[Dysphagia] Re: Dysphagia Digest, Vol 6, Issue 15

[chcky619 at bellsouth.net (Ralph and Patti)]

I am absolutely certain that I don't remember a politician saying anything
about a "duty to die" because I am certain my outrage would have taken me
out at the knees, but the flip side of that coin is:  We as professionals
have a "duty" to provide the window for permission to let go of this
concrete life.  We need to give families permission and the patient themself
the wonderful choice of peace and tranquility. Prolongation of life in the
face of medical obstacles is such a turmoil.  We as healthcare professionals
pride ourselves on enhancement of quality of life and insurance of end of
life discussions within our realm of practice.  It is an incredible burden
that no one takes lightly. There is nothing more reverent than to give
someone the permission to leave this earth.  Patti
----- Original Message -----
From: <dysphagia-request@b9.com>
To: <dysphagia@b9.com>
Sent: Wednesday, May 19, 2004 11:35 AM
Subject: Dysphagia Digest, Vol 6, Issue 15


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> Today's Topics:
>
>    1. FEES in Ohio (Robert Newman)
>    2. Re: NYTimes.com Article: When Alzheimer&#39; s Steals the
>       Mind, How Aggressively to Treat the Body?  (Barbara Cole)
>    3. Re: blue dye (JANET CONFER)
>    4. Aggressive MR POC (Jill Silverman)
>    5. Re: Aggressive MR POC (SuzMorris@aol.com)
>    6. RE: Aggressive MR POC (Pressman, Hilda)
>    7. Re: Aggressive MR POC (Namp304@aol.com)
>    8. RE: Aggressive MR POC (Marie Isbell)
>    9. RE: Aggressive MR POC (Sanders, Liza)
>   10. RE: Aggressive MR POC (Pressman, Hilda)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Tue, 18 May 2004 14:31:34 -0400
> From: "Robert Newman" <ronewman@columbus.rr.com>
> Subject: [Dysphagia] FEES in Ohio
> To: <dysphagia@b9.com>
> Message-ID: <003a01c43d06$597ed940$9e8c1a18@columbus.rr.com>
> Content-Type: text/plain; charset="iso-8859-1"
>
> Not sure if my first email went through, so here goes again. If there is
anyone in the state of Ohio who is performing FEES, meaning actually passing
the endoscope, please email me with your situation. In other words, do you
practice in a hospital, private practice, nursing facility, etc. I thank you
in advance,
>
> Kelly L. Newman, CCC-SLP
> ronewman@columbus.rr.com
>
>
> ------------------------------
>
> Message: 2
> Date: Tue, 18 May 2004 18:19:07 -0400
> From: "Barbara Cole" <bkcole@erols.com>
> Subject: Re: [Dysphagia] NYTimes.com Article: When Alzheimer&#39; s
> Steals the Mind, How Aggressively to Treat the Body?
> To: <marie.isbell@state.tn.us>, <dysphagia@b9.com>
> Message-ID: <003301c43d26$23ba9ae0$0000a398@CPQ20302235594>
> Content-Type: text/plain; charset="iso-8859-1"
>
> And this is EXACTLY why people need to be prodded, forced to confront
these
> issues while they are of sound mound and let their wishes be known.  How
> many times do you hear people say, "I wouldn't want to be kept alive in
that
> situation", yet they do nothing to try and insure that they WON'T be kept
> alive at all costs.  The greatest gift one can give to one's
children/family
> is to relieve them of the decision and put it in writing way before it is
> needed.
>     Years ago there was an uproar over comments made by,  I believe I
recall
> this correctly, the governor of Colorado ? (maybe?). stating the elderly
had
> a "duty to die" because keeping them alive alive at all costs would
bankrupt
> the country. Does anyone else remember this?
>     Barbara
>
>
>
> ------------------------------
>
> Message: 3
> Date: Tue, 18 May 2004 22:01:10 -0700
> From: "JANET CONFER" <justjanetlynn@msn.com>
> Subject: Re: [Dysphagia] blue dye
> To: <dysphagia@medonline.com>
> Message-ID: <BAY11-DAV20uTqtAONy00007c54@hotmail.com>
> Content-Type: text/plain; charset="iso-8859-1"
>
> If blue food coloring was illegal, there would be a huge number of
everyday
> products (just look at labels all throughout your grocery store) being
> recalled and taken off the shelves. The answer...absolutely not! Please
see
> the archives on this topic.
