Dr. Ghazala Hayat is board certified by the American Board of Psychiatry and Neurology and the American Board of Electrodiagnostic Medicine and has clinical neurophysiology certification by the American Board of Psychiatry and Neurology. She is the director of Neuromuscular Services, Clinical Neurophysiology Fellowship and Clinical Neurophysiology Laboratory and the ALS Certified Center of Excellence at Saint Louis University.
Can you tell us a little about yourself?
I graduated from King Edward Medical College in Pakistan. I did my neurology residency and Neuromuscular Disorders Fellowship at Medical College of Virginia. I have been at St. Louis University since 1986. I am Professor of Neurology, Director Neuromuscular Services, Clinical Neurophysiology Services; Director Clinical Neurophysiology Fellowship and Director of ALS Certified Center Of Excellence.
I was recently appointed as Director of CQI for education and research.
Why did you decide to become a neurologist?
I have loved math and physics since high school. Neurology “makes sense to me” as there are tracts, pathways which will correctly predict where the lesion is. Over years many breakthrough discoveries are making Neurology even more interesting.
How long have you been treating people with ALS?
I was involved in ALS care/therapy since my fellowship in Neuromuscular Disorders at Medical College of Virginia. I continued taking care of ALS patients at the neuromuscular clinic since 1886. About 22 years ago the ALS Certified Center of Excellence was established.
How is ALS diagnosed?
The diagnosis of ALS is clinical with laboratory tests ruling out other causes. Patients usually present with progressive weakness of arms, legs, difficulty speaking, swallowing, breathing and walking. The examination shows weakness of muscles, loss of muscle mass, tightness of muscles, hyperactive reflexes, muscle twitches, speech difficulties and gait imbalance. Not every patient will have the same symptoms and may develop some of these symptoms over time. Blood tests are performed to rule out any ALS “mimickers” or other causes of weakness. Imaging of the spine and brain is done to look for any compression, stroke or other causes for weakness. Nerve conduction studies and electromyography can help to confirm the diagnosis if there are wide spread changes in the body.
How is the ALS clinic at Saint Louis University different from a typical clinic?
The ALS clinic is a multidisciplinary clinic. When the patient is seen at the ALS clinic, he/she is evaluated by a neuromuscular specialist, resident/fellow, ALS nurse coordinator, ALSA representative, Physical therapist, Occupational therapist, Respiratory therapist, Speech therapist, Dietician, and Social worker. If needed, we have personnel to provide different equipment evaluation. We have core group of gastroenterologists, pulmonologist, psychiatrists and psychologists for further evaluation and therapy. At the end of the clinic we have round table discussion about each patient and the decisions about different disciplines are made with consultation. This coordinated care provides the best possible treatment to the ALS patients.
Patients can contact the ALS nurse and the physician in between visits for any issues.
What do you love about working at SLU?
Commitment to patient care, education and clinical research.
What are some of the exciting developments in research in ALS?
Stem cell, gene therapies, learning more about different genes.
What are the most common misconceptions about ALS?
“There is a cure available in many parts of the world.” Sadly I have seen patients and families spending their life savings on these therapies, which have not proven to be helpful at all.
“Feeding tubes are not helpful.” Feeding tubes improve quality of life and patients can conserve “energy” for other important functions.
“Once the diagnosis is made, go home and take care of your business.” We can offer many services to the patient and many studies have shown quality of life and may be length of survival to be better for the patients followed in multidisciplinary clinics.
What would you tell someone who has just been diagnosed with ALS?
- We do not have the cure for ALS but we have therapies. Now we have 2 FDA approved medications.
- Follow in a multidisciplinary clinic to get the best possible care.
- We will be with them at every step to help and guide.
- Take your time, but discuss with your loved ones to decide about feeding tube and respirator.
- Have an advanced directive.
- Read about research studies and see if he/she is interested in any.
- Take one day at a time.
- Progression of weakness will be challenging but we will be able to help with assistance from different disciplines.
What is the most rewarding thing about working with people who have ALS?
I am amazed by the courage of the ALS patients, their caregiver. How they adapt to changes, have smiles on their faces with all the challenges and are willing to try new treatment for research studies, even if they will not see the benefit.