[Dysphagia] interesting case

[pressmah at sjhmc.org (Pressman, Hilda)]

I would suggest a neurology consult  Hilda Pressman

-----Original Message-----
From: Malinda Moore [mailto:malindam@samhealth.org]
Sent: Friday, June 25, 2004 8:10 PM
To: Dysphagia@b9.com
Subject: [Dysphagia] interesting case


83 y.o. woman with fairly sudden onset of oral dysphagia with solids 2
months ago and 10 pound weight loss.  There was some abdominal pain around
the same time but no longer.  Remote hx renal failure.  3 months s/p cysto
cystometics procedure for cystitis cystica/urinary leakage.  Oral motor exam
WFL.  Speech intelligible.  Esophageal study was normal.  MBS was normal for
liquids but poor oral bolus formation, manipulation and posterior
propulsion.  Material dropped piecemeal into pharynx with swallow finally
initiated when material reach "critical mass."  No penetration or aspiration
on any consistency or texture.  Solids passed easily through esophagus.  Pt.
was advised after initial eval at 1 month post onset of symptoms (5 pound wt
loss at that time) to take liquid supplement, 3 cans/day, in 4 oz servings
but rarely drank a whole can.  She says most liquids taste bad except
Gatoraid.  Solids also taste bad except for quiche and fresh fruit. No
appetite.  She is not demented although her swallow resembles the oral
textural intolerence noted in many people with late stage dementia who
maintain the ability to swallow liquids.  I have also seen this presentation
in two patients with undiagnosed diabetes.  In both cases, normal swallow
function returned when diabetes was adequately managed.  However, this
patient has normal labs, normal abdominal ultrasound,  However, just this
week she started antibiotics for kidney infection.

The patient is very concerned, noticeably weaker and fatigued.  She lives
alone but has very supportive family locally.

Any ideas welcome and appreciated.

Malinda, CCC-SLP 
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