>
>
> ----- Original Message -----
> From: <PLevy25124@aol.com>
> To: <dysphagia@medonline.com>
> Sent: Monday, May 17, 2004 2:53 AM
> Subject: [Dysphagia] blue dye
>
>
> > i was informed by a repiratory therapist that blue dye may not be legal
> > any
> > more. Is this true or are therapists still using this to assess
> > aspiration?
> >
> > Thanks.
> > Phyllis
> > _______________________________________________
> > Dysphagia mailing list
> > Dysphagia@b9.com
> > http://lists.b9.com/mailman/listinfo/dysphagia
> >
>
>
> ------------------------------
>
> Message: 4
> Date: Wed, 19 May 2004 08:30:57 -0400
> From: "Jill Silverman" <JSilverman@dhmh.state.md.us>
> Subject: [Dysphagia] Aggressive MR POC
> To: <dysphagia@b9.com>
> Message-ID: <s0ab1b56.083@mail4.dhmh.state.md.us>
> Content-Type: text/plain; charset=US-ASCII
>
>      Hi All!  I would first like to thank those who provided me with
helpful suggestions for completing the gum trials with the individual I
described in my e-mail last week - against my better judgement - per Senior
Management's directive.  As I expected, he swallowed the gum immediately and
engaged in SIB - biting his arm and hitting his head - even with the
gum...Needless to say, we are thankfully NOT moving forward with that
idea...Thank G-d!!!
>    However, the Team (or in other words me and the Psychologist) are now
left with the difficult mission of designing another plan.  Please remember
this man is violently aggressive, nonverbal, profoundly mentally retarded,
h/o seizure disorder, & Diabetic - so edibles would certainly complicate
things - even though I do not habitually prefer to use edibles.  With this
group of developmentally disabled individuals who reside in an ICF/MR, often
food is the only natural motivator that is effective...I researched and
suggested mouthing tools (or, chewy toys, tubes, teethers) as something we
might try and was honestly "heckled" and told they were not age appropriate.
Now, yes, this man is in his 40's, but cognitively, he functions at
approximately 6-12mos...Others "prefer" squeeky toys, activity boxes,
mobiles, etc...Why then is my idea so preposterous?!  ANY other ideas anyone
could offer will be sincerely helpful!!!
> Respectfully yours, and awaiting your suggestions, Jill Silverman
>
>
>
> ------------------------------
>
> Message: 5
> Date: Wed, 19 May 2004 09:13:05 EDT
> From: SuzMorris@aol.com
> Subject: Re: [Dysphagia] Aggressive MR POC
> To: JSilverman@dhmh.state.md.us, Dysphagia@b9.com
> Message-ID: <b8.588856ad.2ddcb761@aol.com>
> Content-Type: text/plain; charset="ISO-8859-1"
>
> I chuckled at the lack of "age appropriateness" of the Chewy Tubes.    I
have
> a friend whose husband used them as an alternative to help him stop
smoking!!
>
>
>
>
> Suzanne Evans Morris, Ph.D.
> New Visions
> 1124 Roberts Mountain Rd.
> Faber, VA 22938
> (434) 361-2285 ext. 5
> www.new-vis.com
>
>
> In a message dated 5/19/04 8:33:10 AM, JSilverman@dhmh.state.md.us writes:
>
>
> > I researched and suggested mouthing tools (or, chewy toys, tubes,
teethers)
> > as something we might try and was honestly "heckled" and told they were
not
> > age appropriate. Now, yes, this man is in his 40's, but cognitively, he
> > functions at approximately 6-12mos...Others "prefer" squeeky toys,
activity
> > boxes, mobiles, etc...Why then is my idea so preposterous?! ANY other
ideas
> > anyone could offer will be sincerely helpful!!!
> >
>
>
>
>
>
>
> ------------------------------
>
> Message: 6
> Date: Wed, 19 May 2004 09:35:30 -0400
> From: "Pressman, Hilda" <pressmah@sjhmc.org>
> Subject: RE: [Dysphagia] Aggressive MR POC
> To: "'Jill Silverman'" <JSilverman@dhmh.state.md.us>, dysphagia@b9.com
> Message-ID: <9FE5266F7C76D31197A20050DA1355570C21502C@itr-mail>
> Content-Type: text/plain; charset="iso-8859-1"
>
> The chewy tube is not a toy so the age appropriate question does not seem
> appropriate.  Do you think that he will hold onto it or through it away?
