MEDICAL MANAGEMENT OF ALS CHAT
mswalker (May 19, 2008 11:43:34 AM)
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dr-jackson (May 19, 2008 11:44:31 AM)
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ChatMaster (May 19, 2008 11:44:42 AM)
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ChatMaster (May 19, 2008 11:44:59 AM)
Good morning everyone!
ChatMaster (May 19, 2008 11:45:09 AM)
Welcome to the Medical Management of ALS Chat
ChatMaster (May 19, 2008 11:45:20 AM)
The chat will begin in 13 minutes
irene (May 19, 2008 11:45:29 AM)
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dr-miller (May 19, 2008 11:45:32 AM)
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scott (May 19, 2008 11:45:43 AM)
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glenda-r (May 19, 2008 11:46:08 AM)
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ChatMaster (May 19, 2008 11:47:04 AM)
Welcome everyone to the Medical Management in ALS Chat
ChatMaster (May 19, 2008 11:47:21 AM)
The chat will begin in 11 minutes, thank you for your patience
dr-cwik (May 19, 2008 11:48:19 AM)
(This user has entered Medical Management of ALS)
ChatMaster (May 19, 2008 11:49:08 AM)
Welcome Dr. Cwik, Dr. Miller and Dr. Jackson! The Medical Management of ALS chat will begin in 10 minutes
dr-jackson (May 19, 2008 11:49:10 AM)
loud and clear!
ehoxworth (May 19, 2008 11:51:01 AM)
(This user has entered Medical Management of ALS)
dr-miller (May 19, 2008 11:51:17 AM)
as a new guy to this, I am sending a test message--can you see it?
ehoxworth (May 19, 2008 11:51:34 AM)
yes, i can see it
ChatMaster (May 19, 2008 11:51:43 AM)
yes, thanks!
mary-lou (May 19, 2008 11:54:06 AM)
(This user has entered Medical Management of ALS)
ChatMaster (May 19, 2008 11:54:20 AM)
Hello everyone! Welcome to the Medical Management in ALS Chat with Dr. Robert Miller, Dr. Carlayne Jackson and Dr. Valerie Cwik.
ChatMaster (May 19, 2008 11:54:37 AM)
The Medical Management in ALS chat will begin in 4 minutes.
ChatMaster (May 19, 2008 11:54:58 AM)
We want to be sure to get everyone logged in by 9 am
ChatMaster (May 19, 2008 11:55:05 AM)
noon, ET
mswalker (May 19, 2008 11:55:43 AM)
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mswalker (May 19, 2008 11:57:39 AM)
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ChatMaster (May 19, 2008 11:57:53 AM)
Hello everyone! Welcome to the Medical Management in ALS Chat with Dr. Robert Miller, Dr. Carlayne Jackson and Dr. Valerie Cwik.
ChatMaster (May 19, 2008 11:58:05 AM)
We are going to hold this chat on a 'first asked, first answered' basis. Please type the following "ChatMaster, I have a question" and I will add you to the list of chat names and call on people to ask their questions one at time.
ChatMaster (May 19, 2008 11:58:48 AM)
Today's Guest experts include clinic directors and neurologists Robert Miller of the Forbes Norris MDA/ALS Research Center in San Francisco and Carlayne Jackson of the MDA/ALS Center at University of Texas Health Science Center in San Antonio.
ChatMaster (May 19, 2008 11:59:21 AM)
In addition we have Dr. Valerie Cwik, MDA Vice President – Research and Medical director at MDA National Headquarters in Tucson, AZ
ChatMaster (May 19, 2008 11:59:52 AM)
Again welcome to all and we would like to get started.
ChatMaster (May 19, 2008 12:00:05 PM)
Please type the following "ChatMaster, I have a question" and I will add you to the list of chat names and call on people to ask their questions one at time.
