Ralph, 52, has been married to his husband, Steve, for 8 years. They are both employed as computer software engineers. Since their degrees are in engineering, they have a limited background in health care issues or terminology. Ralph had been hospitalized once for a hernia operation at age 28. He never smoked, consumes alcohol in moderation, is not overweight, and takes one pill each day for his hypertension. Lately. Ralph has noticed that he is tripping when he walks more than usual, and he feels weakness in his legs in the morning. He has been ignoring these symptoms because he does not wish to trouble Steve with such minor symptoms. However, last week at the gym, Ralph was walking on the treadmill and had to grab the sidebars to avoid falling. Steve was on the treadmill next to Ralph and noticed the near-fall incidents. On the drive home, Steve insisted that Ralph schedule an appointment with his primary care physician. Ralph was anxious about making an appointment and afraid of a possible serious diagnosis.

 

At the appointment, Ralph explained his symptoms. Dr. Sharon Murray, the primary care physician, conducted simple tests of strength and reflexes. She concluded that Ralph did have muscle weakness but was not certain of the cause or diagnosis. Dr. Murray referred Ralph to Dr. James Peters. neurologist, and had her CHW make the appointment for Ralph for the following week. Of course, Ralph was afraid that the diagnosis might be serious. He insisted that Steve accompany him to the appointment. 

 

During the first appointment, Dr. Peters was concerned but offered no conclusive diagnosis and ordered additional testing (e.g., MRI scans, nerve conduction tests, and muscle tissue biopsies) over the next few weeks. Ralph complied with the additional testing in hopes of obtaining a correct diagnosis; however, the tests were exhausting and often painful. After Dr. Peters reviewed the test results, an appointment was schedule with Ralph and Steve to discuss the diagnosis. The day before the appointment, Ralph fell at work. He did not sustain any fractures, but he realized that the unknown illness was progressing. He was ready to learn the diagnosis tomorrow. 

 

Dr. Peters gave Ralph the conclusive diagnosis of amyotrophic lateral sclerosis (ALS). which is a progressive nervous system disease that affects nerve cells in the brain and spinal cord and causes loss of muscle control. The symptoms of ALS usually start with muscle twitching and weakness in a limb, slurred speech, and then spreads to other parts of the body. Eventually, ALS affects control of the muscles needed to move. speak, eat, and breathe. This fatal disease has no cure. There is generally no pain in the early stages of ALS. and pain is uncommon in the later stages. According to the ALS Association, the average life expectancy of a person with ALS is 3 years. However, it varies greatly with the typical range being 20 percent live 5 years or more, 10 percent live 10 or more years, and 5 percent will live for more than 20 years. Of course, Ralph and Steve were devastated by the diagnosis and immediately had questions. Dr. Peters had planned for these questions and scheduled a two-hour appointment. By the time Ralph and Steve left his office, they had their initial questions answered. 

 

Since Dr. Peters deals with all types of neurological diseases (e.g.-, ALS. Parkinson's, multiple sclerosis, and strokes). he is familiar with delivering a diagnosis of such a serious illness. As a result, he hired Jackie, a CHW, to coordinate patient appointments, phone calls, insurance eligibility referrals, general information, and community resources to assist the patients and their families throughout the disease process. As Dr. Peters walked Ralph and Steve out of his office, he introduced them to Jackie, the CHW. He explained that she would be their first point of contact for all nonclinical questions. She handed Ralph a cloth tote bag filled with brochures and community resources, a small stack of her business cards, and two bottles of water for the ride home. Ralph and Steve walked to their car, drank the water, and tried to take a few deep breathes of the new reality before attempting to drive home. 

 

Directions:

 

Use the information in the supplemental PPT, the guest speaker's presentation and your own research to answer the following questions. Student's will complete the questions by Wednesday evening and upload. On Thursday morning, each student will receive the answers from another anonymous student (provided by email and included in your Teams folder) and will grade the others answers per the rubric, while also recording feedback to each rubric line section, by video. The video will be recorded through Flip or uploaded from another platform. The final grade for the student will be provided by the professor though there are points to the level of review each student provides to their classmate. 

 

As a new CHW you will obtain more experience in talking with clients about difficult issues. How to provide good and not-so-good feedback is important and showing empathy along with the dialogue will be well received by clients. Additionally, you will have an opportunity to meet over telehealth platforms and being able to portray receptive body language will be helpful for you to build rapport. The assignment incorporates these needed skills as learning outcomes.

 

Questions:

 

1. What information would you, the CHW, include in the tote bag that was given to Ralph and Steve at their initial appointment with Dr. Peters? 

 

 

 

 

 

1. When you first meet with Ralph and Steve next week, what information and questions would you anticipate for the appointment? 

 

 

 

 

 

 

1. At what point, would you suggest that Ralph and Steve begin attending the ALS Community Support group? 

 

 

 

 

 

 

1. When would you start a conversation about advance directive choices for Ralph? How did you make this decision? 

 

 

 

 

 

 

1. What research would you conduct to update your knowledge and understanding about ALS since you have limited experience about the progression of this disease?