[Dysphagia] Dysphagia Services Start-up

[youngd at cope-foundation.ie (Young Denise)]

I have a question I would like to throw out to the list.  I have just taken
on a new position to begin dysphagia services for a Foundation that serves
clients with mild-severe intellectual difficulties across the life span.
Currently my team is trying to outline some policies and procedures for our
services as well as prepare some evaluation documents.  This is an area that
has not previously been explored in my site and there is a lot of work to be
done.  I would greatly appreciate any ideas or hints that can be passed
along to me. 

Thanks!
Denise

-----Original Message-----
From: dysphagia-request@b9.com [mailto:dysphagia-request@b9.com]
Sent: 17 January 2005 19:02
To: dysphagia@b9.com
Subject: Dysphagia Digest, Vol 14, Issue 16


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Today's Topics:

   1. RE: Dysphagia Digest, Vol 14, Issue 12 (Sutula, Isabelle)


----------------------------------------------------------------------

Message: 1
Date: Mon, 17 Jan 2005 10:55:42 -0600
From: "Sutula, Isabelle" <Isabelle_Sutula@mhhs.org>
Subject: [Dysphagia] RE: Dysphagia Digest, Vol 14, Issue 12
To: <dysphagia@b9.com>
Message-ID: <0F110B83C64FD943ACEC25E844B373774BBD65@EXCH3.mh.org>
Content-Type: text/plain;	charset="us-ascii"

What is the Masako maneuver?

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf Of dysphagia-request@b9.com
Sent: Wednesday, January 12, 2005 11:40 AM
To: dysphagia@b9.com
Subject: Dysphagia Digest, Vol 14, Issue 12

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Today's Topics:

   1. wait for swallow study for kids (Walsh, Linda)
   2. RE: MELAS (pressmah@sjhmc.org)
   3. patient s/p surgery (Casper219@aol.com)
   4. Re: patient s/p surgery (Irene Campbell-Taylor)
   5. Workshops (Irene Campbell-Taylor)
   6. Re: Workshops (CASK51454@aol.com)
   7. FEEDING PATIENT WITH BIPAP VENTILATION (Idel, Olga)
   8. Interesting article (Irene Campbell-Taylor)
   9. Growing concern (Irene Campbell-Taylor)
  10. NICU/peds protocol (Naomislp@aol.com)
  11. RE: Growing concern (Paula Leslie)


----------------------------------------------------------------------

Message: 1
Date: Tue, 11 Jan 2005 16:17:10 -0400
From: "Walsh, Linda" <LiWalsh@serha.ca>
Subject: [Dysphagia] wait for swallow study for kids
To: "'dysphagia@b9.com'" <dysphagia@b9.com>
Message-ID:
	
<41963130A3BAD611B0CC00A024B3869005693C0C@MAILSERV.r1se.rha-rrs.ca>
Content-Type: text/plain; charset="utf-7"

At our hospital, we provide swallow studies for all ages.  Our goal is
to
provide service based on patient need so wait times vary.  For
inpatients,
the wait is 0-3 days depending on priority and staff availability.  For
outpatients, there is more variability in wait time depending on total
numbers of referrals and priorities.  High priority cases are seen
within a
few days but low priority cases may wait several weeks.  The high
priority
cases for children tend to be admitted to hospital and are seen within a
couple of days.  Outpatient referrals for children are prioritized in
the
same way as those for adults but tend to be ranked more urgent than many
adults, so they are generally seen within 3-10 days.

From: Lynne <nprw@xmission.com>
Subject: [Dysphagia] how long of wait for swallow study for kids?

I have a question for everyone:  How long do kids usually have to wait
for a swallow study, where you are?
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Merci. 





------------------------------

Message: 2
Date: Tue, 11 Jan 2005 15:55:11 -0500
From: pressmah@sjhmc.org
Subject: RE: [Dysphagia] MELAS
To: mbhauser@velocity.net, dysphagia@b9.com
Message-ID: <9FE5266F7C76D31197A20050DA1355570C2151C8@itr-mail>
Content-Type: text/plain;	charset="iso-8859-1"

Sounds like fatigue is a significant factor.  Perhaps 6 small meals per
day
with high caloric content  Hilda Pressman

-----Original Message-----
From: Mary Hauser [mailto:mbhauser@velocity.net]
Sent: Friday, January 07, 2005 8:16 PM
To: dysphagia@b9.com
Subject: [Dysphagia] MELAS


I am writing for one of my school-based SLP friends.  (Sorry for the
length)

She has been having many neurological symptoms since last April, which
have
increased dramatically since November.  Some symptoms have included
sudden
weakness on left side, numbness and tingling, eye twitching,  and now
dysphagia symptoms (will describe later). This resolves after a few
hours,
but her legs still feel weak and "heavy" and her arm feels numb at
times. 

