I am a 40 year old female. I began having difficulty swallowing pills in the spring and was admitted to the hospital for a neurology workup when I began having difficulty swallowing food in June. They ruled out Myasthenia Gravis and did an EMG of my leg, arm, and hip. The EMG showed a mild myopathic change in the hip and L5/S1 radiculopathy. My ENT scope and exam showed pharyngeal dysphagia, thin vocal chords, and weakness of the tongue. Since that time I have developed slurring in my speech when I talk for long periods of time or when I read out loud. I have an appointment with a neurologist from the ALS clinic in August where they are discussing doing a bulbar EMG. Is it necessary to do a bulbar EMG to rule out bulbar onset ALS or would the prior EMG have shown ALS signs?