My brother has a problem that hasn't been solved through consultation with many doctors. He is 48 years old and started having a speech problem, very altered and slow. They have tested him for possible stroke, etc. He has a fragment of metal that became lodged in his throat years ago and was not removed because they said it was so close to nerves it would be better left alone. I have read so much on metal poisoning and some of the symptoms that it can cause, such as mercury poisoning. Do you think this would be a possibility for him to look into?

L.M.

Most of the time, metal that finds its way into the body by accident is inert. In other words, it does not break down, so there is little chance that it will "poison" the body. The human body is also (usually) pretty good about barricading foreign elements with scar tissue. Nevertheless, bits of shrapnel, bullet fragments and the like may, on occasion, migrate into different tissues. There they may cause problems (for example, by eroding into a blood vessel).
In medicine, one must constantly compare risk with benefit. Usually, the risk of removing a foreign body (such as a bullet fragment) far outweighs the benefit. The "benefit" of removal, after all, is merely the prevention of future complications, which are generally rare.

So ... could this bit of metal be the problem? I would have to say that this is unlikely, but not impossible. Some metals are neurotoxic (poisonous to nerve tissue). But what tissue is being poisoned? If the target of this poison is the brain, then your brother should have several unusual symptoms other than alteration of his speech. If the target is a nearby nerve -- for example the recurrent laryngeal nerve (which is responsible for vocal cord motion) -- then breathiness or hoarseness would result, not "slowing."

"Very altered and slow" speech in a 48-year-old man suggests a problem in the brain. There are a number of neurologic diseases that affect voice, some of which are very rare. This is just a guess on my part; you haven't given me much information to go on, after all! Nevertheless, the symptom you have described worries me. I think it is essential that your brother investigate this problem until he gets a diagnosis.

You wrote that he has been to many doctors, but has he seen the right specialists? When the local docs are stumped, it is time to take the problem to the ivory tower (a university hospital, in other words). Many medical schools have a laryngologist (an ear, nose and throat doctor whose practice is focused on voice disorders) who works in close association with a speech pathologist and a neurologist. If your brother is examined by this sort of team, there is an excellent chance they will be able to put their heads together to arrive at the correct diagnosis.