[Dysphagia] Hot water

[sorriso at adelphia.net (sorriso@adelphia.net)]

A few years ago I was asked to treat a patient with referring symptoms of regurgitation and copious secretions while at the dining table in the SNF/LTC facility where I worked.  Review of his chart revealed the diagnosis of nutcracker esophagus.  I hadn't run across this before and checked my dysphagia file.  Sure enough I had an article I'd copied from the local paper taken from the "Dr. Donohue" syndicated column.  One of his recommendations was to try warm liquids beginning about five or maybe 15 (I think--too lazy to run out to the trunk of my car to check) minutes before a meal.  This did seem to ease his symptoms.  

As a postscript, about a year later I learned that this file was flagged (my best guess is because someone thought they'd catch an SLP treating an esophageal dysphagia and could deny services) and reviewed somewhere federally, not just a plain ole' Medicare review, nearly causing my therapy manager and me a heart attack with the request.  It passed with flying colors likely because I saw the patient for a handful of visits only and set up a program which included the warm liquids (citing Dr. Donohue!) and increased time between the serving of each portion of food.

I was taught in school the ability to identify signs/symptoms of esophageal dysphagia, and to notify an MD of such.  I was taught not to treat esophageal dysphagia but I simply couldn't help myself in that case.  I did offer the patient some relief of symptoms.  In the intervening years I've become more knowledgeable about the interplay between the oral, pharyngeal and esophageal stages of the swallow and always consider the whole system in my treatment.

Linda A. Zanchi, MA CCC-SLP

---- Drirenect@aol.com wrote: 
> It has been well known for a long time that very cold liquids cause diffuse  
> esophageal spasm and, often, pain. You may have had this experience yourself.  
> Ice and close to freezing temperatures cause constriction, reduced blood flow 
>  and stiffness. Heat, especially wet heat, is known to cause increased blood 
> flow  leading to relaxation and easier muscle movement. While no-one knows why 
> heat  helps, arguing from the opposite gives some indication of the potential 
> reasons.  I hope this answers another query I had on the same  topic.
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