[Dysphagia] Thickened liquids!

[Namp304 at aol.com (Namp304@aol.com)]

In a message dated 9/29/2005 2:28:10 PM Central Standard Time,  
dmhignight@comcast.net writes:

I wonder  if there will ever come a day when we no longer support the 
> >  financial pockets of the folks who sell thickened liquids? What an 
>  > incredibly perpetuated myth!!!!!! I wonder every day, as I evaluate my  
> > new admissions, what in the world was this SLP thinking??? And  the 
> > kicker is, the physician goes along with it! Has the medical  community 
> > lost their way? I think so. As I make my way amidst  the muck and mire 
> > of long term care, I am thankful for the sense  and sensibility of people 
> > like Irene who taught me to educate,  educate, educate. Thanks for 
> > letting me vent. Patti D., SLP  



I would also like to repeat, tho it's been said before, that many times  
those of you who work in long term are dealing with a different issue than the  
SLP who saw the patient in the midst of an acute, often life-threatening  
illness, where the lungs simply would not tolerate, to the best of the  
pulmonologist's and perhaps other team members' estimation, any, or at least,  very 
little, aspiration!  We who work in acute do our best to avoid  recommending 
thickened liquids, but when it is obvious that a thicker liquid  is being 
tolerated....to the best we can tell...and especially when the  patient is not actively 
balking at it, we tend to see it as the lesser of the  evils, so to speak.  
Many patients enter acute care from long term with an  active pneumonia and are 
in varying states in terms of ability to tolerate any  PO at all, all the way 
to those who seem near normal in the swallow  department.  One of the biggest 
frustrations is just as they begin to turn  the corner, and I think they are 
showing signs of being able to tolerate thins  again, (recovering more general 
strength or just becoming more alert and able to  use compensatory techniques), 
they are gone!  Back to the LTC facility from  whence they came, or perhaps a 
new one if family felt the reason they became so  ill was lack of good care, 
etc.  I hope most LTC SLPs realize that when  they have a new admission, this 
person is very likely at a different  level than when the acute SLP saw that 
person.  Even 24 hours makes a huge  difference!  I know thickened liquids 
aren't always the most attractive,  but believe me, if I had a serious illness, I 
hope I would look at all the  angles.  I have presented some of these items 
calling them "fruit  smoothies, shakes", etc, and can often educate the patient 
as to the usefullness  of these items, albeit, hopefully, for a short period.  
I usually have  pretty good luck with my patients in this department.  Then, 
I may be  passing the room and overhear the patient care tech making some 
deragatory  remark about "OH, you poor thing, they're making you drink this 
stuff!" and I  want to scream!  
 
Sorry, I guess that touched a nerve!  I think it was the "what was  this SLP 
thinking?" comment that got to me.  We acute SLPs think a LOT of  things.  
Like how best to help the person stay alive and recover the  relative health they 
had before becoming ill!  
 
Thanks for listening!  
Nancy Parkinson, MA, CCC-SLP