[Dysphagia] Re Lung ca patient

[QuinnD at rvh.on.ca (Quinn, Darin)]

Hi Sharon-

I'm not sure if this case can be necessarily compared directly but I also have a current patient with a hilar mass (along with several other malignant tumors) and she has bilateral vocal fold weakness identified on laryngoscopy.  She also was complaining of significant dysphagia - sticking of solids and liquids in throat as well as a lot of regurgitation and vomiting which they initially attributed to the chemo tx.  Clinical examination was normal from a mechanical point of view but she did cough inconsistently and regurgitate both solids and liquids.  I followed up with a MBS study and this confirmed a completely normal oral/pharyngeal swallow mechanism (aside from the weakened vf closure).  A BA swallow was then recommended and it revealed the problem - severe esophgeal dysmotility and LES achalasia.

As with your case, this lady is unfortunately paliative but at least they now know the true nature of the swallowing difficulties so they can hopefully help her to have as much quality of life as possible while here in the hospital.


Darin Quinn, MSc.
Speech-Language Pathologist
Professional Practice Leader, SLP
Royal Victoria Hospital of Barrie
201 Georgian Drive
Barrie, ON  L4M 6M2
(705)728-9090 ext. 4814 

> ----------
> From: 	dysphagia-bounces@b9.com[SMTP:dysphagia-bounces@b9.com] on behalf of sharon.manders@utoronto.ca[SMTP:sharon.manders@utoronto.ca]
> Sent: 	November 17, 2004 6:22 PM
> To: 	dysphagia@b9.com
> Subject: 	[Dysphagia] Re Lung ca patient
> 
> Sorry, I forgot to include his tx. He had a course of radiation that ended in 
> July. The swallowing difficulties started just before his therapy ended. He 
> has lost a lot of weight given that he really hasn't been able to eat/drink 
> for 4 months. 
> 
> He is being hydrated as we speak. The ENT gave no indication about any long 
> term effects. I am only involved because the nurse was horrified yesterday 
> when she tried to give him his meds and saw what happened with the water. He 
> explained to me that he can occasionally get the pills down at home, but is 
> not confident that they always get to the esophagus.
> 
> He is an 85 year old man who was otherwise in good condition when they started 
> radiation. To me he doesn't look that cachectic but the RD and the RN say that 
> he is.
> 
> The thoracic surgeon told me today that there is an esophageal obstruction. I 
> did not proceed with the MBS. The patient is palliative and I am treating him 
> on a comfort/quality of life basis. They are looking into dilation +/- a 
> stent. This will hopefully help with the esophagus but I am concerned re: 
> aspiration. So far he has not presented with a pneumonitis/pneumonia. I think 
> this is because he avoids po except for when he absolutely wants/needs it, and 
> pretty much brings up whatever he does manage to get down.
> 
> Thanks Irene for the reminder re: UES function. I am going to speak with the 
> oncologist tomorrow as he was not in today. At this time I am not aware of any 
> future plans for surgery, but he was admitted from our local cancer hospital. 
> Unfortunately, our records seem to be rather hit and miss and I think that a 
> good long conversation with the oncologist is warranted. 
> 
> Thanks so much to all who responded and please let me know if anyone has any 
> further ideas.
> 
> Sharon
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