|
[Date Prev][Date Next]
[Chronological]
[Thread]
[Top]
[Dysphagia] PEG inadvisability in end stage dementia
I think it is important to remind people that this article applies
strictly to the swallowing and eating problems of advanced dementia,
primarily to those in nursing home care situations, and not to people with
actue CVA nor to most of my pediatric patients in any way. Also, I'm a
little alarmed by the "PVS" (persistent vegetative state) comment - too
many doctors do not know the difference between PVS and severe disability
either motor, cognitive, or both, and very few are aware of the DMCN
article indicating recovery of social responsiveness in some children
diagnosed as having PVS.
Strictly speaking, PVS means re-establishment of sleep-wake cycles,
indicating a functional brain stem, but without any evidence of cortical
function. This is actually rare after truamatic brain injury and more
common after near-drowning or other severe hypoxic-ischemic injuries. It
is not a stage of recovery, but again, some persons may regain social
responses to some degree though they typically remain severely disabled.
"Minimally responsive state" is used in some of these cases if that
recovery is very limited and inconsistent. If this is ever suspected after
TBI, a trial of stimulant medication is absolutely indicated, it is less
clear whether this is ever helpful in anoxic injuries. Bibliography
available on request.
Vikki Stefans, M.D., pediatric physiatrist (rehab doc for kids) at UAMS
and Arkansas Children's Hospital. Working Mom of Sarah T. and Michael C.,
and wife of Henry Stefans. Every mom is a working mom!- OK, dads too.
On Fri, 29 Apr 2005 Namp304@aol.com wrote:
> Dear List,
>
> Within the last few years, I thought there was a published statement, from
> some authoritative group such as the AMA, which outlined the lack of evidence
> for tube feeding efficacy in late/end-stage dementia. Was I dreaming this? If
> not, does anyone have a reference?
>
> Thank you,
> Nancy Parkinson
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
>
|
|