She has been going through numerous Dr. visits/tests and they have a
"possible" diagnosis of "MELAS":  mitochondrial encephalomyopathy with
lactic acidosis, and stroke-like Syndrome.  But  they have not ruled out
MS,
Sjogren's (sp) or something else unknown as yet.  I checked out MELAS,
and
it doesn't sound like something you'd want to develop, and the prognosis
is
poor. There was no mention of dysphagia as symptoms. 

She is 55 years of age, slightly overweight, and less than 5 feet tall.
She takes lotensin for high blood pressure and synthroid for multinodual
goiter. ( All blood tests show thyroid levels are WNL. ) She uses a CPAP
at
night for sleep apnea.

Dysphagia symptoms  (intermittent and can start mid-meal): 
Throat, back of tongue, tongue base, and velum will start to  "thighten"
"ache" and "feel tired" making swallowing very difficult.  She does not
feel
food sticking at laryngeal level or lower. But it is difficult for her
to
manipulate the bolus and start to swallow. It happens with all textures,
and
even some liquids.   In addition, her mouth is usually dry, until she
eats
then she has excess saliva and starts to drool on her left side of her
mouth.  

 She states that she has always had some difficulty swallowing things
like
pills and says she has "excessive" tissue in her pharynx including large
tonsils, uvula and a big tongue  ( I didn't look). 

I suggested small bites, alternate with liquids,  & trying lemon ice to
help
with the sticking.  But since I've never come across MELAS or simlar
symptoms, I'm not sure this is the best for her. 

Has anyone had a patient with MELAS, or similar symptoms?  Is there
something else I can do to help her?

Thanks!
mary_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia


------------------------------

Message: 3
Date: Tue, 11 Jan 2005 17:17:50 -0500
From: Casper219@aol.com
Subject: [Dysphagia] patient s/p surgery
To: dysphagia@b9.com
Message-ID: <609CA1A9.5F8214DF.0224F27A@aol.com>
Content-Type: text/plain; charset=iso-8859-1

Any suggestions for a 60 y.o. male 5 weeks s/p neck surgery (C3)?
During the surgery his esophagus and hypopharynx were moved out of the
surgical field.  His first MBS 10 days post showed he was aspirating all
consistencies.  He has developed a "hacking cough" that he calls
aspiration bronchitis (he is a neurosurgeon).  He has recently been able
to initiate exercise (Masako maneuver).  A follow up MBS showed trace
penetration with thin liquids and improvements allowing him to consume
pureed foods without aspiration.  He has lost weight and is currently
drinking nectar-like liquids and eating pureed food (Ensure and pudding
is what he described his diet).
Thank you for any thoughts.
Mary


------------------------------

Message: 4
Date: Tue, 11 Jan 2005 18:07:02 -0800 (PST)
From: Irene Campbell-Taylor <eripley@yahoo.com>
Subject: Re: [Dysphagia] patient s/p surgery
To: Casper219@aol.com, dysphagia@b9.com
Message-ID: <20050112020702.81850.qmail@web14003.mail.yahoo.com>
Content-Type: text/plain; charset=us-ascii

If the the clinical exam shows no evidence of nerve damage or brain stem
involvement or other neurological event during surgery, the problem is
most likely associated with post surgical edema and/or neural edema that
will resolve over time. 

Casper219@aol.com wrote:Any suggestions for a 60 y.o. male 5 weeks s/p
neck surgery (C3)? During the surgery his esophagus and hypopharynx were
moved out of the surgical field. His first MBS 10 days post showed he
was aspirating all consistencies. He has developed a "hacking cough"
that he calls aspiration bronchitis (he is a neurosurgeon). He has
recently been able to initiate exercise (Masako maneuver). A follow up
MBS showed trace penetration with thin liquids and improvements allowing
him to consume pureed foods without aspiration. He has lost weight and
is currently drinking nectar-like liquids and eating pureed food (Ensure
and pudding is what he described his diet).
Thank you for any thoughts.
Mary
_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia



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

------------------------------

Message: 5
Date: Tue, 11 Jan 2005 18:10:49 -0800 (PST)
From: Irene Campbell-Taylor <eripley@yahoo.com>
Subject: [Dysphagia] Workshops
To: dysphagia@b9.com
Message-ID: <20050112021049.33334.qmail@web14004.mail.yahoo.com>
Content-Type: text/plain; charset=us-ascii

I get several requests for information on workshops I'm giving in the
US. I will be presenting a full day institute at the Arizona Speech
Hearing Association meeting in Sedona on February 25th
www.arsha.org, and one in Akron OH April 15/16. Others to follow as
dates are firmed up.
Irene.



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

------------------------------

Message: 6
Date: Wed, 12 Jan 2005 00:12:37 EST
From: CASK51454@aol.com
Subject: Re: [Dysphagia] Workshops
To: eripley@yahoo.com, dysphagia@b9.com
Message-ID: <1f8.40ef840.2f160bc5@aol.com>
Content-Type: text/plain; charset="US-ASCII"

     
 
 
In a message dated 1/11/2005 8:12:04 P.M. Central Standard Time,  
eripley@yahoo.com writes:

one in Akron OH April 15/16


who is sponsoring this  meeting?




