[Dysphagia] Re: how much water?

[GuptaJ at SESAHS.NSW.GOV.AU (Jai Gupta)]

Hi all, I am really worried when people make a generalist comment that "each patient receives his or her requisite amount of water every day".....we don't have evidence do we? I have come across so many elderly citizens who do not drink a sip of water but live on tea or cordial some on bear ..it may be a culture thing ...and yet many live by 1-2 glass approx 500ml ...some may have more ...if we deduct that everyone must have ... how much is sufficient and is there a survey or study how much this population drinks anyway to survive without bouncing back to hospital ...I agree with Irene .....water is not lethal in the lungs as I have seen pts with 20 - 30% aspiration on Ba, refused to have thickened all the time ...sneaked water tea etc. but never had chest infection per se ....but these are rare cases ...some can cope some cannot we have to clinically observe their intake and what effects it has ...and there are obvious signs of asp pneu we know what they are and we go about it that way...we have to start keeping record.....I think it is hard nut to crack ...how much water and who can tolerate how much in their lungs, as Irene you have stated in the past ..oral care level, immune system, gen health, co-morbid conditions ...I think we cannot have a formula for this ,,we wish we had an easy solution... if anyone has I am happy to debate. ta

Jai Gupta. M.Sc.(S.H.) CPSP MSPA
Manager, Speech Pathology Services.
The Sutherland Hospital







-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of Irene Campbell-Taylor
Sent: Monday, 14 March 2005 11:42 AM
To: Vikki Stefans; smilinggirl336@comcast.net
Cc: dysphagia@b9.com
Subject: RE: [Dysphagia] Re: new list on Medicare holiday coverage


Vikki
Hear, Hear!  I don't really care if everything in the world is thickened  BUT only that attention is paid to the potential risk of dehydration and that it is made certain that each patient receives his or her requisite amount of water every day. This is least likely to happen in LTC and my plea is that attention be paid to the outstanding importance of hydration. And I very tired of the widespread conviction that part of a mouthful of water - even repeatedly, in the airway is going to be lethal.
Irene.

Vikki Stefans <vstefans@george.ach.uams.edu> wrote:
I basically agree that thickened liquids are helpful and use quite a bit
of them. BUT, we don't just do it on general priniciples, we do it for
individual patients whose swallowing studies suggest a definite decrease
in the amount of liquids going into the trachea instead of the esophagus
with thicker consistencies.

I have had a few patients who clinically cleared up respiratory problems
while inpatients after we studied them and stopped thin liquids at least
temporarily. The most memorable was a young man with C5 quadriplegia who
could not be weaned from oxygen though we could get off the vent until
this was done. He had what is commonly called "cervical dysphagia" and it
did improve, so he went home without an Rx for thickener. On an outpatient
basis, we have kids who stop "catching everything" and clear up chronic
congestion once this is done.

Again, it *is* WRONG to just assume that all people with swallowing
problems should have thickened liquids. Attention to nutrition and
hydration is critical when this is done; many people do not drink much if
they have to thicken. Others do fine.

In the real world which includes understaffing and undereducated staff,
there is a tendency to view things as black and white, simple solution
issues. People still have the misconception that if there is 10% (or
less!) aspiration of thin liquid seen on a VFSS, the person could choke to
death on a sip of water. And I still hear the phrase "passed their VFSS"
or "failed their VFSS" way too often. Of course, there is also the
converse misconception that patients in ICUs should all be started on thin
liquids when they have a gag reflex or at least seem able to swallow. :-)

I think I should start adding "all the simple problems have been solved
already" to my sig file.

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, 2 Mar 2005 smilinggirl336@comcast.net wrote:

> I am new to this dysphagia list and I am questioning why SLP's would be
> opposed to using thickened liquids.
>
> I am a proponent of using thickened liquids to reduce the risk of
> aspiration of thin liquids. I refrain from using the term "prevent"
> when it comes to aspiration, as I feel it is impossible to "prevent"
> aspiration, especially with saliva. I find that poor positioning in
> hospital beds and poor feeding techniques can increase the risk of
> aspiration with almost consistency. I feel my job is useful to reduce
> the risk of aspiration and to reduce the frequency of aspiration and I
> may do this by altering the consistency of foods and liquids. I think
> it is also important to look at the nature of the aspirate. I find that
> some patients find it uncomfortable to have coughing episodes while
> drinking and find swallowing thickened liquids to be more comfortable.
> Are not these reasons to use thickened liquids? Whenever possible, I
> want people to be on a "normal" diet; it is equally important that
> patient's will accept the consistencies and be able to meet their
> nutrtional and hydration needs. If these are not met, they will
> develop other problems (i.e. dehyrdation, malnutrition, cognitive
> changes, UTI). There is so much more to look at when we treat a patient
> than just aspiration risk.
>
> I also get upset when I see physician's (or others) document that they
> inserted a PEG tube to prevent aspiration. With the PEG tube, they have
> just opened up another can of worms, and we can't prevent aspiration!
>
> Anyway, as I am new to the list, I hope I am not just restating what has
> already been said - just trying to add my reasoning for using thickened
> liquids.
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Dr I Campbell-Taylor
Clinical Neuroscientist
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