[Dysphagia] Re: The actual .....diet.

[jfurstoss at acmedctr.org (Furstoss, Jeanne ACMC)]

From: Straus S, Richardson W, Glasziou P, and Haynes R., Evidence Based
Medicine, 3rd edition. Elsevier. 2005. page 4....
(For many of us in our chosen specialty field, Swallowing Service
Provision)... we feel a need to be 'up to the minute' and very sure about
what we are doing.  Thus, we invest the time and energy in attempting to ask
questions, search for evidence, and critically appraise the evidience... 
...For conditions we encounter less often, a specialized diagnosis or
adjunct co-morbitiy, we use evidence resources that have been appraised by
others i.e. evidence summaries...
...If we are students or trainees, or have to act for conditions we
encounter infrequently, we blindly accept recommendations from
authoritiies...  


I come to this list serve to be stimulated with direction for questions I
encounter in clinical practice of Swallowing Service; (in addition to
questions regarding techniques I have found primarily clinically
inadequate...oral exercises, thermal stim, mendelson, thick liquids)  and
ideas on how to advance my skills in tracking down the best evidence and
critically appraising it.  I acknowledge the responsibility for my own
practice excellence lays with me.  As a novice on this journey, without my
old textbooks and notes from prior lectures, which I have actually thrown
away, (note Straus et al, page 32, recommendation to 'burn traditional
textbooks..')I am grateful to people I consider having mentored me as they
demonstrate the needed professional skills of consistently reviewing
literature and critically appraising it, well before they make integrated
judgements....  those who are willing to 'Show me the evidence.'  Those are
people I have found on this list serve and I am grateful to them.

Asking novice questions is essential to a learning environ, once we have
taken responsibility to do as thorough a research and i.e. archive review as
our skills allow.  

On this list serve, I have not observed 'experts' on a soap box.  
I have observed a need to be challenged to back up clinical performance with
evidence, as a requirement of our times.

Jeanne Furstoss  MS OTR/L SWC

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of Thomas Bishop
Sent: Saturday, September 17, 2005 6:47 PM
To: dysphagia@b9.com
Subject: RE: [Dysphagia] Re: The actual .....diet.


...totally senseless without thinking...

Isn't it interesting to read impulsive and unprofessional comments by
individuals that claim a sensitivity to professionalism as it relates to
research, clinical interventions and the like...

----------------
THE DESCRIPTION OF THIS MAILING LIST
About Dysphagia  English (USA)  
The Dysphagia Mail List was started in November of 1995. The mail list
provides a forum for various medical professionals to discuss clinical or
research issues and clinical cases, share ideas and news items, ask
questions, or ask for resources related to swallowing and its disorders. Job
postings related to the field of swallowing disorders are also allowed.
---------------

It doesn't sound like a snobby research society publication platform -- why
pretend that it is.  Why can't we relax and share information with
encouragement to better our knowledge, experience and data (without the sad
attacks on companies and individuals).

The only thing that appears senseless is the fact that some "experts" seem
to hover about this platform with what seems to be an underlying need to
"flex" or "vent" frustrations as a means to position themselves as superior.
These "experts" should be encouraged to stick to their own "big-boy"
platform and stop ruling the roost with such self-gratifying submissions
like the ones below.

You "experts" only belittle the valuable contribution you DO HAVE to
dysphagia.  

If you feel a need to reciprocate or defend, then your missing the point --
just chill out on the opinionisms (that word is for the snobs) and be more
encouraging for information which can be guided rather than judged.  

Remember -- this should be a learning environment rather than a testing
environment.


-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On Behalf
Of Barbara C. Sonies
Sent: Saturday, September 17, 2005 5:32 PM
To: Irene Campbell-Taylor; dysphagia@b9.com
Subject: Re: [Dysphagia] Re: The actual .....diet.

Again it is appalling that there are people out there who accept information
that is totally senseless without thinking.


