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Fwd: [Dysphagia] pt wtih hx of laryngeal cancer
- Subject: Fwd: [Dysphagia] pt wtih hx of laryngeal cancer
- From: atsslp at yahoo.com (Alyce Schoenagel)
- Date: Wed Aug 11 15:36:57 2004
Amy,
In my experience, pts with laryngeal cancer/radiation often have edema, along with poor peristalsis-laryngeal elevation remains poor. Radiation causes loss of good
peristalsis, causing pts to feel "like it's not going down" ....because it's not. The VFSS pattern is one of weak swallows with post swallow residual-valleculae/pyriform and posterior pharyngeal wall-this pooling eventually overflows/aspirates. The phlegm (usually it is white/frothy, not thick) is often from persistent/small amounts of penetration/aspiration--plus, this person has had mult VF surgery, so his cords probably don't adduct fully, giving him less airway protection. These folks often tolerate "trials" because the penetration/asp is intermittent/from overflow-which takes more than a few
trials to elicit. How is his voice? Do you notice multiple swallows, even with runny purees? What did his VFSS look like/did he have one?
Alyce Schoenagel
M.S.-CCC-Slp
Harford Memorial Hosp-MD
Date: Tue, 10 Aug 2004 18:58:00 -0400
From: "Amy Bradley"
To:
Subject: [Dysphagia] pt wtih hx of laryngeal cancer
I have a pt. who is s/p numerous surgeries to remove polyps from vocal
cords and completed 6 weeks of radiation therapy 5 weeks ago for
laryngeal cancer. Pt. initially was NPO secondary to poor laryngeal
elevation resulting in aspiration. Pt. has been working on exercise
regime and has improved, tolerating oral trials, however is having
excessive secretions. Pt. reports 'it feels like the food can't go down
all the way.' GI consult reported no narrowing or strictures. The pt.
is constantly coughing up thick phlegm especially when attempting to
eat. Any suggestions?? abradley@regencyhospital.com
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