|
[Date Prev][Date Next]
[Chronological]
[Thread]
[Top]
[Dysphagia] RE: Dysphagia Digest, Vol 20, Issue 1
- Subject: [Dysphagia] RE: Dysphagia Digest, Vol 20, Issue 1
- From: Isabelle_Sutula at mhhs.org (Sutula, Isabelle)
- Date: Fri Jul 1 13:12:49 2005
"Re: straws"
When I do a MBS, I test the patient drinking thin liquid by straw if
they do not have aspiration or penetration with the cup. I have seen a
trend in geriatric patients that even when they have no other problem,
they tend to have laryngeal penetration with residue by straw. I
suspect they have difficulty coordinating sucking with swallowing
because they take too large a bolus and it goes over the back of the
tongue before they are ready to swallow.
-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf Of dysphagia-request@b9.com
Sent: Friday, July 01, 2005 10:54 AM
To: dysphagia@b9.com
Subject: Dysphagia Digest, Vol 20, Issue 1
Send Dysphagia mailing list submissions to
dysphagia@b9.com
To subscribe or unsubscribe via the World Wide Web, visit
http://lists.b9.com/mailman/listinfo/dysphagia
or, via email, send a message with subject or body 'help' to
dysphagia-request@b9.com
You can reach the person managing the list at
dysphagia-owner@b9.com
When replying, please edit your Subject line so it is more specific
than "Re: Contents of Dysphagia digest..."
Today's Topics:
1. RE: therapy (Hummelbrunner, Jackie)
2. re: therapy (smilinggirl336@comcast.net)
3. RE: re: therapy (Clarke-Goertz, Kim (PAPHR))
4. MBS results (v.cooper)
5. RE: MBS results (Paula leslie)
6. RE: MBS results (pressmah@sjhmc.org)
7. RE: MBS results (Katherine Rigley)
8. Feedback on Straw drinking (Alicia Multari)
9. Conference (pressmah@sjhmc.org)
10. RE: Feedback on Straw drinking (pressmah@sjhmc.org)
----------------------------------------------------------------------
Message: 1
Date: Thu, 30 Jun 2005 13:14:48 -0500
From: "Hummelbrunner, Jackie" <JHummelbrunner@lwdh.on.ca>
Subject: RE: [Dysphagia] therapy
To: "'Nancy Burnett'" <NBurnett@cmh.org>, "'dysphagia-bounces@b9.com'"
<dysphagia-bounces@b9.com>, "'adriane blauvelt'"
<ADBlauv@comcast.net>, dysphagia@b9.com
Message-ID:
<0C2018322596F443AD45F385A493C4E209569D@lws03030.hospital.lwdh.net>
Content-Type: text/plain
I couldn't agree more. Document what you have done to facilitate full
understanding of her situation and potential outcomes for the decision
she
is choosing and then I don't think there is much more you can offer.
Jackie Hummelbrunner, M.Sc. Reg. CASLPO, S-LP (C)
Speech - Language Pathologist
Lake of the Woods District Hospital
jhummelbrunner@lwdh.on.ca
SLP/Aud. Coordinator
Rehabilitation Studies & Continuing Professional Development
Health Sciences North
jhummelbrunner@hscn.on.ca
(807) 468 - 9861 ext (481)
TOLL FREE: 1-800-279-4859
-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf
Of Nancy Burnett
Sent: Thursday, June 30, 2005 11:14 AM
To: 'dysphagia-bounces@b9.com'; 'adriane blauvelt'; dysphagia@b9.com
Subject: RE: [Dysphagia] therapy
If she's competent and understands the risks, more power to her!
Nancy Burnett,
Speech-Language Pathologist,
Cambridge Memorial Hospital,
700 Coronation Blvd.,
Cambridge, Ontario.