> From: Irene Campbell-Taylor <eripley@yahoo.com>
> Date: Sat, 17 Sep 2005 15:16:30 -0700 (PDT)
> To: <dysphagia@b9.com>
> Subject: [Dysphagia] Re: The actual .....diet.
> 
> For once in my life I am actually speechless...although not really
surprised,
> given the source (VitalStim, I mean). the appalling thing, to me, is the
> amount of incorrect, nonsensical, dangerous so-called "information" that
is
> out there and being accepted because the recipients have a) been fed
incorrect
> data during training, b) have no scientific background whatsoever and c)
lack
> the capacity for logical thinking.
> Seriously, to have individuals with no basic sciences, far less medical
> knowledge involved in an area that is purely medical still scares the wits
out
> of me. How did this ever come about?
> 
> dysphagia-request@b9.com wrote:
> Send Dysphagia mailing list submissions to
> dysphagia@b9.com
> 
> To subscribe or unsubscribe via the World Wide Web, visit
> http://lists.b9.com/mailman/listinfo/dysphagia
> or, via email, send a message with subject or body 'help' to
> dysphagia-request@b9.com
> 
> You can reach the person managing the list at
> dysphagia-owner@b9.com
> 
> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of Dysphagia digest..."
> 
> 
> Today's Topics:
> 
> 1. the actual cricopharyngeal diet (sorriso@adelphia.net)
> 2. RE: cricopharyngeal diet (pressmah@sjhmc.org)
> 3. RE: the actual cricopharyngeal diet (Copeland, Karen)
> 4. Re: Cricopharyngeal Diet (NeuroSP@aol.com)
> 
> 
> ----------------------------------------------------------------------
> 
> Message: 1
> Date: Thu, 15 Sep 2005 16:14:34 -0400
> From: 
> Subject: [Dysphagia] the actual cricopharyngeal diet
> To: dysphagia@b9.com
> Message-ID:
> <24658682.1126815274834.JavaMail.root@web10.mail.adelphia.net>
> Content-Type: text/plain; charset=utf-8
> 
> Here's the "diet" as requested by a member of the ASHA list from the
VitalStim
> people:
> 
> Initial Diet for Patients with Cricopharyngeal Dysfunction
> 
> The following diet has been shown to be effective to the author (Marcy
Freed)
> for the patients who have a degree of cricopharyngeal dysfunction:
> 
> 1. Crunchy consistency
> a. Fritos
> b. Potato chips
> c. All crackers
> d. Pepperidge Farms Bordeaux cookies
> e. Toast with butter
> 
> 
> 2. Thinned puree consistency
> a. Thinned Oatmeal or Cream of Wheat
> b. Yogurt without fruit
> c. Strained creamed soups
> d. Mousse
> e. Soft drinks
> f. Tomato soup or pea soup
> 
> 3. Soft/Slippery consistency
> a. Angel hair pasta and olive oil
> b. Sweet potatoes with butter or margarine
> c. Soft boiled eggs
> d. Poached eggs
> e. Squash ?EUR" butternut or acorn
> f. Waffles that are cut into tiny pieces
> g. Meat loaf
> h. Whipped potatoes
> 
> The patient may progress as the cricopharyngeal problem improves.
Don?EUR(tm)t
mix
> food and liquid! First swallow food and then have a drink.
> 
> 4. Foods NEVER tolerated
> a. Pudding
> b. Applesauce 
> c. Pureed foods
> d. Mashed potatoes
> e. Red meats such as steak
> 
> The viscosity of food a,b,c and d contribute to increased vallecular and
> pyriform sinus retention. Lower viscosity foods clear more easily.
> 
> 
> 
> ------------------------------
> 
> Message: 2
> Date: Fri, 16 Sep 2005 07:53:37 -0400
> From: pressmah@sjhmc.org
> Subject: RE: [Dysphagia] cricopharyngeal diet
> To: OdonneK@doh.health.nsw.gov.au, sorriso@adelphia.net,
> dysphagia@b9.com, m.sanscartier@videotron.ca
> Message-ID: <9FE5266F7C76D31197A20050DA1355570C2153D2@itr-mail>
> Content-Type: text/plain; charset="iso-8859-1"
> 
> Goldfish crackers are crackers in the shape of goldfish. Crunchy and
small.
