PATIENT 5 CASE STUDY Mason Clark Cameron Buckman

PATIENT 5 CASE STUDY Mason Clark, Cameron Buckman, Ava Embrey, Chelsea Sams

Patient History • Andrew, a 45 year-old single father of two, comes to you in confidence. He’s noticed that the muscles in his hands and feet have gotten progressively weaker lately, and from time to time, he sees these muscles twitch. He used to lift weights at the gym quite a bit, but he now has trouble lifting the bar. His daughter noticed that he seems to be tripping and stumbling quite often and commented that it took him quite a long time to get the key in the door the other day. Andrew claims that mentally he feels fine, but it’s almost like his muscles are slowly giving out on him. You don’t see any twitches going on right now, but you are having a hard time hearing him. He seems to be having trouble projecting his voice and his speech is slightly slurred at times.

Amyotrophic Lateral Sclerosis (ALS) • AKA Lou Gehrig's Disease • Progressive neurodegenerative disorder • Motor neurons degenerate and cease sending signals to muscles, causing paralysis and eventually death.

Biology of the Disease • Prolonged death of motor neurons • Muscles weaken and begin to stop being used • Leads to atrophy (wasting away) of muscles

An Error in Communication

Symptoms • Muscle weakness in hands, arms, legs, muscles of speech, swallowing, and/or breathing. • Twitching/cramping • Impaired use of limbs • Difficulty with speech • Shortness of breath

Stages of the Disease Early Stages Middle Stages • Weakening muscles, cramping, and twitching is 1+ area. • Fatigue, Poor Balance, Weak Grip, Loss of Balance • Symptoms become much more widespread, muscle paralysis begins. • Emotional changes, falls, driving relinquished, weakness in swallowing and breathing muscles. Late Stages • Most/All voluntary muscles are paralyzed, muscles for breathing are severely compromised. • Mobility is extremely limited, poor respiration, and speech, eating, and drinking by mouth may not be possible. At the End • Vast majority of deaths occur due to respiratory failure, but other causes include pneumonia, heart arrhythmias, and aspiration. • Many patients receive medication for fear/anxiety, and are treated to make death as peaceful and painless as possible.

Treatment and Prognosis • No cure has been discovered • Medications such as Rilutek prolong lifespan. • Other medications can be used to treat symptoms • Most people with ALS die within 3 years of diagnosis. • 50% live 3+ years • 20% live 5+ years • <10% live 10+ years • Data from John Hopkins Medicine.

Treatment Plan • Begin prescription of Rilutek • Start weekly physical therapy, and monthly checkups. • Watch for future symptoms, and prescribe medications as needed.

Physical Therapist • Helps to make movement SAFER and EASIER • Keeps muscle from atrophying as quickly • This will help keep the symptoms of ALS at bay.

Pulmonologist • Helps the patient to breathe as the disease progresses • Breathing treatments when symptoms arise can alleviate symptoms • In end stages, patients may need intubation from a pulmonologist.