N1R 3G2
Telephone: 519 - 621 - 2330 ext 1126/Pager 1104
Fax: 519 - 740 - 4978 Attention Nancy Burnett 3BN
Email: nburnett@cmh.org
> -----Original Message-----
> From: dysphagia-bounces@b9.com [SMTP:dysphagia-bounces@b9.com] On
Behalf
> Of adriane blauvelt
> Sent: June 30, 2005 9:49 AM
> To: dysphagia@b9.com
> Subject: [Dysphagia] therapy
>
> Hi everyone,
> I have one client iwht dysphagia who practices all the strategies in
front
> of me,a nd says yes she will do them, but as soon as I leave she does
what
> she wants. I have tried counceling sessions, educating the client and
her
> family, results of the MBS study, and nothign seems to convince her
that
> she needs to stay on ehr diet. Does anyone ahve any
> suggestions?_______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia
------------------------------
Message: 2
Date: Thu, 30 Jun 2005 19:16:52 +0000
From: smilinggirl336@comcast.net
Subject: [Dysphagia] re: therapy
To: dysphagia@b9.com
Message-ID:
<063020051916.21990.42C44524000D4A3C000055E62200762302C0CCCC049D07090902
070407039C@comcast.net>
Content-Type: text/plain
OK, My high horse here......We cannot force patients to do what we want
them to do, even if we know/believe what we are teaching is right.
Expecting patients to obey aspiration precautions or diet modifications
is like expecting people to stop smoking or lose weight because it
increases their risk of heart attack or stroke or diabetes. Our job is
to teach them as best we can - what is wrong, why, best management
strategies, and the possible consequences. People will choose to comply
or not.
I have associated with SLP's who feel that we then should not treat
aspiration pneumonia when patients do not comply with our instructions.
That would be like saying, "You didn't lose the weight, so I'm not
treating your heart attack!" We are professionals, not dictators! We
have to respect everyone's right to choose! That doesn't make our job
any less important -
------------------------------
Message: 3
Date: Thu, 30 Jun 2005 14:30:39 -0600
From: "Clarke-Goertz, Kim (PAPHR)" <kgoertz@paphr.sk.ca>
Subject: RE: [Dysphagia] re: therapy
To: dysphagia@b9.com
Message-ID:
<0528614E554C8045984C7227C67337640249F61F@mailhost.paphr.sk.ca>
Content-Type: text/plain; charset="iso-8859-1"
I agree, but so often I find in our field that the perseverance comes
more
from wanting to help (because that's what we do darn it!) and not as
much
from dictating.
The bottom line remains the same, it is the choice of the patient and
sometimes when trying to "help" we lose sight of that.
I had a mentor tell me once to "never be afraid to see the back of a
patient"; it doesn't necessarily mean you failed, it means they chose
otherwise and that is individuality.
Kim
-----Original Message-----
From: smilinggirl336@comcast.net [mailto:smilinggirl336@comcast.net]
Sent: Thursday, June 30, 2005 13:17
To: dysphagia@b9.com
Subject: [Dysphagia] re: therapy
OK, My high horse here......We cannot force patients to do what we want
them
to do, even if we know/believe what we are teaching is right. Expecting
patients to obey aspiration precautions or diet modifications is like
expecting people to stop smoking or lose weight because it increases
their
risk of heart attack or stroke or diabetes. Our job is to teach them as
best we can - what is wrong, why, best management strategies, and the
possible consequences. People will choose to comply or not.
I have associated with SLP's who feel that we then should not treat
aspiration pneumonia when patients do not comply with our instructions.
That would be like saying, "You didn't lose the weight, so I'm not
treating
your heart attack!" We are professionals, not dictators! We have to
respect everyone's right to choose! That doesn't make our job any less
important -
_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia
------------------------------
Message: 4
Date: Thu, 30 Jun 2005 19:38:46 -0700
From: "v.cooper" <v.cooper@sbcglobal.net>
Subject: [Dysphagia] MBS results
To: <dysphagia@b9.com>
Message-ID: <004001c57de6$01d93790$6501a8c0@VAIO>
Content-Type: text/plain; charset="Windows-1252"
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
------------------------------
Message: 5
Date: Fri, 1 Jul 2005 08:28:27 +0100
From: Paula leslie <Paula.Leslie@newcastle.ac.uk>
Subject: RE: [Dysphagia] MBS results
To: "v.cooper" <v.cooper@sbcglobal.net>, <dysphagia@b9.com>
Message-ID: <42C44151@webmail.ncl.ac.uk>
Content-Type: text/plain; charset="ISO-8859-1"
Hello Virginia
I know things are different here (UK) but I'm lucky in that although I'm
the
equivalent of your acute VF SLP I would virtually always have the
"treating"
SLP (eg you) in with me. I can't do a VF without the clinical history
side,
because it is just a snapshot. For all VFs that are referred to me
there is a
form the treating clinician fills in with all sorts of info, so if the
worst
happens and they can't attend I have a reasonable amount of info to go
with.