ChatMaster (May 19, 2008 12:00:42 PM)
Does anyone want to start off with the first question?
dr-miller (May 19, 2008 12:00:53 PM)
Welcome everyone--Dr Jackson, Dr Cwik and I look forward to this chat!
glenda-r (May 19, 2008 12:01:11 PM)
chatmaster, i have a question
ChatMaster (May 19, 2008 12:01:13 PM)
We are so happy you could all be here today
ChatMaster (May 19, 2008 12:01:28 PM)
Glenda-r, go ahead with your first question, you are first on the list!!
glenda-r (May 19, 2008 12:01:44 PM)
we are in los angeles at UCLA, when will the lithium trials begin
mary-lou (May 19, 2008 12:02:35 PM)
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dr-miller (May 19, 2008 12:02:43 PM)
The lithium trial sponsored by MDA will begin very shortly. The ALS center at UCLA will be participating and you should contact them to indicate your interest asap.
daveg0929 (May 19, 2008 12:02:45 PM)
(This user has entered Medical Management of ALS)
mswalker (May 19, 2008 12:02:54 PM)
Chatmaster, I have a question
ChatMaster (May 19, 2008 12:03:00 PM)
Welcome daveg0929
ChatMaster (May 19, 2008 12:03:11 PM)
mswalker you are now on the list at #2
ChatMaster (May 19, 2008 12:04:04 PM)
glenda-r, does that answer your question? Any follow-up question?
DannyD (May 19, 2008 12:04:23 PM)
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ChatMaster (May 19, 2008 12:04:24 PM)
We are going to hold this chat on a 'first asked, first answered' basis. Please type the following "ChatMaster, I have a question" and I will add you to the list of chat names and call on people to ask their questions one at time.
dr-miller (May 19, 2008 12:04:31 PM)
While we are waiting, I will mention that we have screened our first 3 patients at the Norris center in San Francisco and other sites will begin shortly.
ChatMaster (May 19, 2008 12:04:34 PM)
Welcome DannyD
glenda-r (May 19, 2008 12:04:38 PM)
High-Dose Influenza Virus Vaccine Provides Improved Immune Responses in the Elderly Compared With Conventional Dose: Presented at AGS By Crina Frincu-Mallos, PhD WASHINGTON, DC -- May 8, 2008 -- A high dose of an influenza virus vaccine has been shown to have superior immunogenicity than the standard dose of the vaccine, researchers reported here at the 2008 American Geriatrics Society (AGS) Annual Scientific Meeting. Vaccination elicits a lower antibody response in the elderly population compared with younger adults. Therefore, improvement of the immune response to influenza vaccination in the elderly, who are at higher risk for influenza-related morbidity and mortality, represents an important goal. To address this issue, a high-dose trivalent inactivated split-virion influenza vaccine was developed and tested in this patient population, according to the researchers. Lead author Ann R. Falsey, MD, Associate Professor of Medicine, University of Rochester School of Medicine and Dentistry, Rochest
glenda-r (May 19, 2008 12:04:49 PM)
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irene (May 19, 2008 12:05:09 PM)
Chatmaster, I have a question
ChatMaster (May 19, 2008 12:05:14 PM)
mswalker please go ahead with your question
mswalker (May 19, 2008 12:05:18 PM)
I live in Colorado and very much want to participate in this study. Is it a problem that I am not in L.A.?
ChatMaster (May 19, 2008 12:05:26 PM)
irene I will put you in the next spot
dr-miller (May 19, 2008 12:06:14 PM)
Colorado University will not participate in our MDA sponsored trial, but possibly in another trial. There is a site in our trial in Salt Lake City, Utah
scott (May 19, 2008 12:06:59 PM)
Dr. Miller, to help clarify the MDA sponsored trial that you are spearheading, how many sites will participate in your study?
mswalker (May 19, 2008 12:07:23 PM)
So unless I go to Salt Lake, there is no way that I can participate in this study?
dr-miller (May 19, 2008 12:07:34 PM)
10 sites--We will post a list of our ten sites, located across the US on the MDA website in the next few days.
daveg0929 (May 19, 2008 12:08:00 PM)
CHATMASTER, I HAVE SURVIVED FOR SIX YEARS. WILL I STILL QUALIFY?
