Sorry for the delay in responding. I have been trying to speak with our ALS expert about your question, but have been unsuccessful. In addition to the medical regimen you are currently using, you could try the Robinul, or a medication such as Zyrtec which is an anti-histamine. I am not familar with using botox or radiation, but these are designed to decrease the function of the salivary glands. Chest physical therapy with a therapist or a pneumatic vest may also help to loosen secretions and make them easier to clear. Also if you are having difficulty breathing at night CPAP or BIPAP can be used to assist your breathing. These devices force air into the lungs to assist with breathing. In the process of doing this they also dry out the oral passages, due to the dry air. I will continue to try and catch our ALS expert and ask him your question. If he has any additional thoughts I will add another comment. I would encourage you to have an evaluation at an ALS center (typically located at academic centers) they will be able to perform a multi-disciplinary evaluation and make all the proper recommendations for you. Good luck.