46 year old man who can't swallow because of severe amyotrophic
lateral sclerosis
History of the Present Illness:
The patient was well until 2 years ago when he noted
the progressive onset of weakness. He was diagnosed with ALS and has subsequently
developed progressive generalized weakness compatible with that diagnosis.
Six months ago he began to have very poor respiratory muscle function with
nocturnal hypoxia. Since then he has used assisted positive airway pressure
(BIPAP) at night. He lost his ability to phonate clearly about 3 months
ago. Two months ago he began choking on liquids and solids. For the past
several weeks he has been able to eat only thickened liquids. He has lost
18 pounds in the last 5 months.
