What is a plateau? It depends. Most of us will think of geology first. Dictionary.com:

a land area having a relatively level surface considerably raised above adjoining land on at least one side, and often cut by deep canyons

See?

Not mentioned in the geological definition is the word flat. Definition #2:

a period or state of little or no growth or decline

There we go. Flat. No change. No improvement. No decline.

ALS is a slowly debilitating disease but some with ALS may experience a plateau or a very slowly declining condition that may last for years. Though most will die within three to five years, a small percentage of those afflicted may live for a decade or more.

My first and last plateau seemed to arrive at the same time.

When trying to track down the cause of my breathing issues and occasional and oddly located muscle cramps, my neurologist said, “This could be ALS.” His first consideration was spot on but symptoms did not match strength which usually degrades with ALS. Months earlier, shortly after the first symptoms appeared, I started on a dramatically improved diet and exercise routine which dropped weight and improved muscle tone and strength.

That was the first and last plateau.

It also masked what was really going on with the parade of steadily degrading motor neurons. Other symptoms became more obvious to my neurologist. He found a hitch in my gait (walking). He found a another hitch in my shoulder and arm motion (rotation).

Parkinson’s disease?

Medicine for Parkinson’s had no effect and, over many months of tests, we determined another source but not the cause of the breathing problems or the cramps. The hitch in my gait came from a decades long bad knee and the hitch in the shoulder came from a skateboard accident back in early adulthood (skateboards were made of wood; that should tell you how long ago).

Over the course of that year my health improved. Except for the breathing difficulties, stiffness in the paraspinal muscles, and some very odd hand cramps. Weight dropped, muscles strengthened, and I looked great*.

A year later the first and last plateau ended in ER.

I couldn’t breathe.

*debatable; depends upon who was asked