June 29, 2015 Patient: Hello Professor Li, I feel difficult to swallow and chew these days, what is the best advice from the professor? Li Xiaoguang, Department of Neurology, Peking Union Medical College Hospital Dr. Li Xiaoguang: See if you are straining, if not, the disease is developing. Patient: I guess it’s developed. I’m in a wheelchair every day. Do you need to check? Dr. Li Xiaoguang: If the disease has progressed, I wonder if you have considered a fistula? Suggest a ventilation function! Patient: Yes, thank you, Professor Li, for giving me a reply in your busy schedule. I swallow thin rice well. It’s the medicine and buns that I can’t swallow. Dr. Li Xiaoguang: Yes. Poor coordination of throat muscles. Patient’s family: Does the professor’s poor ventilation mean that gastrostomy cannot be done? Dr. Li Xiaoguang: Yes, see if it can be done October 18, 2015 Patient’s family: Hello Professor Li! I am a family member of xxx, he is having a hard time eating even liquid food, he is having trouble swallowing and chewing, he wants to have a gastrostomy, can I go to your hospital for it? Can I go to your hospital for a gastrostomy? Is the registration number yours? Dr. Li Xiaoguang: How is your ventilatory function? Patient’s family: We can’t have pulmonary function tests in our area, so we haven’t done it. Dr. Li Xiaoguang: Our hospital also depends on the results of ventilation to do a fistula. Patient’s family: He’s having trouble breathing and can’t lie down. The first thing you need to do is to get a good idea of what you want to do. I’m not sure if I can do it. Patient’s family: Oh, does he have to be on a ventilator? Dr. Li Xiaoguang: As soon as possible. Dr. Li Xiaoguang’s comment: This conversation reflects the lack of awareness of the progressive nature of ALS among patients and their families. The procrastination mentality in a sense delays the best opportunity to perform fistula surgery. Prepare early, in advance, unless you have decided not to have a gastrostomy.