[Dysphagia] MBS results

[krigley at beaumonthospitals.com (Katherine Rigley)]

I would agree that overexpose to fluoroscopy is never a good idea.  If I
am conducting a MBSS and need to eval a pt's endurance, I would proceed
with the MBSS per protocol...but whenever indicated, I would then test a
pt's endurance 'off camera.'  The pt may be asked to continue
eating/drinking for several minutes.  Eventually, a few more brief shots
are taken and a tentative comparison of the previous ones is made. 
Especially if there is suspicion of myasthenius gravis or some other
fatiguing condition.  This may not actually 'overexpose' the pt at all,
but rather offer an opportunity to get a closer look at behavior over
time.



Kathy Rigley, M.A., CCC
Speech & Language Pathologist
William Beaumont Hospital-Troy
Phone: (248) 964-0663
krigley@beaumonthospitals.com

>>> <pressmah@sjhmc.org> 07/01/05 09:34AM >>>
A Modified Barium Swallow is a moment in time.  We usually do not test
for
endurance due to concern about increased exposure to x-ray as well as
the
realities of time pressures for th x-ray room.  The treating clinician
should always assess tolerance and intervene as needed.  Your
treatment
protocol can be based on the info from the MVS as well as your
observations
during eating.   

Hilda Pressman, MA, CCC SLP BRS-S
Board Recognized Specialist in Swallowing and Swallowing Disorders


-----Original Message-----
From: v.cooper [mailto:v.cooper@sbcglobal.net] 
Sent: Thursday, June 30, 2005 10:39 PM
To: dysphagia@b9.com 
Subject: [Dysphagia] MBS results


I am trying to get feedback from others who do MBSs regularly.

I work in a SNF. I referred an NPO brainstem stroke pt to acute for
mbs. She
came back w/recommendation for pureed w/thin liquid diet, and a
statement to
"leave the GT in for a week to assess tolerance" No therapy
recommended.
Results showed an 8 sec swallow delay and significant pharyngeal
pooling but
"no penetration or aspiration". I did bedside eval and found resident
to be
coughing severely after 5-6 tsp of pureed and 2-3 tsps of thin from
spoon.
She was clearly in distress. 

Family is very upset because ST at acute told them that she did "Great"
and
was ready to have the tube d/cd. Then I tell them that she does not
appear
safe. When they saw her coughing themselves, they believed me.

Do others make such recommendations based on what I consider to be not
so
great MBS results? Please advise

Thanks,

Virginia Cooper


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