|
[Date Prev][Date Next]
[Chronological]
[Thread]
[Top]
[Dysphagia] Esophageal diversion
I'm relatively new to adult rehab and have an elderly patient who had
surgery for a paraesophageal hernia which then ruptured and subsequently she
underwent esophageal diversion. Her esophagus ends at the chest wall with a
spit fistula. She has a g-tube for gastric drainage and a j-tube for
feeding. I'm thinking that my services may be valuable to promote good oral
health, oral strength, preventing aspiration on secretions. She has no
interest in taking anything by mouth for pleasure, she states that putting
anything in her mouth makes her gag. Any comments and suggestions would be
appreciated. Thank you, Linda
>From: dysphagia-request@b9.com
>Reply-To: dysphagia@b9.com
>To: dysphagia@b9.com
>Subject: Dysphagia Digest, Vol 35, Issue 3
>Date: Tue, 3 Oct 2006 12:01:47 -0600
>
>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. Re: cough related to eating but not aspiration (LJBove@aol.com)
> 2. RE: cough related to eating but not aspiration
> (Reynolds, Cindy [NS])
> 3. FEES course (Aviva Debinski)
> 4. RE: cough related to eating but not aspiration (Langdon, Claire)
> 5. Re: Saliva (Irene Campbell-Taylor)
> 6. Scopolamine (Irene Campbell-Taylor)
> 7. Cough (Irene Campbell-Taylor)
> 8. RE: FEES course (Bartcyn@cs.com)
> 9. Clear fluids (Sharon Manders)
> 10. Clear fluids (Irene Campbell-Taylor)
> 11. Cancer and ALS (Irene Campbell-Taylor)
>
>
>----------------------------------------------------------------------
>
>Message: 1
>Date: Mon, 2 Oct 2006 17:19:26 EDT
>From: LJBove@aol.com
>Subject: Re: [Dysphagia] cough related to eating but not aspiration
>To: Cindy.Reynolds@vch.ca, dysphagia@b9.com
>Message-ID: <2fd.1a9ccd4.3252dc5e@aol.com>
>Content-Type: text/plain; charset="US-ASCII"
>
>In a message dated 06-10-02 13:57:59 EDT, Cindy.Reynolds@vch.ca writes:
>
><< Why is she coughing
> with the bolus well into her esophagus? >>
>probably related to vagal stimulation and retrograde aspiration reflexes,
>see
>the work of Shaker, et al
>Lydia-Jean Bove, MS, CCC-SP
>
>
>------------------------------
>
>Message: 2
>Date: Mon, 2 Oct 2006 15:29:58 -0700
>From: "Reynolds, Cindy [NS]" <Cindy.Reynolds@vch.ca>
>Subject: RE: [Dysphagia] cough related to eating but not aspiration
>To: <LJBove@aol.com>, <dysphagia@b9.com>
>Message-ID: <C0E958926B1F584D8C5912C6838D2673C860EB@vchexmb6.vch.ca>
>Content-Type: text/plain; charset="us-ascii"
>
>Thanks for directing me to these articles.
>
>Cindy Reynolds, M.H.Sc.,
>Manager, Speech-Language Pathology
>Lions Gate Hospital
>Assistant Clinical Professor, UBC
>604-984-5747
>
>
>-----Original Message-----
>From: LJBove@aol.com [mailto:LJBove@aol.com]
>Sent: Monday, October 02, 2006 14:19
>To: Reynolds, Cindy [NS]; dysphagia@b9.com
>Subject: Re: [Dysphagia] cough related to eating but not aspiration
>
>In a message dated 06-10-02 13:57:59 EDT, Cindy.Reynolds@vch.ca writes:
>
><< Why is she coughing
> with the bolus well into her esophagus? >>
>probably related to vagal stimulation and retrograde aspiration
>reflexes, see
>the work of Shaker, et al
>Lydia-Jean Bove, MS, CCC-SP
>
>
>
>------------------------------
>
>Message: 3
>Date: Tue, 3 Oct 2006 09:55:47 +1000
>From: Aviva Debinski <adebin@bigpond.net.au>
>Subject: [Dysphagia] FEES course
>To: dysphagia@b9.com
>Message-ID: <1db158caad117600c519a3c0805eebb8@bigpond.net.au>
>Content-Type: text/plain; charset=US-ASCII; format=flowed
>
>Is anyone aware of FEES course in NEw York around DEc 13 2006?
>Aviva Debinski
>Ph: +61 3 95762116
>Fx: +61 3 95096021
>Email: adebin@bigpond.net.au
>
>------------------------------
>
>Message: 4
>Date: Tue, 3 Oct 2006 09:13:11 +0800
>From: "Langdon, Claire" <Claire.Langdon@health.wa.gov.au>
>Subject: RE: [Dysphagia] cough related to eating but not aspiration
>To: "Reynolds, Cindy [NS]" <Cindy.Reynolds@vch.ca>, <dysphagia@b9.com>
>Message-ID:
> <C876A9C058E49D48BAFDE959E6B2023807F78545@2kqe005mes.qe2.health.wa.gov.au>
>
>Content-Type: text/plain; charset=iso-8859-1
>
>Perhaps Gastro could investigate for eosinophilic oesophagitis? It sounds
>like vagally mediated cough in response to poor motility.
