Dying of cancer can be a horrible way to go, but as a cancer
specialist I sometimes forget that there are diseases that are
equally, if not more, horrible. One that always comes to mind is
amyotropic lateral sclerosis (ALS), more commonly known as Lou
Gehrig’s disease. It is a motor neuron disease whose clinical
course is characterized by progressive weakness, muscle atrophy
and spasticity, with ultimate progression to respiratory muscles
leading to difficulty breathing and speaking (dysarthria) and to
the muscles controlling swallowing. The rate of clinical course
is variable, often beginning with muscle twitching in an arm or
a leg or slurring of speech. Ultimately, however, ALS progresses
to the loss of ability to move, speak, eat, or breathe. The most
common cause of death is from respiratory failure, usually
within three to five years after diagnosis, although there is
the occasional outlier with a less malignant form of the disease
with a slower course of progression who can live a long time,
such as St