[Dysphagia] FW: Conditioned dysphagia

[DGregore at Christianacare.org (Gregore, Dale)]

Resending as it did not post the first time.  Please see below.  Need ideas!

>  -----Original Message-----
> From: 	Gregore, Dale  
> Sent:	Friday, December 01, 2006 4:39 PM
> To:	dysphagia at b9.com
> Subject:	Conditioned dysphagia
> 
> Need suggestions for this case I just evaluated  yesterday:
> 
> 13 months ago, a 17 year old patient observed his sister choking on a soft
> pretzel:  she required the Heimlich from Mom, scary situation but no
> damage done, sister is fine. One week after this choking incident, he was
> reclining, had "about 8" gummy shacks in his mouth> choked:  spit
> everything out.  Scary situation for him
> 
> Since then, he initially refused to eat for fear of choking:  then liquids
> only; existed on tomato soup, cream of wheat and milk/ ice cream pretty
> much until recently.  (+) eats ice cream at school for lunch.  Limits his
> eating in public. Expresses fear of choking, states it is beyond his
> control.  Very anxious.
> 
> Anxiety meds and ADD meds have been stopped due to the fact that they
> affected his appetite, per mom
> 
> He eats crispy crunchy snacks no problem.  Avoids any meats and puddings
> (interesting texture disparity there) 
> 
> Sitting and eating a meal with family is difficult.  Parents are very
> supportive.  He initially lost 20# then gained it back w/ liquid
> supplements.  did have a Upper GI:  normal; clinical swallow function
> normal 
> 
> Patient is seeing a behavioral therapist.  He was receptive when I spoke
> about the factors one can 'control' during eating:  rate, quantity and
> position (referring to his reclining position intake while wolfing gummy
> snacks)  he chose cheez its, soda and ice cream and exhibited no overt
> dysphagia symptoms on direct examination and/ or when attention was
> diverted (talking, putting puzzle together)  nice kid seeking absolutes,
> "you mean I cant choke when I'm sitting up?" to which I just couldn't say
> 'yes'. 
> 
> Anyone have a similar case before?  I would appreciate suggestions for
> treatment planning/ approach, etc....thanks. 
> 
> Dale R. Gregore, M.S. CCC SLP
> Christiana Care Health System
> Delaware, USA
>  
> 
>