[Dysphagia] request for help

[J.Smith at cgmc.org.au (Smith, Joanne)]

Thank you Irene for your response. I am however unsure of what exactly
'waterbrash' is. I did remember reading that white foamy saliva is often
refluxed saliva. Is waterbrash the same. How is this treated?
 
Thank you to all others who have responded. Each response is very much
appreciated.

-----Original Message-----
From: Irene Campbell-Taylor [mailto:eripley@yahoo.com]
Sent: Saturday, 28 February 2004 18:32
To: Smith, Joanne; 'CFR42@aol.com'; pbates@sunflower.com; dysphagia@b9.com
Subject: Re: [Dysphagia] request for help


Sounds more like waterbrash than saliva.

"Smith, Joanne" <J.Smith@cgmc.org.au> wrote: 

A gentleman has just been referred to me who has seen a number of Speech
Pathologists. I was wondering if all options had been covered for the
following gentleman, or if anyone had any further suggestions about managing
his saliva or increasing oral intake. All help is much appreciated. 

74 year old gentleman who suffered a left medullary and bilateral cerebellar
infarct in May 2000. Patient history includes ETOH abuse, TURP, gout, Ca
prostate, reflux oesophagitis, gastritis, duodenitis. 

Since his stroke the patient had been fed by PEG and has been unable to
manage saliva. He presented with dysarthria (now resolved), dysphonia (now
mild dysphonia) and right facial weakness. Patient has been trialing small
amounts of puree diet (1-2 teaspoons) but has recently given up as he
reported being unable to 'swallow'.

Botulinum Toxin in! jections into parotids were ineffective and patient
continues to have difficulties with saliva. During a 45 minute session
patient spat out approximately 200ml of white frothy saliva. On examination
of oral cavity his faucial arches were coated in thin white frothy saliva.

Bedside examination: Trialled 1 teaspoon of puree fruit. Adequate oral
stage. Reduce laryngeal excursion. Patient required up to five swallows
before he felt he had cleared bolus from pharynx. Pt reported it had gone
down 'right way' as nil coughing or throat clear. Subsequent saliva had a
yellow tinge (from fruit).

Thank you for all suggestions.
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Dr I Campbell-Taylor
Clinical Neuroscientist
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