> Very popular with the kids RD is Registered Dietician
> 
> -----Original Message-----
> From: Kimberley ODonnell [mailto:OdonneK@doh.health.nsw.gov.au]
> Sent: Tuesday, September 13, 2005 7:56 PM
> To: sorriso@adelphia.net; dysphagia@b9.com; m.sanscartier@videotron.ca
> Subject: Re: [Dysphagia] cricopharyngeal diet
> 
> 
> 
> Hi all
> Please excuse my ignorance, hopefully just due to the fact that I am from
> Australia, but what is a goldfish cracker and what does RD stand for?
> Thanks in advance.
> Kim
> 
> Kimberley O'Donnell
> Speech Pathologist - BAppSc MSPAA CPSP
> Royal Rehab. Centre Sydney
> ph:(02) 9808 9210 or (02) 9807 1144 - pager 48
> 59 Charles Street RYDE NSW 2112
> 
>>>> Michel Sanscartier 14/09/2005 9:04:48 am
>>>> 
> That is something else!
> 
> Cricopharyngeal diet!!!
> 
> 
> 
> First, as I always answer to that group, why don't you ask the
> 
> RD you work with?
> 
> Linda, did you ask him or her?
> 
> Did you ask her also to discuss with you if the patient had an esophageal
> dysphagia.
> 
> I know that in the US, RDs don't dare to do much in upper dysphagia
> problems.
> 
> BUT, they know a lot in esophageal dysphagia and they work everyday with
> that.
> 
> GERD and all the esophageal problems is clinical nutrition 101 for us.
> 
> 
> 
> Second, viscosity is for liquid PLEASE.
> 
> 
> 
> A FOOD properties analysis is a class that all RD take (at least in
Canada).
> 
> There are many levels of organoleptic properties of food but only 3 are
> relevant for dysphagia:
> 
> 
> 
> - Texture for all food (machines, utensils and mouth can measure it).
> 
> Texture is usually used in the industry for solid food. The qualifying
would
> be : hard, soft, puree, * (there are at least 25 others).
> 
> 
> 
> - Consistency is an empirical measure that can be defined by a
consistometer
> (there's honey, nectar and clear consistencies). It's like asking: what is
> your height: the answer would tall or short or medium. The liquid is
> submitted to the gravity. The little metal container cost over $500 us
last
> time I called.
> 
> 
> 
> - Viscosity is measure by a viscosimeter. That little machine cost over
$10
> 000 us.
> 
> It's precise but as you will probably read soon, there's no link between
> viscosity of liquids and consistency (except maybe for honey). The
measures
> are in Kpascal / sec or in centipoise. It's like asking someone the same
> question: what is your height: in that case, the answer would be 152 cm or
5
> feet.
> 
> 
> 
> I'm sure that the RD you work with could have told you the same things.
> 
> 
> 
> Third, if your patient has a Wallenberg syndrome or a stroke that wasted
his
> CN IX, X and/or XI there are many things that you could try. You probably
> know it for rehab (Mendelson) but the diet? Please, work with the RD from
> your hospital. I sincerely hope that RDs will become more involved in
> dysphagia. We can make a great team, I know it.
> 
> 
> 
> In case someone corrects my mistakes like that last time, please know that
> I'm a French Canadian speaking and that I'm far from being perfect
> bilingual. I'm doing my best here.
> 
> 
> 
> 
> Michel Sanscartier RD, MSc
> 1900 rue Beaudry
> Montr?al, Qc
> H2L 3E9
> 514-522-3847
> m.sanscartier@videotron.ca
> ----- Original Message -----
> From: 
> To: "dysphagia listserv"
> Sent: Tuesday, September 13, 2005 5:23 PM
> Subject: [Dysphagia] cricopharyngeal diet
> 
> 
>> There has been a discussion going on on the ASHA Division 13 list
>> regarding what the heck a cricopharyngeal diet is. In response to a post
>> requesting assistance with a patient, one therapist suggested a
>> cricopharyngeal diet, prompting the question, "what is it?"
