[Dysphagia] Growing concern

[eripley at yahoo.com (Irene Campbell-Taylor)]

While doing some online research I came across the following that was presented at a state SHA meting (I won't mention which one as I don't want to embarass anyone). It was sponsored by Novartis, for obvious reasons but the notion expressed sums up a fundamental and extremely important problem in the fireld of swallowing disorders - one that the Italians have dubbed "deglutology"

Introduction 

? In the past ?dysphagia? was a secondary

diagnostic category

? As a primary diagnosis ?dysphagia? crosses

professional practice boundaries.

? As a co-morbidity dysphagia crosses many
diagnostic categories.
 
"Dysphagia" has NEVER been a diagnostic category, secondary or otherwise. To think of it as such is extremely hazardous to management because it bypasses the first and most fundamental aspect of intervention - What is the CAUSE of the SYMPTOM called "dysphagia". Without knowing the cause, no VALID intervention can take place. To say that the cause is, for example CVA, is insufficient. What type, where, how large, involving which nerves, structures etc.
 Above, it is referred to a a "comorbidity". Either the author doesn't know the meaning of "comorbidity" or somehow the definition of "symptom" changed when I wasn't looking.

In medicine, comorbidity describes the effect of all other diseases an individual patient might have other than the primary disease of interest. 

A symptom is: An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain. AND dysphagia.

To have "Courses on dysphagia" and "Texts on dysphagia" makes as much sense as "Courses on fever". One can't treat fever without knowing its cause. Of course, one can lower fever by various means but this is of little use unless its cause is determined: flu, cholera, plague, etc etc. Likewise, one can attempt to "treat" dysphagia symptomatically but without knowing the cause, the chance of treating effectively or even eliminating it is lost. What, for example, would one feel to discover that it had been caused by a medication and could be easily "cured" by d/c ing or changing the medication or changing the dosage? 

Irene.




Dr I Campbell-Taylor
Clinical Neuroscientist
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