I
> consulted on a youngster recently for whom the chewy tube was too soft and
> we found a harder plastic ring (from a toy) which he accepted.  Hilda
> Pressman
>
> -----Original Message-----
> From: Jill Silverman [mailto:JSilverman@dhmh.state.md.us]
> Sent: Wednesday, May 19, 2004 8:31 AM
> To: dysphagia@b9.com
> Subject: [Dysphagia] Aggressive MR POC
>
>
>      Hi All!  I would first like to thank those who provided me with
helpful
> suggestions for completing the gum trials with the individual I described
in
> my e-mail last week - against my better judgement - per Senior
Management's
> directive.  As I expected, he swallowed the gum immediately and engaged in
> SIB - biting his arm and hitting his head - even with the gum...Needless
to
> say, we are thankfully NOT moving forward with that idea...Thank G-d!!!
>    However, the Team (or in other words me and the Psychologist) are now
> left with the difficult mission of designing another plan.  Please
remember
> this man is violently aggressive, nonverbal, profoundly mentally retarded,
> h/o seizure disorder, & Diabetic - so edibles would certainly complicate
> things - even though I do not habitually prefer to use edibles.  With this
> group of developmentally disabled individuals who reside in an ICF/MR,
often
> food is the only natural motivator that is effective...I researched and
> suggested mouthing tools (or, chewy toys, tubes, teethers) as something we
> might try and was honestly "heckled" and told they were not age
appropriate.
> Now, yes, this man is in his 40's, but cognitively, he functions at
> approximately 6-12mos...Others "prefer" squeeky toys, activity boxes,
> mobiles, etc...Why then is my idea so preposterous?!  ANY other ideas
anyone
> could offer will be sincerely helpful!!!
> Respectfully yours, and awaiting your suggestions, Jill Silverman
>
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
>
>
> ------------------------------
>
> Message: 7
> Date: Wed, 19 May 2004 09:40:01 EDT
> From: Namp304@aol.com
> Subject: Re: [Dysphagia] Aggressive MR POC
> To: JSilverman@dhmh.state.md.us, Dysphagia@b9.com
> Message-ID: <1ee.20f6872e.2ddcbdb1@aol.com>
> Content-Type: text/plain; charset="US-ASCII"
>
> I have to say, the "age appropriateness" re Chewy Tubes seems a bit
> misplaced.  In my experience, many adults have a tendency to use chewing
of various
> objects to release tension.
> Nancy Parkinson
>
>
> ------------------------------
>
> Message: 8
> Date: Wed, 19 May 2004 09:02:07 -0500
> From: "Marie Isbell" <Marie.Isbell@state.tn.us>
> Subject: RE: [Dysphagia] Aggressive MR POC
> To: <dysphagia@b9.com>
> Message-ID: <s0ab2293.057@state.tn.us>
> Content-Type: text/plain; charset=US-ASCII
>
> I work with adults with developmental disabilities.  One option we use
> is acrylic water fountain tubing you can get at hardware store.  It
> comes in various diameters, is clear and quite firm, and will not absorb
> food if dipped.  There is also a whitish opaque tubing sold in the same
> area, but that is not FDA approved.  I usually cut a piece about 8" long
> for the person to chew on.
>
> Marie M. Isbell, MA, CCC-SLP
> West TN Regional PNM Team
> West TN Regional Office
> 8383 Wolf Lake Drive
> Bartlett, TN 38133
> (901) 213-1847
> Fax: (901) 372-3460
> Marie.Isbell@state.tn.us
>
> This e-mail may contain PRIVILEGED and CONFIDENTIAL information and is
> intended only for the use of the specific individual(s) to which it is
> addressed.  If you are not an intended recipient of this e-mail, you are
> hereby notified that any unauthorized use, dissemination or copying of
> this e-mail or the information contained in it or attached to it, is
> strictly prohibited.  If you have received this e-mail in error, please
> delete it and immediately notify the person named above by reply mail.
> Thank you.
>
> >>> "Pressman, Hilda" <pressmah@sjhmc.org> 5/19/2004 8:35:30 AM >>>
> The chewy tube is not a toy so the age appropriate question does not
> seem
> appropriate.  Do you think that he will hold onto it or through it
> away?  I
> consulted on a youngster recently for whom the chewy tube was too soft
> and
> we found a harder plastic ring (from a toy) which he accepted.  Hilda
> Pressman
>
> -----Original Message-----
> From: Jill Silverman [mailto:JSilverman@dhmh.state.md.us]
> Sent: Wednesday, May 19, 2004 8:31 AM
> To: dysphagia@b9.com
> Subject: [Dysphagia] Aggressive MR POC
>
>
>      Hi All!  I would first like to thank those who provided me with
> helpful
> suggestions for completing the gum trials with the individual I
> described in
> my e-mail last week - against my better judgement - per Senior
> Management's
> directive.  As I expected, he swallowed the gum immediately and engaged
> in
> SIB - biting his arm and hitting his head - even with the
> gum...Needless to
> say, we are thankfully NOT moving forward with that idea...Thank
> G-d!!!