dr-miller (May 19, 2008 12:08:12 PM)
Participants must visit one of our ten sites for screening and monitoring during the study
mswalker (May 19, 2008 12:08:23 PM)
Ok thank you
dr-miller (May 19, 2008 12:08:41 PM)
sorry, but participants must have had symptoms for less than 3 years
ChatMaster (May 19, 2008 12:08:53 PM)
daveg0929, I will put you on the list to ask a question right after Irene
ChatMaster (May 19, 2008 12:09:22 PM)
Irene please go ahead with your question
jimb (May 19, 2008 12:09:56 PM)
(This user has entered Medical Management of ALS)
ChatMaster (May 19, 2008 12:10:14 PM)
Welcome jimb
ChatMaster (May 19, 2008 12:10:26 PM)
We are going to hold this chat on a 'first asked, first answered' basis. Please type the following "ChatMaster, I have a question" and I will add you to the list of chat names and call on people to ask their questions one at time.
irene (May 19, 2008 12:10:44 PM)
Hi I have just read about another combination of drugs, used a combination of two drugs, "noscapine" which is a very old cough medicine, and "pioglitazone" which is a commonly used anti-diabetes drug (commercially known as "Actos"), can u tell me about this
janet (May 19, 2008 12:13:35 PM)
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dr-jackson (May 19, 2008 12:14:03 PM)
Sorry - I am not familiar with any data on this combination. Prior studies with a cough medicine - dextromethorphan - failed to show efficacy. It is now being studied, however, as a treatment for emotional lability.
mswalker (May 19, 2008 12:14:14 PM)
Chatmaster, I have a question
ChatMaster (May 19, 2008 12:14:15 PM)
Welcome janet
dr-miller (May 19, 2008 12:14:20 PM)
Irene--this is a combination that I am also not familiar with. I will look into it.
irene (May 19, 2008 12:14:31 PM)
Thank you
ChatMaster (May 19, 2008 12:14:31 PM)
mswalker I will put you on the list for upcoming questions
ChatMaster (May 19, 2008 12:15:01 PM)
daveg0929 do you have a follow-up question for the doctors?
Den510 (May 19, 2008 12:15:27 PM)
(This user has entered Medical Management of ALS)
ChatMaster (May 19, 2008 12:15:37 PM)
Welcome Den510!
daveg0929 (May 19, 2008 12:15:42 PM)
NOT YET
Gin (May 19, 2008 12:15:44 PM)
(This user has entered Medical Management of ALS)
ChatMaster (May 19, 2008 12:16:15 PM)
ok, mswalker please go ahead with your question
mswalker (May 19, 2008 12:16:17 PM)
What is your feeling about the drug R Pramipexole? Do you think it shows more or less promise than Lithium?
ChatMaster (May 19, 2008 12:16:19 PM)
Welcome Gin!
ChatMaster (May 19, 2008 12:16:20 PM)
We are going to hold this chat on a 'first asked, first answered' basis. Please type the following "ChatMaster, I have a question" and I will add you to the list of chat names and call on people to ask their questions one at time.
dr-miller (May 19, 2008 12:17:13 PM)
A recent trial of pramipexole was small but showed encouraging results (more modest than Lithium). A trial is planned to carry this forward with pramipexole.
mswalker (May 19, 2008 12:17:38 PM)
Any idea when this study will occur?
dr-miller (May 19, 2008 12:18:08 PM)
The study is beginning to enroll now at some sites.
mswalker (May 19, 2008 12:18:36 PM)
Thank you
dr-jackson (May 19, 2008 12:18:42 PM)
The R Pramipexole drug shows promising results in animal studies and the study is being initiated at approximately 20 sites across the country. Unfortunately, we will not be able to predict which medication may be more effective until the early clinical trials are complete.
ChatMaster (May 19, 2008 12:19:11 PM)
We are going to hold this chat on a 'first asked, first answered' basis. Please type the following "ChatMaster, I have a question" and I will add you to the list of chat names and call on people to ask their questions one at time.
ChatMaster (May 19, 2008 12:19:36 PM)
Please let me know who wants to ask the next question
daveg0929 (May 19, 2008 12:19:54 PM)
CHATMASTER, WHY THE CUT OFF AT THREE YEARS? ISN'T THERE SOME VALUE IN TESTING LONER SURVIVORS?
daveg0929 (May 19, 2008 12:20:44 PM)
LONGER NOT LONER
mswalker (May 19, 2008 12:21:06 PM)
Chatmaster, I have another question
dr-miller (May 19, 2008 12:21:10 PM)
The main reason for the cutoff at 3 years is to test earlier patients because there is more likely to be a treatment effect in early disease.