So I, as the acute person have a good report from the treating SLP with
the
whys & wherefores and what they want assessing in what manner, which I
can go
beyond if I deem appropriate. Then I send back a detailed report. If
the
treating SLP has not been in on the session I would at least phone and
preferably meet to go over the tape (but part of that is internal
training).
I know this is not always possible due to working patterns (but in the
UK we
should make more of an effort).
You may have done all this already. Can you phone the VF SLP or get to
see
her/him? What exactly did they try, how much, off what size spoon or
cup etc.
If all the report said is what you've given here, then that's a very
poor
report indeed and I would be straight back the acute SLP. No I would
not make
recommendations on that sort of info but I wouldn't produce that sort of
report either.
You must have thought your patient was ready for something to request
the VF.
It's possible that your client needs a bigger bolus than teaspoon sizes
to
trigger an effective swallow (most people do). Was the 8 sec delay
because
the patient was holding it in the mouth and once it did move back the
swallow
kicked in nicely? Or were there barium filled valleculae and piriforms
for 8
secs with the staff all holding their breath?
I think more info is needed from both sides to see why the behaviour is
so
different in the same patient. Sorry I can't offer any magic solutions.
Good Luck!
Paula
>===== Original Message From "v.cooper" <v.cooper@sbcglobal.net> =====
>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
>
>
>_______________________________________________
>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
------------------------------
Message: 6
Date: Fri, 1 Jul 2005 09:34:41 -0400
From: pressmah@sjhmc.org
Subject: RE: [Dysphagia] MBS results
To: v.cooper@sbcglobal.net, dysphagia@b9.com
Message-ID: <9FE5266F7C76D31197A20050DA1355570C2152DE@itr-mail>
Content-Type: text/plain; charset="iso-8859-1"
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
_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia
------------------------------
Message: 7
Date: Fri, 01 Jul 2005 09:55:55 -0400
From: "Katherine Rigley" <krigley@beaumonthospitals.com>
Subject: RE: [Dysphagia] MBS results
To: <dysphagia@b9.com>, <v.cooper@sbcglobal.net>, <pressmah@sjhmc.org>
Message-ID: <s2c51323.026@smtpgw.beaumont.edu>
Content-Type: text/plain; charset="us-ascii"
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
_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia
_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia
-------------- next part --------------
BEGIN:VCARD
VERSION:2.1
X-GWTYPE:USER
FN:Rigley, Katherine
TEL;WORK:248-96-40663
ORG:;Speech Pathology - Troy
EMAIL;WORK;PREF;NGW:KRigley@beaumonthospitals.com
N:Rigley;Katherine
END:VCARD
BEGIN:VCARD
VERSION:2.1
X-GWTYPE:USER
FN:Rigley, Katherine
TEL;WORK:248-96-40663
ORG:;Speech Pathology - Troy
EMAIL;WORK;PREF;NGW:KRigley@beaumonthospitals.com
N:Rigley;Katherine
END:VCARD
BEGIN:VCARD
VERSION:2.1
X-GWTYPE:USER
FN:Rigley, Katherine
TEL;WORK:248-96-40663
ORG:;Speech Pathology - Troy
EMAIL;WORK;PREF;NGW:KRigley@beaumonthospitals.com
N:Rigley;Katherine
END:VCARD
BEGIN:VCARD
VERSION:2.1
X-GWTYPE:USER
FN:Rigley, Katherine
TEL;WORK:248-96-40663
ORG:;Speech Pathology - Troy
EMAIL;WORK;PREF;NGW:KRigley@beaumonthospitals.com
N:Rigley;Katherine
END:VCARD
------------------------------
Message: 8
Date: Fri, 01 Jul 2005 10:12:27 -0400
From: "Alicia Multari" <MULTARIA@nychhc.org>
Subject: [Dysphagia] Feedback on Straw drinking
To: <Dysphagia@b9.com>
Message-ID: <s2c5172e.091@gwia.nychhc.org>
Content-Type: text/plain; charset="US-ASCII"
I have a question re: straw drinking with patients and how with some
patient's it faciliates easier transport and more natural swallowing
while in others it clearly appears to lead to coughing..Why is it that
there is such variability within populations (dementia, aphasia etc)?
