### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
my mom is having serious issues. She can no longer speak, and lost all swallowing for two years until about 3 months ago. She can now swallow a little bit. At one point Mayo clinic told her she had some form of bulbar palsy but couldn t explain what or why. A year later a neurologist told her it was ALS. She had no other symptoms though at that point and no lower motor neuron issues. She had no change for about 1 in a half years. We had several doctors question the ALS diagnosis. In Sept of 14 she tested off the charts positive for Lyme. Started treatments in November and in the last few months has declined quite a bit. She is having weakness in her legs (still walking) and some brain fog and overall weakness I guess I would say. This is year four of the first time we noticed her symptoms (which was slow speech) She does not want to see another neurologist because it has been such a long and hard battle to find answers and have not had a good experience anywhere. She is now 69 years old and was in good health prior to this. Do you believe this to be ALS or can lyme disease cause this?

### output:

Hi, Welcome to Chat Doctor .com I am Chat Doctor. Mariano Into Bruno Mascaras. I have gone through your query with diligence and would like you to know that I am here to help you. We need to do 1. MRI Brain 2. MRI Whole Spine 3. Mini Mental State Examination4. Examination of Cranial Nerves5. Examination of Muscle Power6. Examination of Sensation7. Examination of Reflexes Accurately know her present status. Please share all the reports with us so that we can guide you in a proper manner Hope you found the answer helpful. If you need any clarification / have doubts / have additional questions / have follow-up questions, then please do not hesitate in asking again. I will be happy to answer your questions. In the future, for continuity of care, I encourage you to contact me directly in Chat Doctor at http://bit.ly/ask