How do you counsel patients with ALS on the benefits of enteral nutrition?

I agree with Drs. @Dr. First Last and @Dr. First Last but what I find frequently is that patients are reluctant to have PEG because of a number of psychological factors; fear of the surgery, fear of having a tube, fear of disease progression, fear that it will keep them alive indefinitely as in the old vegetative state cases (i.e., Karen Ann Quinlan case). I find it most helpful to say that PEG is not being recommended to prolong life (although good nutrition will have benefits) but to improve q...

We start by encouraging patients to supplement their diet with whatever they want to eat, focusing on calories. If eating is taking too long and they are choking, or they are losing weight (>10 lbs in 6 months) we introduce the concept of a gastric feeding tube. We emphasize the benefits; can still eat, does not show, easier to take medications (crush or liquid form), describe the placement procedure (we recommend PEG, occasionally REG, and rarely by surgery). We have had success with our gastro...

Gastrostomy is important for ALS patients with significant bulbar dysfunction. Yet, it is typically a difficult discussion as it has a profound impact on their lifestyle. I typically take time to introduce the possibility of gastrostomy gradually to provide enough time for patients to think about it and discuss it with family members. I try to provide a detailed picture of the tubes, procedures, post-procedure care, formulas, and potential complications and try to convince patients based on pote...