[Dysphagia] Complicated patient

[sharon.manders at utoronto.ca (sharon.manders@utoronto.ca)]

Hi,

I am posting this for a colleague. If anyone has any ideas for where to go 
next with this man, she would be very grateful. Thanks 

The pt was admitted Sept. 27th 2004 with a dx of neck infection/ possible 
oesophageal obstruction progressing to respiratory failure & dysphagia. ?2 
days post dental surgery (at his dentist)
Past Med Hx: DMII, HTN

He bounced back and forth between the ICU and medicine floors and then went 
back to ICU Dec 28th 2004 with a diagnosis of botulism affecting his breathing 
and swallowing and was put on nocturnal venting due to recurrent hypercapneic 
arrest.

Neuro consult (Jan 22nd, 2005): Dx- Acute onset severe bulbar pure motor 
syndrome ? pt stable and gradually improving. (i.e., now walking and 
attending physio classes)

Differential diagnoses from this consult were: Botulism; Mf-GBS (Miller-Fisher 
variant of Guillain Barre); MG; Parkinsons-Plus syndrome 

Respirology consult (Feb. 24th 05)- currently aspirating saliva and not 
spontaneously expectorating

Pt was trached Oct. 16th 04 for resp. failure 
Initiated corking Jan 11, 2005
Changed to #6 Shiley cuffed and fenestrated Jan. 21 2005
Pulled out by pt and replaced ? Feb. 5th 2005
Now corked during the day and off at night (no nocturnal vent)
Pulled out by pt and replaced - Feb 24th 2005 

Current mode of Feeding: J-tube

He has not been able to take a drop of po since admission. Has anyone had a 
similar patient and any luck with any kind of treatment that we can do with 
him? Cognitively, he is WNL and able to participate, follow directions, etc.

Thanks in advance

Sharon