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[Dysphagia] use of papaya extract in ALS
He would appear to be suffering the effects of the common hazard of enteral feeding - reflux - and the recent posting I sent indicates that only about 50% of people on PPIs actually experience reduction of Hcl in the stomach. It has been known for some time that there is acid production breakthrough during sleep with PPIs but not until recently the information that they are as ineffective in many as it appears - and, of course, they don't control reflux. The Gaviscon helps a great deal for most as it protects the esophageal lining from acid irritation thereby reducing the production of mucus. Perhaps he isn't getting the Gaviscon often enough. Papaya extract won't help as can't reduce the production of the mucus. Many years ago, a geriatrician gave me a useful tip re these sorts of problems in ALS patients, particularly those who feel that they are choking on their own saliva. As sensation is intact, one treats the symptom only. He uses topical lidocaine in the pharynx of these
unfortunate patients. If they can't feel the sensation, it ceases to be a problem. Of course, with enteral feeding, they are still at increased risk of chemical penumonitis but, even with the best positioning possible considering the physical impairment, that can't be helped very much. Palliation is the issue and relief from distress. It's an important issue that, in my experience, rarely enters the discussion re G-tubes and ALS patients. As they have a motor neuron disease, the lack of esophageal peristalsis and LES tone makes them even more vulnerable to chronic, even lethal aspiration pneumonitis with enteral feeding.
Mary Wagg <MWagg@doh.health.nsw.gov.au> wrote:
Dear all
One of the patients in our ALS clinic is having huge problems with
mucus production. As soon as he has any oral intake (even a few sips of
water) or any intake via the PEG he begins to produce large amounts of
mucus that he can't, due to his advanced bulbar symptoms, poor cough,
and the mucoid nature of the secretions, clear effectively. As a
result, his intake even via PEG is reduced because of a feeling of
suffocation with intake.
He is having Nexium via the PEG, and more recently has added Gaviscon
prior to introduction of the feed. The Gaviscon seems to have helped
somewhat. Oral suction as a last resort has also given some relief.
Can anyone tell me if papaya extract via the PEG is as useful as PO?
He is unable to tolerate dark grape juice orally in sufficient amounts
to be helpful.
Many thanks for your input
Mary
Mary Wagg
Speech Pathologist
Royal North Shore Hospital
St Leonards NSW 2065
ph: 9926 7741
email: mwagg@doh.health.nsw.gov.au
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recipient, please delete it and notify the sender. Views
expressed in this message are those of the individual sender,
and are not necessarily the views of NSW Health or Cancer Institute
of NSW.
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