>    However, the Team (or in other words me and the Psychologist) are
> now
> left with the difficult mission of designing another plan.  Please
> remember
> this man is violently aggressive, nonverbal, profoundly mentally
> retarded,
> h/o seizure disorder, & Diabetic - so edibles would certainly
> complicate
> things - even though I do not habitually prefer to use edibles.  With
> this
> group of developmentally disabled individuals who reside in an ICF/MR,
> often
> food is the only natural motivator that is effective...I researched
> and
> suggested mouthing tools (or, chewy toys, tubes, teethers) as something
> we
> might try and was honestly "heckled" and told they were not age
> appropriate.
> Now, yes, this man is in his 40's, but cognitively, he functions at
> approximately 6-12mos...Others "prefer" squeeky toys, activity boxes,
> mobiles, etc...Why then is my idea so preposterous?!  ANY other ideas
> anyone
> could offer will be sincerely helpful!!!
> Respectfully yours, and awaiting your suggestions, Jill Silverman
>
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
>
>
> ------------------------------
>
> Message: 9
> Date: Wed, 19 May 2004 10:55:48 -0400
> From: "Sanders, Liza" <LSanders@CVTC.state.va.us>
> Subject: RE: [Dysphagia] Aggressive MR POC
> To: "'Jill Silverman'" <JSilverman@dhmh.state.md.us>,
> "'dysphagia@b9.com'" <dysphagia@b9.com>
> Message-ID: <13CDCA7DC43ED311809400902762830B016C6276@CVTC03>
> Content-Type: text/plain; charset="iso-8859-1"
>
> It is difficult to sort through all of the problems that persons with
> complex issues have.  It sounds like the chewing/biting/SIB is part of the
> larger issue that is also being addressed with this person.  Maybe looking
> at it as part of the big picture rather than just the behavior itself will
> yield answers.  I would imagine that this person is on psychotropic
> medication and that his response to it is closely monitored.  Is the
> psychologist writing a behavior treatment plan to go with the medication
> monitoring now or is a plan already established?  Whatever is done with
> regard to the biting would need to be included in this.  What are the
> reasons that the behavior occurs?  Has there been an OT consulted to do a
> sensory work up?  This person could have sensory needs (proprioceptive,
> vestibular, etc.) that are not being met.  Are there environmental
triggers?
> It definitely takes the whole team to work through these issues.  I don't
> see this as a SLP or psychology issue alone.  There is certainly a limit
to
> what we as SLP's have to offer if these other things are not thoroughly
> evaluated.
>
> I agree with what everyone says about the chewy tubes being appropriate
for
> any age.  Does this person have PICA behavior?  That is the big concern
that
> I would have with giving something like this to this person.
>
>  -----Original Message-----
> From: Jill Silverman [mailto:JSilverman@dhmh.state.md.us]
> Sent: Wednesday, May 19, 2004 8:31 AM
> To: dysphagia@b9.com
> Subject: [Dysphagia] Aggressive MR POC
>
>      Hi All!  I would first like to thank those who provided me with
helpful
> suggestions for completing the gum trials with the individual I described
in
> my e-mail last week - against my better judgement - per Senior
Management's
> directive.  As I expected, he swallowed the gum immediately and engaged in
> SIB - biting his arm and hitting his head - even with the gum...Needless
to
> say, we are thankfully NOT moving forward with that idea...Thank G-d!!!
>    However, the Team (or in other words me and the Psychologist) are now
> left with the difficult mission of designing another plan.  Please
remember
> this man is violently aggressive, nonverbal, profoundly mentally retarded,
> h/o seizure disorder, & Diabetic - so edibles would certainly complicate
> things - even though I do not habitually prefer to use edibles.  With this
> group of developmentally disabled individuals who reside in an ICF/MR,
often
> food is the only natural motivator that is effective...I researched and
> suggested mouthing tools (or, chewy toys, tubes, teethers) as something we
> might try and was honestly "heckled" and told they were not age
appropriate.
