[Dysphagia] MBS results

[sorriso at adelphia.net (sorriso@adelphia.net)]

I agree with Paula, teaspoon size bites are likely not heavy enough to open the upper esophageal sphincter in turn causing the delay and resultant pooling.

Linda A. Zanchi, MA CCC-SLP
 
---- Paula leslie <Paula.Leslie@newcastle.ac.uk> wrote: 
> 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
> >
> >
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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
> 
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