FW: [Dysphagia] pt wtih hx of laryngeal cancer

[abradley at RegencyHospital.com (Amy Bradley)]

His voice is breathy.  His VFSS indicated, just as you said, poor
peristalsis and residue in pyriforms which was aspirated after the
swallow.  In response to the other email, his secretions were very thick
and tinted slightly yellow.  A Scopolomine patch was ordered, however
did not help with secretions.  He remained NPO, and was d/ced with a
PEG.  Thanks for all your help.

-----Original Message-----
From: Alyce Schoenagel [mailto:atsslp@yahoo.com] 
Sent: Wednesday, August 11, 2004 4:37 PM
To: dysphagia@b9.com
Subject: Fwd: [Dysphagia] pt wtih hx of laryngeal cancer

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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