ALS is Still Incurable— But There’s Real Hope (ALS Doctor Explains)

So my first one for you is, how did you come to specialize in rehabilitation medicine and specifically in caring for people with ALS?

That is a fantastic question because a lot of people don't know about rehabilitation medicine as a specialty.

Rehab medicine physicians are specialists in caring for individuals with life-changing disabilities like spinal cord injury, stroke, brain injury, and we also practice at the intersection of neurology and orthopedics.

So I found in medical school that I really loved those subjects, neurology and orthopedics, but I found myself really wanting to walk alongside families who had large life-changing diagnoses, so rehab medicine was a perfect fit for me.

Once I started my practice, I, I started to encounter individuals who were diagnosed with ALS, and I, I saw a, a gap in the kind of supportive holistic care that they needed after that diagnosis.

And so I, I quickly found that to be my area of passion and have never looked back.

It's a very meaningful career for, for me, and, uh, I think it's an underserved area in general.

So do you work with, like, other neurological conditions, or are you pretty full with ALS right now?

At, at the beginning of my career, I, I worked with a very broad ar- array of, uh, neurological conditions and, and over time I've, I've narrowed down to ALS being the primary diagnosis that I work with, but I, I do see a variety of other diagnoses in, in some of my clinics still.

So when most people hear rehabilitation, they think of recovering from an injury or surgery, at least from a PT perspective, but what does rehabilitation mean in the disease that only takes things away?

That, that's a fantastic question because a lot of people think that rehabilitation just means exercise and improvement, but really it's much more holistic, particularly in neurodegenerative diseases like ALS, Parkinson's, Huntington's disease.

There's a lot that we can do even when we can't reverse the, the progressive nature of the dise- disease.

Uh, we can do a lot to prevent secondary complications that are associated with muscle weakness or immobility, and we can provide compensatory strategies so individuals can enjoy the highest quality of life and functional independence despite having a, a disability.

So how would you define success in ALS rehabilitation?

Well, similarly to how we would define success in, in any type of rehabilitation endeavor, that we have really tailored our treatments to the goals and preferences of the people that we care for.

Sure.

That was a good answer.

Sorry, I put you on the spot with that one, didn't I? [laughs]

Oh, I love it.

[laughs] So to help people understand ALS better, what is happening inside the body when someone has it?

Yeah.

ALS is, uh, is a tricky disease in that we're still trying to fully understand what causes it.

We've been able to elucidate bits and pieces along the pathway.

We know that there are an increasing number of genes that are associated with ALS, and then we think that there are environmental triggers that happen during the course of someone's lifetime.

Uh, we know for certain that certain exposures like military service or the use of tobacco are associated with higher risk of ALS, and there are other things that we're not quite clear that could be, uh, triggers for someone to develop ALS.