Hi, I have bad anxiety, and have developed a specific fear that I have early onset bulbar ALS. I have been seen by my Dr numerous times and have also seen a NP at the same office. All say it is anxiety and that it is not likely ALS or MS. My Dr put me on Xanax daily, I was taking (I think) 1.25mg daily. he had me taking 3.3 pills a day. I expressed that I wanted to stop taking xanax. He suggested that it wasnt a good idea but if I really wanted to i could slowly reduce my dose, but not stop. in the past roughly 2 months I have reduced my dosage in 2 stages for about 3 weeks at a time until I am now taking 2 pills a day, 1 in the morning, half in the afternoon, and half about an hour before bed. I have had a worsening of symptoms lately but they never truely went away while I was on the xanax though they did seem to subisde for quite a while. Now I have been having a bit of a rough time lately, it seems obvious that it is because I had reduced my meds but of course with anxiety I am afraid it is just teh disease progressing. some of these symptoms I have had for years, and while they don t all really fit ALS, I have read in many places that ALS early on can be subtle and missed by most examinations. So here is what I am experiencing along with about how long it has been happening: 1. difficulty swollowing, I never actually choke on fluids, and i CAN swollow, but for about 7 years or so sometimes when I go to swollow food, its as if my throat simply does nothing. my toungue pushes the food back then nothing happens and so teh food sits in teh space behind my toungue and i panic feeling like im going to choke. I have never actually had food go into my windpipe though. Very rarely a tiny bit of fluid from saliva or a drink kind of feels like it gets passed my vocal folds and I am constantly clearing my throat, but again I never actually choke or have to cough fluids out.I dont know why it started but it was sudden and has gradually gotten worse and gone away for periods. Sometimes (rarely) I will eat and not realise till after that I did not have trouble the whole time. sometimes food and fluids feel like its leaking a bit up into my nose, but again its subtle and not much actually going up there, also sometimes i swollow fine and my nose stays sealed fine. 2. I feel like I am having difficulty speaking properly, not slurring, but being articulate and speaking clearly, especially pronouncing R sounds like in cheeseburger and K sounds like in Kick or stick . Noone else including my wife notices any trouble speaking and they say I m teh only one who notices, but I feel my tounge move incorrectly and it bothers me. This is only about the last 3 or 4 months. 3. Jaw fatigue. about 1 year or so I feel like my jaw gets very tired from eating very quickly and I can t ever recall that happening in the past. My jaw strength does not seem weak, I think I can bite down just as hard, its just my jaw (and toungue) get tired. 4. fatigue in hands. (typing this is making my fingures and forearms kinda burn) same as the jaw tongue issues, when I do yard work I notice extreme fatigue in my hands arms and shoulders that I dont remember in the past. Not so much a lack of strength, just extreme tiredness in teh muscles quickly like when I trim hedges or carry lumber. 5. muscle twitching in various places all over but specifically for about a month or 2 my left bottom eyelid and left corner of my mouth, the tiny little muscles just twitch for hours. but also sometimes a fingure, or my calf. This is noticeable fast twitching, doesnt seem to be like faciculations that I read about, but still it scares me. its not all over in an area and does not look like worms crawling under the skin as I read about but still it botheres me. 6. facial and scalp muscles extremem fatigue from smiling. If I have a voncersation for any extended time and I m smiling a lot or often sometimes my while face and scalp feels very tired, like burning muscles after a workout, just from the smiling. I can smile, it just tires my face out sometimes. 7. Throat feels tired if I talked for too long, I dont lose my voice, again just the burning kind of tired tight feeling in my voice box. Only if I talk constantly for an extended period which I do not normally do. 8. I generally feel weak all over, I don t think I ncecesarrily AM weaker, I just feel weaker. 9. I feel off balance sometimes when I walk like I m shakey or wobbly. I dont trip or fall, I just don t feel right. I am 36 years old, male, not at all athletic. I get little to no exercise other than yard work. I work in IT so I sit at a desk all day. I do not go to the gym. but I still feel like I should not feel so beat just from doing yard work. I an 5 9 220 lbs caucasian. I would not say I m a healthy eater, but I also am not a junk eater. I d say in between. I rarely eat candy or fastfood, but I eat a lot of carbs like breads and potatoes, chicken, beef. I rarely eat fruit. I consume a lot of coffee but almost never soda. I drink water when I m not drinking coffee. I m terrified. I feel like my Doc is tired of seeing me. He seems unconcerned, the NP wasnt concerned either. The Doc even had guest Docs with him on 2 occasions (im not sure if they were training or interviewing or watching him) but they didn t seem concerned either. I m terrified though because I read about how ALS is easily overlooked. I also btw have GERD and take a ppi twice a day every day per the prescription. I used to have terrible heartburn almost all the time. There are other symtoms I feel like I m forgetting but generally these are the major ones. Thanks for your time, sorry for the long questions.