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The ALS Association, Greater Sacramento Chapter November 2012 ...

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Ask the Doc: Q & A with Edward Kasarskis, MD, PhD<br />

Edward Kasarskis, M.D., Ph.D. is Director of the multidisciplinary <strong>ALS</strong> Center at the University of Kentucky Neuroscience Center in Lexington,<br />

Kentucky, professor in the Department of Neurology at the University of Kentucky, and Chief of Neurology at the VA Medical Center in Lexington<br />

KY.<br />

Q: What is the best way to support your loved one at an <strong>ALS</strong> <strong>Association</strong> Clinic appointment<br />

A: This is an important question because the role of the caregiver, usually a spouse, is perhaps<br />

the single most important factor in effectively dealing with <strong>ALS</strong>.<br />

Dr. Kasarskis<br />

In our clinic, we frequently comment among ourselves that we do not really understand how a caregiver physically<br />

can do this day in and day out. While most physicians and other health professionals have never actually experienced<br />

giving daily direct care to an <strong>ALS</strong> patient ourselves, here are a few thoughts "from the outside looking in."<br />

Caregiving can be overwhelming and exhausting, meeting the physical and emotional needs of someone you love<br />

while also managing the details and stresses of running a household, and possibly fulfilling the role of a parent of a<br />

school age child in addition. So, how do they do this<br />

Preparation. Before you come to the clinic, be prepared. Bring a list of all the medications your spouse, partner, parent,<br />

or family member is taking, with the specific doses and other details. Better yet, bring all your medicines in a<br />

zip-lock bag. Also be sure to write down a list of all your questions large and small so you’ll really remember to ask<br />

them. It’s just like keeping a running grocery list at home so you don't forget anything important when you go to the<br />

store. Having the list really helps.<br />

Communication. In addition to the questions you bring with you, be sure to ask about anything you don’t understand<br />

as you talk with the <strong>ALS</strong> neurologist, respiratory therapist, physical therapist, nutritionist, occupational therapist,<br />

and nurse. If you don’t understand something or if you are unsure how to execute something they’re suggesting,<br />

get more information or even ask for a demonstration. This may be particularly true in the case of PT and OT<br />

recommendations.<br />

Take a notepad and take notes so you can review them later when you have more time. Bring your iPad to watch a<br />

video demonstration about transfer techniques. Some suggestions will sound easy enough at the clinic but when you<br />

get home, you may find you have more questions. Much of the journey with <strong>ALS</strong> is on-the-job training. You keep<br />

learning new things as the situation changes. Sometimes when you’re in the clinic you’ll find you’ll be working with<br />

the <strong>ALS</strong> team to solve a problem that is specific to you. <strong>The</strong> most successful caregivers and patients work together<br />

with the <strong>ALS</strong> team to actively problem solve, communicating what they think is the best approach given their circumstances,<br />

and what they do and do not understand.<br />

Confidence in going forward. <strong>The</strong> Clinic Team will outline a general roadmap for the future, indicating the next likely<br />

challenge and alerting you to the potential solutions. For example, this might be something like, "On the next visit<br />

we will be discussing and probably recommending a gastrostomy tube for nutritional support." Sometimes that may<br />

be psychologically difficult to hear. Who wants to face a problem before they have to But knowing you’re ready for<br />

what may happen next perhaps having a walker ready, or understanding what communication devices will be available<br />

to you should you need them helps reduce the innate resistance to change and problems, and ensure you will<br />

have what you need when you need it.<br />

Confidence in going forward also comes from taking care of yourself physically and emotionally. I know, that’s easier<br />

said than done when you’ve got so much on your shoulders. Remember that your health and wellbeing are critical to<br />

the health and wellbeing of your loved one. If you get run-down, you risk personal injury and illness while you are<br />

helping your family member with <strong>ALS</strong>.<br />

So if you can, get help from someone to assist you in running your day-to-day activities and managing the chores,<br />

errands, and hassles of everyday life. Try to minimize fatigue by building in breaks and doing things just for yourself:<br />

taking a walk or seeing friends at the corner coffee shop. Having some personal time is priceless and important.<br />

Make sure you can regularly have a little respite from your virtual non-stop responsibilities.<br />

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