[Dysphagia] severe esophageal/pharyngeal dysfunction

[ppollywogger at juno.com (ppollywogger@juno.com)]

i am seeing a patient in the nursing home 58 yr old male who was treated for lower esophageal cancer about 2yrs ago with radiation (to the lower portion) and later had part of the esophagus removed - including the crico-esophageal sphincter - the remaining portion of the esophagus was stretched upward... pt & spouse report normal swallow function until recently, though he has had ~120# wt loss since the original surgery... mbs reveals 0 epiglotic movement, poor pharyngeal constriction & absent esophageal relaxation (go figure). needless to say he aspirates everything, including his own secretions... in the past month he's been treated for aspiration pneumonia & received a j-tube. he is being suctioned prn d/t asp. of secretions. obviously he's verrry fragile. has anyone seen anything like this? my gut tells me there is little hope for this fella - but i wanted to post this in case someone has some magic beans for me.

thanks in advance - margaret