[Dysphagia] MELAS

[pressmah at sjhmc.org (pressmah@sjhmc.org)]

Sounds like fatigue is a significant factor.  Perhaps 6 small meals per day
with high caloric content  Hilda Pressman

-----Original Message-----
From: Mary Hauser [mailto:mbhauser@velocity.net]
Sent: Friday, January 07, 2005 8:16 PM
To: dysphagia@b9.com
Subject: [Dysphagia] MELAS


I am writing for one of my school-based SLP friends.  (Sorry for the length)

She has been having many neurological symptoms since last April, which  have
increased dramatically since November.  Some symptoms have included sudden
weakness on left side, numbness and tingling, eye twitching,  and now
dysphagia symptoms (will describe later). This resolves after a few hours,
but her legs still feel weak and "heavy" and her arm feels numb at times. 

She has been going through numerous Dr. visits/tests and they have a
"possible" diagnosis of "MELAS":  mitochondrial encephalomyopathy with
lactic acidosis, and stroke-like Syndrome.  But  they have not ruled out MS,
Sjogren's (sp) or something else unknown as yet.  I checked out MELAS, and
it doesn't sound like something you'd want to develop, and the prognosis is
poor. There was no mention of dysphagia as symptoms. 

She is 55 years of age, slightly overweight, and less than 5 feet tall.
She takes lotensin for high blood pressure and synthroid for multinodual
goiter. ( All blood tests show thyroid levels are WNL. ) She uses a CPAP at
night for sleep apnea.

Dysphagia symptoms  (intermittent and can start mid-meal): 
Throat, back of tongue, tongue base, and velum will start to  "thighten"
"ache" and "feel tired" making swallowing very difficult.  She does not feel
food sticking at laryngeal level or lower. But it is difficult for her to
manipulate the bolus and start to swallow. It happens with all textures, and
even some liquids.   In addition, her mouth is usually dry, until she eats
then she has excess saliva and starts to drool on her left side of her
mouth.  

 She states that she has always had some difficulty swallowing things like
pills and says she has "excessive" tissue in her pharynx including large
tonsils, uvula and a big tongue  ( I didn't look). 

I suggested small bites, alternate with liquids,  & trying lemon ice to help
with the sticking.  But since I've never come across MELAS or simlar
symptoms, I'm not sure this is the best for her. 

Has anyone had a patient with MELAS, or similar symptoms?  Is there
something else I can do to help her?

Thanks!
mary_______________________________________________
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