>> 
>> We've come to learn that it stems from vitalstim education and the
>> identification of and significance of cricopharyngeal dysfunction in
>> dysphagia. The diet evidently refers to a solid food's viscosity and fat
>> content in that a goldfish cracker is "better" than applesauce for the
>> identified patient. No research evidence has been cited in the
>> discussion.
>> 
>> There, you know as much as I do (for those of you who didn't already
>> know).
>> 
>> My question to this list is, what do you know about the cricopharyngeal
>> diet? Can you add more to the discussion? Is this a valid premise? Is
>> there research?
>> 
>> Linda A. Zanchi, MA CCC-SLP
>> _______________________________________________
>> Dysphagia mailing list
>> Dysphagia@b9.com
>> http://lists.b9.com/mailman/listinfo/dysphagia
>> 
> 
> 
> 
> 
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> 
> ------------------------------
> 
> Message: 3
> Date: Fri, 16 Sep 2005 08:49:23 -0500
> From: "Copeland, Karen"
> Subject: RE: [Dysphagia] the actual cricopharyngeal diet
> To: , 
> Message-ID:
> 
> Content-Type: text/plain; charset="US-ASCII"
> 
> BBBWWWWWAAAAAHHHHHHHAAAAAAAHHHHHAAAAAAA!!!!!!
> 
> Karen :)
> p.s. when you read the diet while drinking coffee, you are at risk for
> having an episode of nasal regurgitation during laughter. Does she get
> any kickback for naming specific products?
> 
> 
> -----Original Message-----
> From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
> Behalf Of sorriso@adelphia.net
> Sent: Thursday, September 15, 2005 3:15 PM
> To: dysphagia@b9.com
> Subject: [Dysphagia] the actual cricopharyngeal diet
> 
> Here's the "diet" as requested by a member of the ASHA list from the
> VitalStim people:
> 
> Initial Diet for Patients with Cricopharyngeal Dysfunction
> 
> The following diet has been shown to be effective to the author (Marcy
> Freed) for the patients who have a degree of cricopharyngeal
> dysfunction:
> 
> 1. Crunchy consistency
> a. Fritos
> b. Potato chips
> c. All crackers
> d. Pepperidge Farms Bordeaux cookies
> e. Toast with butter
> 
> 
> 2. Thinned puree consistency
> a. Thinned Oatmeal or Cream of Wheat
> b. Yogurt without fruit
> c. Strained creamed soups
> d. Mousse
> e. Soft drinks
> f. Tomato soup or pea soup
> 
> 3. Soft/Slippery consistency
> a. Angel hair pasta and olive oil
> b. Sweet potatoes with butter or margarine
> c. Soft boiled eggs
> d. Poached eggs
> e. Squash - butternut or acorn
> f. Waffles that are cut into tiny pieces
> g. Meat loaf
> h. Whipped potatoes
> 
> The patient may progress as the cricopharyngeal problem improves. Don't
> mix food and liquid! First swallow food and then have a drink.
> 
> 4. Foods NEVER tolerated
> a. Pudding
> b. Applesauce 
> c. Pureed foods
> d. Mashed potatoes
> e. Red meats such as steak
> 
> The viscosity of food a,b,c and d contribute to increased vallecular and
> pyriform sinus retention. Lower viscosity foods clear more easily.
> 
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
> 
> 
> 
> ------------------------------
> 
> Message: 4
> Date: Fri, 16 Sep 2005 10:08:48 EDT
> From: NeuroSP@aol.com
> Subject: Re: [Dysphagia] Cricopharyngeal Diet
> To: ldcrabtr@pmt.org, dysphagia@b9.com
> Message-ID: <208.9789efb.305c2bf0@aol.com>
> Content-Type: text/plain; charset="US-ASCII"
> 
> Just so you know.....I have not taken the Vital Stim course, and a number
of
> patients who I have seen in my practice, have presented with swallowing
> difficulties which have been attributed to cricopharyngeal dysfunction.
> 
> John 
> 
> 






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