but neurogennic dysphagia is never normal, of course), share it with me please.
I somehow think about silent reflux, probably just wishful thinking as I do not have any other signs.
Trust me I still hope it is somehow anxiety but I really cannot see how anxiety could cause aspiration below the true vocal cords...

[J4son]

Twitchydoc, you know that I am one of your fans on this board. I mean I’ve always enjoyed reading your posts because most of the time it contains medical facts, data, scientific evidences and studies, and you’re one of the few here who had contacts with some of the most renowned ALS specialists in the world. Since I have zero medical knowledge I can’t argue against the fact that your neuromuscular specialist is a bit concerned as you say. But a bit concerned doesn’t match the doomsday tone of your post. So with all humility I would like to add the following:

- Remember your hypothenar atrophy a couple of years ago? You were also in a state of great panic, and you said your doc couldn’t say if it was just some fat lost or true atrophy. What makes today different from other episodes of panic?

- Maybe you should do the videofluoroscopy; after all you are already panicking, so maybe it will reassure you.

- you might just have Globus pharyngeus, sometimes it is related to GERD but often it has no known causes or even some psychogenic or somatoform causes.

- Docen you are a doctor, and in my personal opinion a very good one. But you always seem to dismiss the fact that psychological issues and misdirected safety behaviors might play a role in what we have.

- Personally I don’t think you have GERD, neither MND but I am ready to bet that in a year from now in January 2016, you’ll still be ok and maybe worrying for something else.

I wish you the best; I know how annoying it is to be concerned over a health issue.

[TwitchyDoc]

Thank you very much Jason, I appreciate it very much. You are right, I tend to dismiss psychogennic causes as I am trained to find organic ones..

[crotwich]

Docen, like most of us on this board, you are way too much hypersensitive about your health condition. Whenever we notice some new symptom, we immediately tend to think that it is surely connected with our fasciculations and that we are doomed. But in reality, there is a much bigger chance that your swallowing issues are caused by something completely else. Especially, after so many years of twitching behind you. Maybe it is a side effect of some antiepileptic you're using (Trobalt)?

[TwitchyDoc]

I stopped everything afew weeks, including Tegretol. Nothing changed, unfortunately.

[Little Lost]

Could the motion of the benign twitching itself be causing the slight difficulty, rather than a disease.

For example thought I was a gonner for sure when I was asked 3 years ago if they could film my soft palate fasciculations. Now they are hardly ever there. When I got them it was hard to swallow. Now they are gone I have no problem. It was the physical obstruction by the contraction and relaxing twitches interfering with normal fine movement, not any actual neurodegenerative disease.

Keep strong. If you undergo observations and tests you will always always find something somewhere. TD You will be fine.

Hx

[crotwich]

I stopped everything afew weeks, including Tegretol. Nothing changed, unfortunately.

Antiepileptic drugs (especially Trobalt) are very mysterious entities and it is well known that they can cause swallowing issues (I suppose you know that). Maybe you just need to wait a little bit longer. Everything will be OK.

[TwitchyDoc]

It is not the twitching, it is the wet sounding voice after drinking that scares me as it is a typical sign of aspiration.

[Little Lost]

Enlarged adenoids, slight throat inflammation. In the fearful early days I used to get bits of tissue and stick them up my nose then swallow a few gulps of something highly coloured like orange juice. There is always a very slight spot on the tissue but have to strain to see. If I had irritation there was always more.

Oh the hidden world of the BFS,

[TwitchyDoc]

Would it not be easier and more reliable to just blow your nose, if you were looking for nasal regurgitation? So I assume when you drink, your voice sounds exactly the same. My issue is with possible aspiration into the lower airways.

[Little Lost]

No because blowing nose can force liquid through, nose tissues is more passive, as for my voice after drinking will try just now....hang on

[TwitchyDoc]

Interesting, never thought about such a passive test, you are definitely right. Usually I know my colleagues test it by blowing the patients nose - if there is nasal regurgitation, is will show up.

[physerv24]

Docen I can relate to your fears. I have been having problems with my voice since late October. I have been to an ENT who scoped me and indicated some irritation but nothing with respect to functionality. My issue is not with swallowing. My issue is with speaking. I have had "extreme" sinus drainage for at least 5 months and when enough of it starts running down the back of my throat, it's as if it collects there and it affects the function of my soft palate. I know this because when it gets real bad and I try to speak, air escapes through my nose and I sound like someone with a cleft palate. If I drink something and clear my throat very hard, it goes away. It was only happening to me every couple of weeks, now it's every other day. It scares the hell out of me. My voice if obviously much weaker and I can no longer sing, which I used to do every day for at least the last 30 plus years. The only way I can describe it is it feels like my throat is narrowed or closes up when I attempt to sing. I hate it.

My neuros won't do an emg of my bulbar area because I have full functionality of my tongue and no swallowing or chewing problems. Additionally, I have suffered from reflux for at least 12 years and have been on ppi's for that long. I wake up almost every night with really bad indigestion, so they think the issues I'm having with my voice is related to LPR. I just wish they would do the emg.

Vince