[Dysphagia] use of papaya extract in ALS

[MWagg at doh.health.nsw.gov.au (Mary Wagg)]

Thanks Irene for your response.  The decision to place PEGs in people
with motor neurone disease certainly needs consideration from all
angles.   Someone confronted with end of life decisions requires a lot
of information to help them through the difficult decision making
process regarding non invasive ventilation, PEG etc.  In my experience
in a multidisciplinary MND clinic, PEG and NIV can certainly prolong
life. For some patients  this is a high priority, for others it is not. 
 When PEGs are placed with thoughtful consideration of rate and pattern
of disease progression, cognitive status, psychosocial issues, risks,
and benefits vs disadvantages my experience has been that most people
with MND who choose to have a PEG, not only have a longer life but
better quality of life, and most unwanted side effects can be managed
effectively.

This particular man's problem with reflux is by far the most difficult
one I've encountered.  He is 51 years old, chose PEG placement and was
considered a good candidate. He is still at home with his wife who is
doing a wonderful job caring for him.  He is linked with Palliative care
services and well supported by community services and a
multidisciplinary team here at the hospital.  Unfortunately his disease
progression was hastened along last month when he had two seizures. 
After the first seizure his dysarthria and dysphagia were significantly
worse and he has not regained his previous level of functioning. His
reflux is induced both by oral and PEG intake, although his oral intake
is now minimal because of the secretions. 

I will suggest extra Gaviscon to help control the reflux.  While 
papaya extract does not address the underlying  reflux, it can be
helpful in thinning the secretions so that they are easier to
expectorate.  My experience has only ever been with it being taken
orally, hence my question about its efficacy when taken via the PEG.  

Mary






Mary Wagg
Speech Pathologist
Royal North Shore Hospital
St Leonards NSW 2065
ph: 9926 7741
email: mwagg@doh.health.nsw.gov.au

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