ChatMaster (May 19, 2008 12:21:48 PM)
thank you mswalker, you will be up next
mswalker (May 19, 2008 12:22:25 PM)
From the Lithium study that was conducted in Italy just recently, how many of the participants were bulbar? Did it show significant results in these patients?
dr-jackson (May 19, 2008 12:23:09 PM)
Another reason for the 3 year cutoff, is because most clinical trials are only 6-12 months in duration and we may not see sufficient change in strength or function in patients who are progressing more slowly to determine if a drug might be effective.
daveg0929 (May 19, 2008 12:23:44 PM)
THANK YOU
ChatMaster (May 19, 2008 12:24:01 PM)
thanks daveg, mswalker please restate your question
dr-miller (May 19, 2008 12:24:03 PM)
good question, but the number of patients was so small (only 16 were treated) that it isn't possible to analyze the subgroup of patients with bulbar symptoms. About 20% of patients have bulbar onset in most trials.
DannyD (May 19, 2008 12:24:20 PM)
Chatmaster I have a question
mswalker (May 19, 2008 12:24:38 PM)
Ok thank you
ChatMaster (May 19, 2008 12:24:40 PM)
DannyD I will put you on the list
ChatMaster (May 19, 2008 12:25:06 PM)
DannyD, go ahead with your question
Kari (May 19, 2008 12:25:50 PM)
(This user has entered Medical Management of ALS)
DannyD (May 19, 2008 12:25:56 PM)
As studies have shown that preserving the function of microglial cells protects motor neurons, do you foresee any treatments geared towards those targets
ChatMaster (May 19, 2008 12:26:00 PM)
Welcome Kari!!
Kari (May 19, 2008 12:26:07 PM)
Hello. Thanks
ChatMaster (May 19, 2008 12:26:14 PM)
We are going to hold this chat on a 'first asked, first answered' basis. Please type the following "ChatMaster, I have a question" and I will add you to the list of chat names and call on people to ask their questions one at time.
dr-jackson (May 19, 2008 12:27:03 PM)
DannyD - Certainly as we learn more about what causes ALS, we will better able to develop therapies which target specific disease mechanisms.
dr-miller (May 19, 2008 12:27:44 PM)
Also, we know of at least two trials in the planning stage that will address this important mechanism of microglial function.
mswalker (May 19, 2008 12:27:59 PM)
Chatmaster, I have a question
ChatMaster (May 19, 2008 12:28:27 PM)
mswalker you will be next after DannyD's question is answered
dr-miller (May 19, 2008 12:29:18 PM)
Chatmaster--I think Dr Jackson and I both answered it
ChatMaster (May 19, 2008 12:29:22 PM)
ok, mswalker please go ahead with your question
mswalker (May 19, 2008 12:30:17 PM)
Will the participants in the Lithium study be required to take Rilutek during the study?
dr-miller (May 19, 2008 12:31:15 PM)
participants will be able to take riluzole--but it is not required. We anticipate that about half of the patients will be taking riluzole (Rilutek).
ChatMaster (May 19, 2008 12:31:57 PM)
Does anyone have any questions about non-lithium topics at all?
DannyD (May 19, 2008 12:32:11 PM)
chatmaster I have question
ChatMaster (May 19, 2008 12:32:47 PM)
Ok, DannyD please go ahead with your next question
DannyD (May 19, 2008 12:33:22 PM)
Are either of your centers involved in the diaphragm pacer study and if so have the early results been as promising as we hope
dr-jackson (May 19, 2008 12:34:10 PM)
We are not involved in the diaphragm pacer study at UTHSCSA.
DannyD (May 19, 2008 12:34:36 PM)
I'm currently about 2 months into it and it appears to be helping
dr-miller (May 19, 2008 12:34:37 PM)
DannyD--our center is involved in this study. It is too early to say how promising the results are, although there are encouraging signs suggesting that we are slowing the rate of progression of diaphragm weakness.
