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Medicine in general is manifestly unprepared to help in ALS, but I will say that the RT at our ALS clinic seems like one very sharp cookie, and she said if we ever need (and some need it far ahead of any enormous limb effect, even in non bulbar I understand) she works a great deal with bi paps. Of course, she is at a certified ALS center all day long - does the lung function testing.
 
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