> Now, yes, this man is in his 40's, but cognitively, he functions at
> approximately 6-12mos...Others "prefer" squeeky toys, activity boxes,
> mobiles, etc...Why then is my idea so preposterous?!  ANY other ideas
anyone
> could offer will be sincerely helpful!!!
> Respectfully yours, and awaiting your suggestions, Jill Silverman
>
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
>
>
> ------------------------------
>
> Message: 10
> Date: Wed, 19 May 2004 11:32:52 -0400
> From: "Pressman, Hilda" <pressmah@sjhmc.org>
> Subject: RE: [Dysphagia] Aggressive MR POC
> To: "'Sanders, Liza'" <LSanders@cvtc.state.va.us>, "'Jill Silverman'"
> <JSilverman@dhmh.state.md.us>, "'dysphagia@b9.com'" <dysphagia@b9.com>
> Message-ID: <9FE5266F7C76D31197A20050DA1355570C21502F@itr-mail>
> Content-Type: text/plain; charset="iso-8859-1"
>
> Pt should also be assessed and/or treated for reflux.  Mouthing behaviors
> are often reduced with treatment.  Mouthing produces increased secretions
> which help to neutralize the acid.  If the pt is feeling "heartburn" the
> mouthing behavior is helping him.  Hilda Pressman
>
> -----Original Message-----
> From: Sanders, Liza [mailto:LSanders@cvtc.state.va.us]
> Sent: Wednesday, May 19, 2004 10:56 AM
> To: 'Jill Silverman'; 'dysphagia@b9.com'
> Subject: RE: [Dysphagia] Aggressive MR POC
>
>
> It is difficult to sort through all of the problems that persons with
> complex issues have.  It sounds like the chewing/biting/SIB is part of the
> larger issue that is also being addressed with this person.  Maybe looking
> at it as part of the big picture rather than just the behavior itself will
> yield answers.  I would imagine that this person is on psychotropic
> medication and that his response to it is closely monitored.  Is the
> psychologist writing a behavior treatment plan to go with the medication
> monitoring now or is a plan already established?  Whatever is done with
> regard to the biting would need to be included in this.  What are the
> reasons that the behavior occurs?  Has there been an OT consulted to do a
> sensory work up?  This person could have sensory needs (proprioceptive,
> vestibular, etc.) that are not being met.  Are there environmental
triggers?
> It definitely takes the whole team to work through these issues.  I don't
> see this as a SLP or psychology issue alone.  There is certainly a limit
to
> what we as SLP's have to offer if these other things are not thoroughly
> evaluated.
>
> I agree with what everyone says about the chewy tubes being appropriate
for
> any age.  Does this person have PICA behavior?  That is the big concern
that
> I would have with giving something like this to this person.
>
>  -----Original Message-----
> From: Jill Silverman [mailto:JSilverman@dhmh.state.md.us]
> Sent: Wednesday, May 19, 2004 8:31 AM
> To: dysphagia@b9.com
> Subject: [Dysphagia] Aggressive MR POC
>
>      Hi All!  I would first like to thank those who provided me with
helpful
> suggestions for completing the gum trials with the individual I described
in
> my e-mail last week - against my better judgement - per Senior
Management's
> directive.  As I expected, he swallowed the gum immediately and engaged in
> SIB - biting his arm and hitting his head - even with the gum...Needless
to
> say, we are thankfully NOT moving forward with that idea...Thank G-d!!!
>    However, the Team (or in other words me and the Psychologist) are now
> left with the difficult mission of designing another plan.  Please
remember
> this man is violently aggressive, nonverbal, profoundly mentally retarded,
> h/o seizure disorder, & Diabetic - so edibles would certainly complicate
> things - even though I do not habitually prefer to use edibles.  With this
> group of developmentally disabled individuals who reside in an ICF/MR,
often
> food is the only natural motivator that is effective...I researched and
> suggested mouthing tools (or, chewy toys, tubes, teethers) as something we
> might try and was honestly "heckled" and told they were not age
appropriate.
> Now, yes, this man is in his 40's, but cognitively, he functions at
> approximately 6-12mos...Others "prefer" squeeky toys, activity boxes,
> mobiles, etc...Why then is my idea so preposterous?!  ANY other ideas
anyone
> could offer will be sincerely helpful!!!
> Respectfully yours, and awaiting your suggestions, Jill Silverman
>
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
>
>
> ------------------------------
>
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
>
>
> End of Dysphagia Digest, Vol 6, Issue 15
> ****************************************
>