Gin (May 19, 2008 12:35:23 PM)
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dr-miller (May 19, 2008 12:35:29 PM)
DannyD--in what way does it seem to be helping you?
DannyD (May 19, 2008 12:35:47 PM)
I'm able to sleep flat and my MIP & MEP appear to be higher lying flat than sitting up
Kari (May 19, 2008 12:36:20 PM)
Chatmaster, I have a question
dr-miller (May 19, 2008 12:36:21 PM)
DannyD--that is encouraging news. Congrats
ChatMaster (May 19, 2008 12:36:58 PM)
Kari, please go ahead with your question
Kari (May 19, 2008 12:37:47 PM)
Diaphram pacer study? I am not aware of this, can you explain?
dr-miller (May 19, 2008 12:39:35 PM)
Kari--the diaphragm pacing study involves surgically implanting a pacemaker into the diaphragm to recondition the diaphragm and help with breathing function. It is experimental to do this in ALS and we are excited that this may be helpful, but more data is needed before we will know just how helpful it is in ALS.
scott (May 19, 2008 12:40:11 PM)
Dr. Jackson, what are your thoughts on diaphragm pacing?
DannyD (May 19, 2008 12:41:43 PM)
chatmaster I have a question
ChatMaster (May 19, 2008 12:42:28 PM)
ok Danny, you will be up next
daveg0929 (May 19, 2008 12:42:40 PM)
CHATMASTER I HAVE A QUESTION
ChatMaster (May 19, 2008 12:42:56 PM)
Ok, Daveg you will be after DannyD
daveg0929 (May 19, 2008 12:43:29 PM)
ANY RESULTS IN THE CO Q10 STUDIES?
dr-jackson (May 19, 2008 12:43:34 PM)
Scott - I am hopeful that it will help slow the decline in respiratory muscle function, but agree that it is too early to tell. We already can provide excellent respiratory muscle support with the use of non-invasive ventilators (Bipap) which have been proven in clinical trials to both prolong survival as well as improve quality of life.
ChatMaster (May 19, 2008 12:43:57 PM)
daveg we will get to your question after finishing with Scott and DannyD's questions
ChatMaster (May 19, 2008 12:45:14 PM)
DannyD please go ahead with ur next question
DannyD (May 19, 2008 12:45:17 PM)
Based on the small study out of Canada, that showed no detrimental effects to moderate exercise do either of you recommend exercise for your patients beyond range of motion?
dr-jackson (May 19, 2008 12:45:47 PM)
Daveg - Unfortunately, a study using up to 2700mg of Co-Q10 per day failed to show any effect in slowing the rate of decline of the ALS functional rating scale (ALSFRS). This scale rates performance on a large range of daily activities, including breathing and swallowing. As a result of this study, no further trials of Co-Q10 are planned.
Kari (May 19, 2008 12:46:26 PM)
But the BiPap does not actually "improve" muscle function, or does it? I know the benefits of the Bipap from a respiratory standpoint but I was not aware of any "muscle" improvement involved.
Kari (May 19, 2008 12:46:36 PM)
chatmast, sorry, I am out of turn!
esther (May 19, 2008 12:46:40 PM)
(This user has entered Medical Management of ALS)
dr-miller (May 19, 2008 12:46:45 PM)
DannyD--We are very bullish on MODERATE (not intense) exercise for our patients, especially early in the course of disease. When activities of daily living become tough, then exercise may not be so helpful.
ChatMaster (May 19, 2008 12:46:59 PM)
Kari you will be next after finishin Danny and Daveg's question
Kari (May 19, 2008 12:47:05 PM)
sorry!
dr-jackson (May 19, 2008 12:47:34 PM)
DannyD - there was a recent study from Columbia University confirming that moderate resistance exercise can be helpful. We usually recommend some form of low impact aerobic activity as well - swimming is great!
ChatMaster (May 19, 2008 12:48:03 PM)
Danny and Daveg0929, have your questions been answered adequately?
daveg0929 (May 19, 2008 12:48:33 PM)
YES THANK YOU.
