Ask the Doctor: Lou Gehrig’s Disease; Low-Dose Aspirin
Q: My cousin has just been diagnosed with Lou Gehrig’s disease—can you provide some information about this condition?
A: Amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig’s disease (after the famous baseball player who was diagnosed with ALS in 1939), is a neurological disease that attacks nerve cells and weakens muscles, causing loss of physical function that affects the patient’s ability to walk, talk, eat, and breathe. Average life expectancy for ALS patients is within two to five years from the time of their diagnosis, though some patients live more than 10 years with the disease. ALS patients are usually between the ages of 55 and 75 when they are diagnosed, and it’s estimated that more than 15,000 Americans have ALS.
Early symptoms of ALS include muscle cramps, muscle twitches, tight muscles, muscle weakness, slurred and nasal speech, and difficulty chewing or swallowing. In ALS, motor neurons in the brain and spinal cord break down and die, which prevents the transmission of messages from the brain to the muscles. Muscles grow progressively weaker, and the patient eventually loses control of their muscle movements. To date, there is no cure for the disease, although two FDA-approved medications, riluzole (Rilutek) and edaravone (Radicava), can slow its progression.
In about five to 10 percent of ALS cases, another family member also has ALS. This type of ALS is called “familial ALS,” and inherited genetic factors are the cause. However, the majority of ALS cases are not hereditary, and the cause is unknown.
In recent years, the National ALS Registry was established to collect data on ALS and provide funding for research to gain a better understanding of the disease. The registry also has a biorepository that conducts research on samples of biological material, such as blood, hair, and DNA, that has been collected from ALS patients. The registry, which can be accessed online at https://wwwn.cdc.gov/als/, also offers resources for patients, including information about ALS support groups and new clinical trials.
Q: My doctor recommended that I take a low-dose aspirin every day to prevent a heart attack or stroke. How does aspirin work, and what other medications have similar actions?
A: Daily aspirin therapy is often recommended for adults who are at risk for a heart attack or stroke, as well as for patients who have already had either of these cardiovascular events. In blood vessels that are narrowed by atherosclerosis (which occurs when plaque accumulates and builds up on the interior walls of the blood vessels), clots can block blood flow to the heart and/or brain, resulting in a heart attack or stroke. Aspirin helps prevent platelets in the bloodstream from clumping together and forming a clot, so it is called an antiplatelet drug; other antiplatelet drugs include clopidogrel (Plavix) and ticagrelor (Brilinta). Other drugs that help prevent blood clots are called anticoagulants, because they deactivate or inhibit production of clotting factors; warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto), and dabigatran (Pradaxa) are examples of anticoagulants.
Many patients wonder why they are advised to take low-dose “baby” aspirin (75 to 81 milligrams) rather than full-strength aspirin (325 milligrams). This is because aspirin can cause internal bleeding, and bleeding risk is lower with low-dose aspirin. Research has shown that low-dose aspirin is just as effective at preventing cardiovascular events as full-strength aspirin, and it won’t raise your bleeding risk as much. If you take any of these medications, be alert for signs of internal bleeding, such as blood in your stool, black, tarry stools, coughing up or vomiting blood, and weakness or lightheadedness, and report these symptoms to your doctor immediately if they occur.
—Editor-in-Chief Orli R. Etigin, MD
The post Ask the Doctor: Lou Gehrig’s Disease; Low-Dose Aspirin appeared first on University Health News.
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