[Dysphagia] Growing concern

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

Paula Leslie <Paula.Leslie@newcastle.ac.uk> wrote:


I do think there is a place for "dysphagia" courses though. Perhaps, as I go
on and on about, courses in "SWALLOWING and what can go wrong".

*** It's the use of "dysphagia" I object to as it means very different things to different people. It is still defined as "difficulty passing foos through the esophagus" in many medical dictionaries. "Swallowing Disorders" or "Deglution Disorders" is clearer.

 It is quite possible,
I've seen it, that the clinical team are so focussed in on the primary
diagnosis of eg CVI that they presume that is the cause of the swallowing
disorder, and miss the actual cause eg meds, progressive (but undiagnosed)
condition etc. There is a danger of being mislead by the primary diagnosis.

****Which is the reason I ignore the Dx and look at what the history and clinical exam tells me.

"I have a 62 year old gentleman who suffered from a stroke causing ischaemia
in the right side of his brainstem. He then developed aspiration and
dysphagia. This has been progressive over the last 3 months and he now cannot
swallow anything at all and is on PEG.There is no history of any significant
medical problem apart from dyspepsia in the past."

*** All one has to see is "brainstem stroke" and "progressive" to know that there's more here than meets the eye e.g meds first as a possible, paraneoplastic syndrome, influence from GER (chemical pneumonitis ), problems associated with the PEG etc. etc. What comorbidities are there - there have to be some such as diabetes, thyroid dysfunction that can contribute to swallowing problems. Anyone working in this field MUST know this as the ASHA position paper on skills and knowledge points out.

Irene.




>===== Original Message From 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
>Exclusive Distributor:
>www.interactivetherapy.com
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>Dysphagia mailing list
>Dysphagia@b9.com
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Paula Leslie
Degree Programme Director
Surgical and Reproductive Sciences
Faculty of Medical Sciences
University of Newcastle
Newcastle upon Tyne
NE2 4HH
UK
T +44 (0) 191 222 6279
F +44 (0) 191 222 8988
http://www.ncl.ac.uk/sars/postgrad/MSc.htm





Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com