DannyD (May 19, 2008 12:48:56 PM)
Also as BiPAP shows to to be a therapy that is highly beneficial wouldn't it behoove the the acaemy of neurologists to petition Medicare to raise the threshold for coverage?
nsoures (May 19, 2008 12:48:56 PM)
(This user has entered Medical Management of ALS)
esther (May 19, 2008 12:49:04 PM)
I am going to SE Asia tomorrow and will be taking Malarone as a malaria preventive. I have bulbar als - speech and tongue/lip weakness, and my dr. has told me to stop the rilutek while Ii am taking the Malarone, due to liver toxicity. What is your oppinion? Will I regress during my 2 weeks off the drug?
dr-jackson (May 19, 2008 12:49:16 PM)
Kari - Studies with Bipap showed that it slowed the rate of decline of the forced vital capacity - a common way to measure respiratory muscle strength. Bipap also prevents the lung tissue from collapsing at the base of the lungs which also might "improve" lung function.
ChatMaster (May 19, 2008 12:50:04 PM)
esther we are finishing up another question,
dr-miller (May 19, 2008 12:50:47 PM)
Kari--BiPAP slows the progress of ALS, improves quality of life, and prolongs survival. So far, neither Diaphragm pacing nor BiPAP have been shown to "improve" muscle function.
Kari (May 19, 2008 12:50:50 PM)
My mother uses it combined with oxygen only at night and yes, we have seen a great improvement in her quuality of life since she started on the Bipap.
esther (May 19, 2008 12:51:18 PM)
Also,I just logged on - did you talk about the lithium trials? Where can I read the Italian study?
ChatMaster (May 19, 2008 12:51:21 PM)
Dr. please continue with DannyD's follow-up question if possible
Kari (May 19, 2008 12:51:22 PM)
Thanks.
dr-jackson (May 19, 2008 12:51:29 PM)
DannyD - We have just completed a study comparing the use of Bipap when started with a forced vital capacity of 80% (early initiation) vs. 50% or less (current practice). Once we have the data analyzed, we will hopefully be in a position to advocate for earlier coverage. Remember, that Medicare will cover Bipap if your maximal inspiratory pressure is less than 60. This usually occurs well before the vital capacity drops below 50%.
ChatMaster (May 19, 2008 12:51:34 PM)
Esther you will have the next question
ChatMaster (May 19, 2008 12:51:42 PM)
We are going to hold this chat on a 'first asked, first answered' basis. Please type the following "ChatMaster, I have a question" and I will add you to the list of chat names and call on people to ask their questions one at time.
DannyD (May 19, 2008 12:52:04 PM)
thanks
ChatMaster (May 19, 2008 12:52:19 PM)
Esther please restate your questions for us, thank you
dr-jackson (May 19, 2008 12:53:18 PM)
Esther - you should not experience any ill effects from discontinuing the Rilutek for 2 weeks.
ChatMaster (May 19, 2008 12:53:31 PM)
thank you dr-jackson
dr-miller (May 19, 2008 12:53:58 PM)
Esther--The lithium study was published in the Proceedings of the National Academy of Sciences in January 2008. You should be able to Google and find the results. The first author was Prof Fornai. There is info on MDA website also.
ChatMaster (May 19, 2008 12:54:39 PM)
thank you dr-miller for that response
ChatMaster (May 19, 2008 12:55:03 PM)
The Medical Management in ALS chat will end in 4 minutes
esther (May 19, 2008 12:55:06 PM)
What is your opinion of the value of lilthium, and what are the downsides?
BobbyRay (May 19, 2008 12:55:45 PM)
(This user has entered Medical Management of ALS)
ChatMaster (May 19, 2008 12:56:39 PM)
Esther we did speak of lithium earlier in the chat and the transcript of this conversation will b posted at www.mda.org/chat/transcripts.html in the next week.
ChatMaster (May 19, 2008 12:56:55 PM)
Welcome BobbyRay, we are in the last few minutes of the chat
jimb (May 19, 2008 12:57:01 PM)
I have a question: Are Medicare and insurers paying for diaphragm pacing? If not, is there some other source of funding? I gather one of the concerns is that, if insurers will not pay for the procedure, they also will not pay for any (later) problems arguably associated with the procedure. Thoughts?
