How do you counsel patients with ALS on the benefits of enteral nutrition?  

I agree with Drs. @Lee and @Bromberg but what I find frequently is that patients are reluctant to have PEG because of a number of psychological factors; fear of the surgery, fear of having a tube, fear of disease progression, fear that it will keep them alive indefinitely as in the old vegetative st...

We start by encouraging patients to supplement their diet with whatever they want to eat, focusing on calories. If eating is taking too long and they are choking, or they are losing weight (>10 lbs in 6 months) we introduce the concept of a gastric feeding tube. We emphasize the benefits; can sti...

Gastrostomy is important for ALS patients with significant bulbar dysfunction. Yet, it is typically a difficult discussion as it has a profound impact on their lifestyle. I typically take time to introduce the possibility of gastrostomy gradually to provide enough time for patients to think about it...