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[Dysphagia] CP myotomy?
has he had endoscopy to look for gastritis and GER with esophagitis? He
could be having reflux layngitis too. If endoscopy is not desired, empiric
trial of Rx for GER and maybe even H. pylori could be done. Pneumonia can
be due to atlectasis or limited mobility, can he see a pulmonologist or at
least get PFTs adn CXR?
Vikki Stefans, M.D., pediatric physiatrist (rehab doc for kids) at UAMS
and Arkansas Children's Hospital. Working Mom of Sarah T. and Michael C.,
and wife of Henry Stefans. Every mom is a working mom!- OK, dads too.
On Wed, 22 Jun 2005, fay nascimento wrote:
> I need some input for the following:
>
> 45 y.o. male, adm to hospital April 3, 2005 with pneumonia. He requested a swallowing assessment as he has been having increasing difficulty with swallowing at home and wondered whether or not his difficulty with swallowing has contributed to his current respiratory problems.
>
> PMHx: chronic respiratory failure and recurrent pneumonia, C5-6 injury with resultant partial quadriplegia in 1993, cervical fusion, right vocal cord paralysis and thyroplasty in 1994, chronic pain, Crohn's disease, bowel resection in 1998, smoking, narcotic use, DVT, pulmonary embolism, laparotomy for a bleeding duodenal ulcer, theophylline toxicity, organic brain syndrome and a "tethering" of the right diaphragm.
>
> Has home ventilation nocturnally and has a tight to the shaft Bivona #8 trach
> Has G-feeds as well as some oral feeding prior to admission to hospital
> Diet at home consisted of fairly unrestricted items and included things like pasta and hamburgers and thin fluids
>
> An MBS was completed when he first got his trach in 2002 and reported nothing significant with the oral preparatory and oral phases, and the pharyngeal phase was timely with consistent epiglottic deflection, trace penetration of thin fluids during the swallow (but ejected with hyolaryngeal movement), and no other penetration/aspiration. There was slight vallecular residue with solids that was cleared with a liquid wash.
>
> Since that time, he has been back a couple of times for pneumonia and a fall while in his wheelchair.
>
> An MBS was repeated this adm. He has lost a significant amout of weight and his stoma is huge now around his trach.
>
> He had an MBS repeated at the end of May/05 and found: very slight hyolaryngeal movement during the pharyngeal swallow and this movement appeared to triggered in a timely fashion with the head of the bolus reaching the valleculae. There did not appear to an epiglottic deflection. All material overflowed the valleculae, the epiglottis ad entered into the airway. Four attempts were seen to swallow the material. The UES did not open. The material was aspirated and there was no coughing response to the aspiration. Upon review, it was questioned whether a slight protrusion was seen on the posterior pharyngeal wall about the level of the larynx; ? if it was attempted UES attempts to open.
>
> He had a laryngoscopy after this as they wondered if there was some obstruction. There was nothing found, and the ENT dilated the UES. His suggestion now is repeat MBS and if no improvement, then CP myotomy.
>
> The MBS will be done today. I am not certain what the myotomy may do in light of this other pharyngeal difficulties (such as decreased HL movement, Hx of R VF paralysis, silent aspiration).
>
> What has happened (possibly) to this gentleman? What can we suggest?
>
> IF YOU HAVE ANY THOUGHTS/COMMENTS/SUGGESTIONS, they are all welcome!
>
> Thank you.
> Fay
>
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