DEAR DR. ROACH: My mother-in-law died at age 73 from amyotrophic lateral sclerosis (ALS). There was no family history of the disease. My sister-in-law, age 72, is now experiencing occasional problems with lisping. Could this be the first sign of her developing familial ALS? She is in great physical condition otherwise, and she has no complaints of cramps or muscle weakness. — Anon.
ANSWER: ALS, sometimes called Lou Gehrig’s disease, is a disease of the parts of the brain and spinal cord that are responsible for movement. The most common initial symptom is weakness, usually more on one side than the other and typically in an arm or a leg. However, 20% of people will have symptoms in their muscles of eating and speaking, so it is unfortunately possible that lisping could represent the onset of muscle weakness in the lips and tongue.
While the average age of onset is 55, with most occurring between the ages of 40-70, cases can occur as young as 20 and as old as 87. Sometimes physicians fail to realize that ALS can and does happen in older individuals.
Ninety percent of people who develop ALS do not have a family history, but when there is a family history, the risk is much higher. When there is a family history, genetic testing can be helpful when combined with an evaluation by a neurologist. I’d recommend that your sister finds a neurologist specifically trained in neuromuscular diseases.
DEAR DR. ROACH: In 2018, at age 86, I had a colonoscopy where some benign polyps were found. I was recommended to come back in three years for another colonoscopy, but in 2021, procedures were not being done because of COVID. Once they started doing them again, I consulted with my primary care doctor about the risks and benefits. We decided not to do the colonoscopy.
Recently, my bowel movements have changed, becoming less frequent and more difficult. I am worried that I should have gotten the colonoscopy and that perhaps colon cancer is developing. I don’t have blood in my stool and have taken the fecal occult blood test with negative results. Are there any other tests that you recommend? — J.K.
ANSWER: Although a screening colonoscopy is not usually recommended in people over 85, there are sometimes reasons to do them, such as in an extraordinarily healthy person with a family history of colon cancer.However, the issue for you is no longer about screening; it is about finding out why you are having these symptoms.
Any change in bowel habits, especially in older individuals, should get your physician to think that there might be a new medical problem. Colon cancer is not the most likely cause, but it is on the list.
One consideration would be a fecal DNA test, which is pretty sensitive (although not perfect) at identifying colon cancer. It would likely save you from needing the colonoscopy, which has increased risk in a person in their 90s. A consultation with your gastroenterologist could be appropriate, but a colonoscopy still might be the best test.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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