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A 44-year-old man came to the physician to discuss the results of the electromygraphy (EMG) conducted one week ago. He has had progressive muscle wasting, frequent muscle twitches at rest, mild difficulty swallowing and a 6.8 Kg weight loos during the past 3 months. He has been concerned that this might represent a serious illness. Physical examination shows atrophy of the muscles of the right upper extremity and left lower extremity and brisk deep tendon reflexes. The results of the EMG are compatible with Amytrophic Lateral Sclerosis. Which of the following is the most appropriate way to initiate a discussion about these results with the patient?

A- "I'd like to talk to you about your EMG, but I want your wife to be present, can you return later with her?"
B- "You do have a very serious muscle disease called ALS. This cannot be cured but I will be here to help you. Have you heard about ALS?"
C- "You seem to have a significant muscle disease and I am going to start you on a medication right away. Have you thought about a living will or power of attorney for medical affairs?"
D- "Your EMG shows diffuse denervation and four limbs increased amplitue, which confirms our worst suspicions. you have ALS."
E- "Your EMG shows diffuse muscle disease and I will refer you to a specialist. In the mean time I'd like to tell you about a website that provides lots of helpful advice about living with the disease."
 

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B

B- "You do have a very serious muscle disease called ALS. This cannot be cured but I will be here to help you. Have you heard about ALS?"
 

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B

"You do have a very serious muscle disease called ALS. This cannot be cured but I will be here to help you. Have you heard about ALS?"
 
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