------------------------------

Message: 7
Date: Wed, 12 Jan 2005 16:46:46 +1100
From: "Idel, Olga" <Olga.Idel@wh.org.au>
Subject: [Dysphagia] FEEDING PATIENT WITH BIPAP VENTILATION
To: <dysphagia@b9.com>
Message-ID:
	<47ACDC47DB22434FA20CF493AF0264E120F840@beccmail.ssg.org.au>
Content-Type: text/plain;	charset="us-ascii"

Hello. I am wondering if anyone could share their swallowing
asssessment/ feeding practices/ policies with patients requiring CPAP or
BiPAP ventilation via face mask. I am trying to establish an evidence
based protocol for our acute respiratory unit and finding the literature
to be quite lacking. Any suggestions/ advice would be greatly
appreciated.
 
Many thanks.
Olga


------------------------------

Message: 8
Date: Wed, 12 Jan 2005 04:56:19 -0800 (PST)
From: Irene Campbell-Taylor <eripley@yahoo.com>
Subject: [Dysphagia] Interesting article
To: dysphagia@b9.com
Message-ID: <20050112125619.20814.qmail@web14023.mail.yahoo.com>
Content-Type: text/plain; charset=us-ascii

http://gut.bmjjournals.com/cgi/content/abstract/54/2/183
 
The procedure described here seems to be counterintuitive but improves
symptomatology by decreasing the exposure time of the esophagus to acid.


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

------------------------------

Message: 9
Date: Wed, 12 Jan 2005 06:17:13 -0800 (PST)
From: Irene Campbell-Taylor <eripley@yahoo.com>
Subject: [Dysphagia] Growing concern
To: dysphagia@b9.com
Message-ID: <20050112141713.47301.qmail@web14006.mail.yahoo.com>
Content-Type: text/plain; charset=us-ascii

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

------------------------------

Message: 10
Date: Wed, 12 Jan 2005 10:43:27 -0500
From: Naomislp@aol.com
Subject: [Dysphagia] NICU/peds protocol
To: dysphagia@b9.com
Message-ID: <23BD70C7.51ADABDC.007AB243@aol.com>
Content-Type: text/plain; charset=iso-8859-1

We are trying to begin offering dysphagia services in our NICU/pediatric
units but having some difficulty establishing a protocol for assessment.
For those working with these populations, do you write reports as
narrative or use some sort of assessment tool/form when performing
evaluations? Have you developed your own protocols in your facilities?
If anyone could forward sample eval protocol or form, would be much
appreciated...
Thanks in advance,
Naomi


------------------------------

Message: 11
Date: Wed, 12 Jan 2005 17:37:16 +0000
From: Paula Leslie <Paula.Leslie@newcastle.ac.uk>
Subject: RE: [Dysphagia] Growing concern
To: dysphagia <dysphagia@b9.com>, Irene Campbell-Taylor
	<eripley@yahoo.com>
Message-ID: <41E09055@webmail.ncl.ac.uk>
Content-Type: text/plain; charset="ISO-8859-1"

Hello Irene

I agree whole heartedly with the symptom/diagnosis concerns.  Dysphagia
is not 
a medical diagnosis although the NHS here does have it as primary
diagnosis 
code for hospital episode stats, generally for doctor/surgeons.  That
may be 
useful for tracking the symptom independent of the disorder but you may
then 
lose #s that should be registered to the disease.  And I don't know how
often 
drs record this when they have a medical diagnosis anyway.  Hospital
stats and 
SLP stats here can be very messy.

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".  A
person must 
know what the signs of a disordered swallow are.  Then work back to what
the 
medical diagnosis ie, underlying cause is/might be.  Sometimes there is
no 
diagnosis but we can begin the investigation process.  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.

In fact my boss just received this emailed from a surgical colleague in
a 
distant district:

"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."

The few tests they've done are negative and they want to go for surgery
- 
WHOA!!  We said.  Hold that knife.  Get to neuro and an SLP maybe.

I think perhaps there is something else going on...?

Without doubt, to know how a diagnosed condition affects the swallow and
how 
it will progress, is essential.  And this is one of the first things
that 
should be taught on a "dysphagia" course but SLT/Ps are usually generic
and 
need to work across all medical diagnoses.  They also need to know about

aspects that can be diagnosis independently eg hydration, nutrition, 
environment, psychosocial factors, and the HEALTHY swallow process.  So
I 
think we do need "swallowing and when it goes wrong courses" but not the

"dysphagia" title perhaps??

Paula


>===== Original Message From Irene Campbell-Taylor <eripley@yahoo.com>
=====
>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
>_______________________________________________
>Dysphagia mailing list
>Dysphagia@b9.com
>http://lists.b9.com/mailman/listinfo/dysphagia

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



------------------------------

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*****************************************


------------------------------

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