[Dysphagia] Hypodermoclysis

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

Having been raised in the US and educated clinically within the US 
medical system, where I've personally never seen hypodermoclysis used, 
it's not that hard to understand why SLPs here would not know about the 
procedure.   Having read about it, it's hard to understand why it's 
never used in the US. (Does anyone here ever see it used?) 
Veterinarians use it on animals - but people-docs don't.  When I asked 
a house physician about the procedure, his response was, "we don't use 
that; there have been complications."  Which is kind of silly, since it 
implies that IV's are complication free!  The other problem that SLPs 
in the US would face is that these methods of hydration are medical 
procedures, and we are not in a position to provide specific medical 
recommendations.  If the SLP has a good working relationship with the 
MDs, and feels confident in their knowledge, then it's a situation 
where it could be discussed, but many SLPs do NOT feel confident in 
their medical knowledge (our training is woefully inadequate in that 
arena).  And for some reason, US docs don't seem to use 
hypodermoclysis.  I wonder what is taught about it - if anything - in 
US medical schools.  There are recent references in Medline - here's 
one....

[[Barua, P, Bhowmick, BK. Hypodermoclysis?a victim of historical  
prejudice  Age and Ageing 2005; 34: 215?217
Hypodermoclysis (HDC) had fallen into disrepute after adverse clinical 
incidents that were obviously the result of improper use of an 
ingenious technique. HDC has clear advantages over alternative 
parenteral routes. It has stood the rigour of scientific scrutiny but 
failed to regain its past glory. This is possibly because of our 
ignorance and inability to detach ourselves from an age-old prejudice. 
This is an attempt to demystify some of the myths that surround it. The 
hope is that older people are not denied an element of health care that 
they are perhaps most well suited to.]]

There is a followup letter in Age and Ageing (November), but that 
journal has a six month delay before the full text is available to me 
in our library.  I'll be interested in seeing what that reader had to 
say in response.

For SLPs, the dilemma remains - if we recommend that a patient receive 
thickened liquids, thickened water, and there are compliance issues 
(which there almost always are, in my experience), we do share in the 
responsibility for any complications that result from dehydration.  
Recommendations often have negative effects.  We manage whole patients, 
not just tracheas and trays.  And management of these patients is a 
TEAM approach - SLPs cannot do this alone, nor should we try.  We KNOW 
that dehydration harms patients.  We DON'T have evidence that some 
aspiration of water harms patients... there are many variables.

I understand that the original issue was for a patient for whom oral 
ingestion of regular water was quite difficult and traumatic.  The 
overall dilemma of trying to hydrate this patient, though, is the same. 


Pam Smith

-----Original Message-----
From: Cheryl Goettsche <cagoettsche@yahoo.com>
To: Irene Campbell-Taylor <eripley@yahoo.com>; dysphagia@b9.com
Sent: Sat, 4 Feb 2006 18:20:36 -0800 (PST)
Subject: Re: [Dysphagia] Hypodermoclysis

   Not resistant, but what is another option.

Irene Campbell-Taylor <eripley@yahoo.com> wrote:  I never cease to be 
amazed at
the amount of resistance there seems to  be by those who have never 
tried it or
even seen it done. I keep hoping  that the US will somehow haul itself, 
albeit
kicking and screaming,  into at least the latter part of the twentieth 
century
with respect to  this painless, useful and otherwise widely used 
procedure. With
respect  to general health care, especially of the elderly, the 
Europeans have
it all over us in North America - and I do include Canada.
  Ah well, at least Medicare does have a code for it.


Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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