Transcript Patient #5: Andrew

PATIENT #5: ANDREW
Ashton Crowe
Rayvin Ewers
Miranda McCormick
ANDREW’S CASE
 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
SIGNS OF DISEASE
Hands and feet muscles are getting weaker and sometimes
twitch
Used to work out, but now he has trouble lifting the bar
Has been tripping and stumbling
Had trouble putting the key in the door
Muscles are slowly giving out on him
Trouble projecting his voice
Heard slightly slurring his words
SYMPTOMS
Weakening of hand and feet muscles
Muscle twitching
Trouble lifting heavy things
Tripping and stumbling
Bad coordination
Trouble projecting his voice
Slurred speech
DIFFERENTIAL DIAGNOSIS
There was an option that he may have a brain tumor in the
frontal lobe. This was ruled out because usually, when there is a
brain tumor in the frontal lobe, there is usually behavioral changes
along with other symptoms.
There was also an option for tremors. This diagnosis was ruled out
because in this case, there would be many tremors in many parts of
the body and that is unusual.
Our last differential diagnosis was Rhabdomyolysis. This was
ruled out because it only affects the muscles such as in the hands or
feet, it usually doesn’t affect speech.
ACCURATE DIAGNOSIS
The accurate diagnosis for Andrew is Amyotrophic
Lateral Sclerosis (ALS)/ Lou Gehrig’s Disease. His feelings
of weakness, tripping and stumbling, and slurred speech
led us to this diagnosis.
ALS can have many symptoms. For most people, muscle
weakness and muscle twitching are the first signs. For more
progressed diagnoses, slurred speech can be a symptom.
With symptoms most like other ALS cases, ALS was the
most accurate diagnosis.
EXAMPLE OF SYMPTOMS VIDEO
https://www.youtube.com/watch?v=uDAKAPR-b1E
(1:47-2:08)
TEST TO DETERMINE DIAGNOSIS
Electromyogram (EMG)
During this test, a doctor inserts a needle electrode through your skin. It tests
the electrical activity in your muscles when they are contracted and at rest. If
electrical activity is low, it can be used to diagnose ALS.
Magnetic resonance imaging (MRI)
Uses radio waves and a powerful magnetic field to produce detailed
images of your brain and spinal cord. This can be used to eliminate other
factors that may be causing the symptoms.
Nerve Conduction Study
This study measures your nerves' ability to send impulses to muscles in
different areas of your body. This study can be used to determine nerve
damage or muscle diseases.
ERRORS IN COMMUNICATION
In ALS, the immune system damage the axon and
dendrites of motor neurons. This will ultimately destroy the
neurons ability to transport messages from one neuron to
another. This can be dangerous because eventually,
messages can no longer be sent from the brain because of
damage to motor neurons.
WHAT IS THE CAUSE
Although the true cause is unknown there are many theories as
to how the motor neurons are damaged, such as during the
process of RNA there is a protein that becomes a mutation due
to an incorrect amino acid. This mutation then leads to the
shriveling and degeneration of the motor neurons. Other
believed causes are genetic mutation (inherited from a parents),
chemical in balance (normally have higher levels of glutamate,
a liquid surrounding the brain and nerve cells, that can be toxic
if too much is present), or disorganized immune system (attacks
the body’s own nerve cells, or any cell in general).
PROGNOSIS
Many people with ALS die of respiratory failure within 3-5 years
of being diagnosed.
Individuals have increasing problems with moving, swallowing,
and speaking/forming words.
Eventually people with ALS will no longer be able to stand or
walk, get in or out of bed, or use their hands and arms.
In the later stages of this disease certain individuals will have
difficulty breathing due to the muscles of the respiratory system
weakening.
10% of individuals may be able to survive 10 or more years.
TREATMENT
There is no cure
There is a drug known as Riluzole and it is the only drug for ALS that is FDA
approved. It can prolong life for about 2-3 months. It does not relieve the
symptoms though.
NeuRx Diaphragm Pacing System uses implanted electrodes and a battery
pack to cause the diaphragm to contract. It can work for about 16 months
before the onset of severe respiratory failure. This is also FDA approved.
Drugs are available for spasticity, pain, panic attacks, and depression.
Physical Therapy, Occupational Therapy, and rehabilitation may help with
joint immobility.
Some patients may agree to forms of mechanical ventilations.
WHERE IT ALL STARTED
Lou Gehrig was a baseball player in the 1920s1930s who was diagnosed with ALS and brought a lot
of light on the disease. He played major league
baseball for over 13 years of his life on first base for
the New York Yankees. He became very popular and
competed against Babe Ruth for major titles. Lou was
also given a spot in the hall of fame. He was first
diagnosed with a bladder condition, but the treatment
only made him weaker. This lead the doctors to ALS, or
later called Lou Gehrig’s Disease.
CARETAKER
Andrew will need may need a caretaker in the
later stages of ALS. This caretaker may help with
feeding him and helping him perform every day
activities. Also, he may need breathing care.
PHYSICAL THERAPIST
A physical therapist can help him with exercising muscles
to help prolong muscle function. Andrew will only need a
physical therapist for the time that he can use his muscles.
Once he loses all ability to move his muscles, he will not
need a physical therapist any longer.
OCCUPATIONAL THERAPIST
An occupational therapist may help Andrew perform
everyday activities for a longer amount of time. Over time,
the need of an occupational therapist will be less and less
because he will eventually lose all ability to perform all
every day activities.
SPEECH THERAPIST
A speech therapist can help with the communication
abilities of Andrew over time. He will eventually not need
a speech therapist once his speech ability is lost.
PSYCHIATRIST
Andrew may need psychological and social support to
help deal with the understanding and acceptance of his
disease.
SOCIAL WORKER
A social worker may be needed to help decide who
Andrew’s children will go after his passing. This can help
with some of the psychological stress of Andrew and his
children.
ALS STORY
www.Youtube.com/watch?v=hNISt4fja9U