Fwd: Re: [Dysphagia] re: Difficult case-choking UPDATE

[shsimon at optonline.net (shsimon@optonline.net)]

Here's an update on my difficult patient.
Modified Barium Swallow Study was completed in A-P and lateral views.  Pt with fairly good oral prep and oral stages of the swallow.  Premature spillage was obseved with mild post swallow pharyngeal pooling,  laryngeal penetration without aspiration.  Backflow from the level of the CP was mildly observed.
Esophageally, pt displayed hold up to a large degree on regular diet consistency in the upper esophagus and reduced esophageal peristalsis.  Pt was placed on a mechanical soft diet with thin liquids to aid in pushing bolus through the esophagus.  A hiatel hernia was observed above the diaphragm,  and GERD was also noted.
I spoke with primary M.D. about possible Sjogren Syndrom and even printed out some information.  She stated that even if it is that nothing really could be done.  She did not rule it out though.
Pt with continued decline in medical status this week: more falls, O2 sats all over the place, refusing to use Bipap at night and extremly fatigued.
Pt was started on Reglan, but d/c'd  secondary to medical decline.  
Stacey