ChatMaster (May 19, 2008 12:57:08 PM)
do you have a question for the Doctors?
dr-miller (May 19, 2008 12:57:13 PM)
The Italian study was the most promising result of any ALS trial ever published. Unfortunately it had some significant flaws (very small study, etc) so we feel that it is urgent for us to repeat and confirm (or NOT) those results. We have funding from MDA to do just that and our study is starting as we speak. There are significant side effects from lithium, and it interacts with many other drugs, so careful monitoring of blood levels and safety by experts is needed.
mswalker (May 19, 2008 12:58:13 PM)
Chatmaster I have a question
ChatMaster (May 19, 2008 12:58:40 PM)
mswalker will be our last question after jimb's question has been answered
dr-miller (May 19, 2008 12:58:47 PM)
Jimb--some insurers are paying for the pacing, and some are not. Other sources of funding are currently being searched for.
jimb (May 19, 2008 12:59:10 PM)
Thanks.
ChatMaster (May 19, 2008 12:59:31 PM)
go ahead mswalker with your question
mswalker (May 19, 2008 12:59:46 PM)
Does Lithium have any harmful interations with dextromethorithan and quinidine? (used to counter the extreme emtional side effects of the disease).
dr-miller (May 19, 2008 1:02:08 PM)
mswalker-- the list of drugs that interact with lithium is very long, but we know of no specific interaction with dextromethorphan or quinidine . We consider every drug to be a potential interacter with lithium until proven otherwise.
ChatMaster (May 19, 2008 1:02:18 PM)
The Medical Management of ALS chat is now coming to an end.
daveg0929 (May 19, 2008 1:02:22 PM)
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ChatMaster (May 19, 2008 1:02:27 PM)
Transcripts of this chat will be posted at www.mda.org/chat/transcripts.html in the next week
ChatMaster (May 19, 2008 1:02:35 PM)
Thank you Dr. Robert Miller, Dr. Carlayne Jackson and Dr. Valerie Cwik for your participation in this experts chat. We look forward to having you again at an Experts chat.
DannyD (May 19, 2008 1:02:38 PM)
Thanks for your time
ChatMaster (May 19, 2008 1:02:48 PM)
MDA has 4 Living with ALS chat groups that meet weekly. Please see our chat calendar at www.mda.org/chat/calendar.html for a listing of MDA Chat groups.
Den510 (May 19, 2008 1:02:59 PM)
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ChatMaster (May 19, 2008 1:02:59 PM)
Thank you all for your participation!
dr-jackson (May 19, 2008 1:03:08 PM)
You are welcome!
esther (May 19, 2008 1:03:14 PM)
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dr-miller (May 19, 2008 1:03:16 PM)
Thanks for the great questions!!
ChatMaster (May 19, 2008 1:03:28 PM)
Chatters can click on the Rooms tab and double-click on MDA Foyer if you want to keep chatting.
mswalker (May 19, 2008 1:03:30 PM)
Thank you!
scott (May 19, 2008 1:03:47 PM)
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jimb (May 19, 2008 1:03:49 PM)
Thank you.
ehoxworth (May 19, 2008 1:03:51 PM)
Thanks so much for all the hard work you doctors put into this!
ChatMaster (May 19, 2008 1:03:53 PM)
Again thank you all!
BobbyRay (May 19, 2008 1:04:01 PM)
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irene (May 19, 2008 1:04:02 PM)
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janet (May 19, 2008 1:04:11 PM)
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ChatMaster (May 19, 2008 1:04:22 PM)
MDA will be having another ALS expert chat on May 28 http://www.mda.org/news/080507als_month_chats.html
dr-miller (May 19, 2008 1:04:26 PM)
thanks for inviting me to do this--a real pleasure
dr-miller (May 19, 2008 1:04:29 PM)
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jimb (May 19, 2008 1:04:33 PM)
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ChatMaster (May 19, 2008 1:04:35 PM)
I am going to close the Medical Management of ALS chat now. Goodbye!
dr-jackson (May 19, 2008 1:04:43 PM)
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DannyD (May 19, 2008 1:05:05 PM)
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