Alicia Multari, MS CCC-SLP
Elmhurst Hospital Center
Elmhurst, NY 11373
-----------------------------------------
CONFIDENTIALITY NOTICE:
The information in this E-Mail may be confidential and may be legally
privileged. It is intended solely for the addressee(s). If you are not
the intended recipient, any disclosure, copying, distribution or any
action taken or omitted to be taken in reliance on this e-mail, is
prohibited and may be unlawful. If you have received this E-Mail
message in error, notify the sender by reply E-Mail and delete the
message.
------------------------------
Message: 9
Date: Fri, 1 Jul 2005 11:26:15 -0400
From: pressmah@sjhmc.org
Subject: [Dysphagia] Conference
To: Dysphagia@b9.com
Message-ID: <9FE5266F7C76D31197A20050DA1355570C2152E1@itr-mail>
Content-Type: text/plain; charset="iso-8859-1"
October 27-28, 2005
Wayne, NJ
CONTEMPORARY ASPECTS OF ADULT DYSPHAGIA:
FOCUS ON TREATMENT
An opportunity to update your clinical skills. The conference,
presented by
St. Joseph's Regional Medical Center features Lori M. Burkhead-Dysphagia
Treatment in the Tracheostomized and Ventilator Dependent Patient;
Leslie A.
Will-Perspectives on Swallowing Disorders and Their Treatment in
Parkinson's
Disease with Emphasis on LSVT(r) and the Staff of the Swallowing Center
at St.
Joseph's Medical Center Treatment Recommendations from the Modified
Video
Fluoroscopic SwallowStudy. (Earn 12 credit hours/1.2 ASHA CEUs. You
may
attend one or both days. Contact: 973-754-2924 or pressmah@sjhmc.org.
Printed brochures will be available in approximately 2 weeks. I can
e-mail
a copy now if you have Publisher
Hilda Pressman, MA, CCC SLP BRS-S
Board Recognized Specialist in Swallowing and Swallowing Disorders
------------------------------
Message: 10
Date: Fri, 1 Jul 2005 11:29:23 -0400
From: pressmah@sjhmc.org
Subject: RE: [Dysphagia] Feedback on Straw drinking
To: MULTARIA@nychhc.org, Dysphagia@b9.com
Message-ID: <9FE5266F7C76D31197A20050DA1355570C2152E3@itr-mail>
Content-Type: text/plain; charset="iso-8859-1"
I have found that for some patients you get a better swallow as you are
reverting to an infantile pattern of suck-swallow. The straw also keeps
the
clients head in neutral. For others, who demonstrated apraxia for
swallowing they don't know what to do with the amount in their mouth
while
the straw remains. For these patients we are often able to demonstrate
a
safe swallow by removing the straw to allow the patient to swallow and
then
offering the straw again.
Hilda Pressman, MA, CCC SLP BRS-S
Board Recognized Specialist in Swallowing and Swallowing Disorders
-----Original Message-----
From: Alicia Multari [mailto:MULTARIA@nychhc.org]
Sent: Friday, July 01, 2005 10:12 AM
To: Dysphagia@b9.com
Subject: [Dysphagia] Feedback on Straw drinking
I have a question re: straw drinking with patients and how with some
patient's it faciliates easier transport and more natural swallowing
while
in others it clearly appears to lead to coughing..Why is it that there
is
such variability within populations (dementia, aphasia etc)?
Alicia Multari, MS CCC-SLP
Elmhurst Hospital Center
Elmhurst, NY 11373
-----------------------------------------
CONFIDENTIALITY NOTICE:
The information in this E-Mail may be confidential and may be legally
privileged. It is intended solely for the addressee(s). If you are not
the intended recipient, any disclosure, copying, distribution or any
action taken or omitted to be taken in reliance on this e-mail, is
prohibited and may be unlawful. If you have received this E-Mail
message in error, notify the sender by reply E-Mail and delete the
message.
_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia
------------------------------
_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia
End of Dysphagia Digest, Vol 20, Issue 1
****************************************
|
|