Ask the Doc: Q & A with Edward Kasarskis, MD, PhD

Edward Kasarskis, MD, PhD is Director of the University of Kentucky ALS Multidisciplinary Clinic at Cardinal Hill Rehabilitation Hospital in Lexington, Kentucky, professor in the Department of Neurology at the University of Kentucky, and Chief of Neurology at the VA Medical Center in Lexington KY. 

Dr. Kasarskis

Q:  This may sound odd, but my husband, who has ALS, and I were visiting a friend. She became ill and was vomiting, and all I could think of was what would happen to my husband if he became sick to his stomach? What normal things that the body does could become difficult for a person with ALS?

Dr. Kasarskis:  This is an excellent question. I can see how this would be a concern. For someone with ALS, the reflex to vomit would most likely be intact. The issue would be that your husband would be more prone to aspirate (inhale) what he might vomit than would be someone without ALS. If your husband feels he is going to vomit, it’s wise to turn him on his side right away to protect his airway and lungs, and to help get the material out of his mouth as soon as possible. 

Other normal bodily functions can pose special challenges for people with ALS. Although bladder control remains normal some ALS patients voluntarily reduce their fluid intake to limit the number of trips they have to make to the bathroom. This may make some sense from a mobility perspective, but this approach cannot be endorsed since dehydration creates its own set of serious problems.  Constipation is very common and can be a side effect of medications.  However, many diets are lower in fiber than they should be, and most people with ALS get less exercise than before they developed ALS. Stool softeners, a bulking agent (like Metamucil) and fluids are helpful.

For some people with ALS, being able to cough productively can be difficult. For someone without ALS, coughing is normally easy. We take a deep breath and cough without even thinking about it. But for people with ALS, taking that deep breath can be difficult. Respiratory therapists teach a technique called “air stacking”: the person takes a series of four to five smaller breaths to inflate their lungs incrementally, and then they have the air volume they need to produce an effective cough. There are also assistive mechanical devices that inflate the lungs with gentle pressure by mask, and then the pressure switches to a vacuum-type function and the machine sucks out secretions.

Mouth secretions can be a challenge, too. If they’re too thick, perhaps from dehydration, they can be difficult to cough up. A thinning agent, such as Mucinex®  (which is available over the counter) can be effective. But if secretions are too thin, they may increase a person’s propensity to drool. The best bet is to work closely with a Respiratory Therapist and your physician to deal with these issues when they come up.

There are some functions of the human body that do not change due to ALS. Sex, for example, continues to work as it did before the person developed ALS, although positioning can sometimes pose challenges and fatigue can interfere with desire. Other functions directed primarily by the autonomic nervous system such as digestion, urination, defecation -- are typically not affected.

Don’t assume that you can’t ask about these basic issues. Whatever questions you have, be sure to ask your physician and other professionals who are supporting you through your journey with ALS.

Each issue we feature a leading neurologist specializing in ALS responding to a question. If you would like to submit questions for a future Q & A, please send your questions to Amber Walters. Please understand that we won’t be able to address all questions and we won’t be able to respond to individuals personally.