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[Dysphagia] Growing concern
JoAnn Eaton <joanneaton@charter.net> wrote:
Irene
I also think it's important to have courses on dysphagia.
*** I didn't say there shouldn't be courses or texts- but they should not be called "dysphagia" as that means the course is all about a symptom - such as having a course on nausea. The causes are endless and the sloppy use of language leads to sloppy thinking i.e. that dysphagia is a disease entity in and of itself.
BTW, dysarthria is also a symptom so the course is properly entitled "Motor speech disorders" but aphasia is a diagnostic entity that in most locations SLPs cannot make - as it is a diagnosis. It requires something along the lines of "Thie patient's communication is consistent with a non-fluent aphasia ...."
Irene.
After all, don't
we have courses on dysarthria and aphasia. None of those are root causes,
but they all address the need to know the root cause to treat the
individual. But your point of the tendency of some to treat the symptom
without understanding the underlying cause is a valid reminder for all of us
in educating ourselves and others.
JoAnn Eaton
----- Original Message -----
From: "Paula Leslie"
To: "dysphagia" ; "Irene Campbell-Taylor"
Sent: Wednesday, January 12, 2005 11:37 AM
Subject: RE: [Dysphagia] Growing concern
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 =====
>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
_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia
Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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