In February 2003, Steve Nichols of Clifton, Va., had lived with ALS nearly nine years. Both limb and bulbar onset had not only stolen his strength, but severely affected Nichols’ speech and eating habits.
“I still tried to talk but anything more than one syllable was unintelligible to everyone, even to my wife’s trained ear,” Nichols says. “I was still eating for taste and pleasure, but the bulk of my diet was given through a feeding tube.”
Nichols says his swallowing was “slightly compromised” with a lot of “backwash,” and that without tongue movement to push food around he was unable to chew. He aspirated “moderately,” and “almost without fail on certain pleasure foods, like Reese’s Peanut Butter Cups,” which he was unwilling to give up.
He also was having an extremely difficult time coughing up lung secretions, and when he was able to get them up “the volume would be so great it would block my trachea.” He tried an in-exsufflator, steam, and a vibrating vest, in combination with drugs to lessen secretions, Robinul and scopolamine patches, but nothing seemed to help. Two bouts of pneumonia prompted him to search for other solutions.
Nichols consulted otolaryngologist (ear, nose and throat expert) Patty Lee at Otolaryngology Associates, P.C., in Fairfax, Va.
“Mr. Nichols’ problem was that he was aspirating,” Lee says. “He already had a feeding tube, so it wasn’t that he couldn’t get nutrition, it’s just that he was aspirating on his own saliva.”
Nichols opted to eliminate his risk for aspiration altogether with a laryngeal diversion, which Lee performed.
“I’m very satisfied with the procedure,” he says. “It was a good move for me.”