[Dysphagia] Difficult case- consistent choking

[sorriso at adelphia.net (sorriso@adelphia.net)]

Is this Dr. Irene Campbell-Taylor with a new email address?  I hope I'm not "outing" you if you are trying to preserve anonymity but this response is classic Irene (and if you're trying to hide you should have chosen a different email name!) but it's unlike her not to sign her name in response.

Linda A. Zanchi, MA CCC-SLP

---- Drirenect@aol.com wrote: 
>  
> Given her meds and Hx I would guess that she  has Sjogren syndrome ( dry eyes 
> and OA) ? the xerostomia contributing  significantly to both GERD and 
> choking. Most of her meds will make the  xerostomia worse and she may well be 
> chronically dehydrated ? more likely  hypovolemic hyponatremia than hypernatremia 
> given her age and meds.. Her  hydration status needs to be checked and monitored 
> consistently ? food should be  moist and cohesive since xerostomia alone may 
> intermittently disrupt the  swallow. Scleroderma is also commonly associated 
> with Sjogren. Elderly persons  often do not c/o xerostomia and you indicate some 
> possible cognitive impairment.  It is also not possible to identify 
> dehydration by appearance  alone. 
> The falls could be due to meds (ataxia) or  to hemodynamic instability 
> related to  dehydration. 
> See: 
> Bouman WP; Pinner G; Johnson H  . Incidence of selective serotonin reuptake 
> inhibitor (SSRI) induced  hyponatraemia due to the syndrome of inappropriate 
> antidiuretic hormone (SIADH)  secretion in the elderly. Int J Geriatr 
> Psychiatry, 13:12-15  1998  
> In a sample of 32 eldely  patients taking SSRIs, four developed symptomatic 
> hyponatremia due to SIADH  (12.5%). Four more developed asymptomatic 
> hyponatremia following introduction of  an SSRI (12.5%), although laboratory 
> confirmation of SIADH was lacking. This  study shows a high incidence in elderly patients 
> of this potentially dangerous  complication. The use of SSRI?s in elderly 
> people must include monitoring of  electrolytes for early detection and reduction 
> of morbidity. 
> Nederfors T. Xerostomia:  prevalence and pharmacotherapy. With special 
> reference to beta-adrenoceptor  antagonists. Swed Dent J Suppl 116:1-70.1996. 
> The effects of one week on  propranolol and atenolol were compared with 
> placebo in three different trials by  600 subjects and 68 controls. Saliva 
> composition but not flow rates were  affected by the drugs, most changes being in 
> total protein composition and  amylase , both significantly decreased with the 
> saliva becoming thicker than  normal. 
> Lewis IK; Hanlon JT; Hobbins  MJ; Beck JD. Use of medications with potential 
> oral adverse drug reactions in  community-dwelling elderly. Spec Care Dentist 
> 13:171-6.1993. 
> Prevalence and indicators of  medication use with potential oral health 
> implications among 4,163 subjects were  studied. Medications were grouped into 
> seven potential oral adverse drug  reaction categories. Eighty percent of 
> participants were taking at least one  medication from any of the seven categories. 
> Drugs with the potential to cause  xerostomia were taken by 56.1%, abnormal 
> hemostasis by 51.7%, soft tissue  reactions by 23.4%, taste changes by 11.0%, 
> alteration in host resistance by  8.7%, gingival overgrowth by 5.0%, and movement 
> disorders by 2.4% of  participants 
> Korsten MA; Rosman AS;  Fishbein S; Shlein RD; Goldberg HE; Biener A. Chronic 
> xerostomia increases  esophageal acid exposure and is associated with 
> esophageal injury. Am J Med  90:701-6.1991. 
> This was a study of sixteen  male patients with xerostomia secondary to 
> radiation for head and neck cancers  or medications. There were nineteen 
> age-matched male control subjects with  comparable histories. Clearance of acid from the 
> esophagus and 24-hour  intraesophageal pH were abnormal in patients with 
> xerostomia. Symptoms and signs  of esophagitis were significantly more frequent. 
> As swallowing saliva is the  major means of esophageal clearance, chronic 
> xerostomia may predispose to  esophageal injury by decreasing the clearance of acid 
> from the esophagus and  altering  intraesophageal  pH 
> And there are many more  similar. 
> 
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