>
>Claire Langdon
>Senior Speech Pathologist
>Sir Charles Gairdner Hospital
>Hospital Avenue Nedlands
>West Australia
>
>Phone: 61-8-9346-2044
>email: Claire.Langdon@health.wa.gov.au
>
>
>-----Original Message-----
>From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]
>Sent: Tuesday, 3 October 2006 01:52
>To: dysphagia@b9.com
>Subject: [Dysphagia] cough related to eating but not aspiration
>
>
>Patient profile: 36yr old woman with Type 1 diabetes-poorly controlled
>as a child. She has had multiple admissions for hyperglycemic
>ketoacidosis although not since 1996. Since 1999 she has developed
>frequent insulin reactions with seizures and cyanosis. She is in
>chronic renal failure and has diabetic retinopathy. She is also
>hypothyroid although well controlled on meds. Meds: Humalog; Insulin;
>betamethasone; synthroid; cytomel; oxybutrin; furosemide, Diovan and
>metclopramide
>
>
>
>She has gastroparesis but does not have any diagnostic signs of reflux
>(she has had the full workup). Her "dysphagia" symptoms are as follows:
>after eating for a few minutes she begins to violently cough. This
>really only occurs with solids-She has the most problems with breads but
>of interest she finds that she can manage meat quite well. The client
>is devastated by this problem as she is no longer able to go out and eat
>socially.
>
>
>
>The cranial nerve examination--I tested all 12 nerves-only showed one
>finding of potential relevance. Her tongue was weak as evidenced by the
>fact she could not hold it steady on protrusion. In addition, lateral
>movements were awkward. There was slightly reduced strength against
>resistance Lt >Rt . During the interview the client stated that she has
>"lots of saliva' but in fact, inspection of the oral cavity revealed she
>was tending more towards xerostomia -probably b/c she was NPO for the
>test. The client then went on to say that her 4 year old daughter still
>drools and her own mother had commented that my client drooled for most
>of her childhood.
>
>
>
>We began radiological testing by re-doing the upper GI series. As
>expected it showed significant gastroparesis. We then began the food
>trials. With thin fluids, the mechanics and timing of the swallow were
>absolutely normal. Of interest so were the solids-she initiated the
>swallow in a timely manner; hyo-laryngeal excursion was complete in both
>planes and each bolus passed through the UES and was well into the
>esophagus but then she began to cough. There was no evidence of
>laryngeal penetration at any time, nor did we detect residue in the
>valleculae or pyriforms -nothing that could account for the coughing
>bout but yet she coughed and coughed. The cough appears to be
>triggered mid-sternum. Obviously with the gastropareis her stomach
>appeared full of barium and the lower esophagus was beginning to
>fill-but when asked if she felt full, the client denied feeling this
>sensation.
>
>
>
>My questions to you are as follows. Has anyone seen a similar
>presentation? (My understanding is that most people with diabetes have
>a higher cough threshold) . Is there anything we could suggest apart
>from smaller and more frequent meals to help her? Why is she coughing
>with the bolus well into her esophagus? Do you think it may be her
>body's attempt to clear food by opening up her LES? Or???
>
>
>
>Thank you for any insights you may have
>
>
>
>
>
>Cindy Reynolds, M.H.Sc.,
>
>Manager, Speech-Language Pathology
>
>Lions Gate Hospital
>
>Assistant Clinical Professor, UBC
>
>604-984-5747
>
>
>
>_______________________________________________
>Dysphagia mailing list
>Dysphagia@b9.com
>http://lists.b9.com/mailman/listinfo/dysphagia
>
>
>
>------------------------------
>
>Message: 5
>Date: Tue, 3 Oct 2006 03:29:51 -0700 (PDT)
>From: Irene Campbell-Taylor <eripley@yahoo.com>
>Subject: [Dysphagia] Re: Saliva
>To: dysphagia@b9.com
>Message-ID: <20061003102951.37935.qmail@web30201.mail.mud.yahoo.com>
>Content-Type: text/plain; charset=iso-8859-1
>
>
>Since June 2005 she has a problem with eating as her mouth will start
>filling with saliva (frothy and quite glutinous) which she can't swallow
>adequately as it happens so fast and so much that she has to spit it out
>until it stops. It can last 10-20 minutes.
>
> *** Is everyone quite sure that it's saliva? Whitish, frothy exudate is
>more often from the esophagus.
>
> She can ONLY eat sweet biscuits
>or chocolate
> *** Any specific type of biscuit (cookie)?
>
>Her doctor has had X-ray and CT Scan which are clear,
> *** Of what?
>
>
>
>
>
>
>
>
>
>Dr I Campbell-Taylor
>Clinical Neuroscientist
>Exclusive Distributor:
>www.interactivetherapy.com
>
>------------------------------
>
>Message: 6
>Date: Tue, 3 Oct 2006 04:41:27 -0700 (PDT)
>From: Irene Campbell-Taylor <eripley@yahoo.com>
>Subject: [Dysphagia] Scopolamine
>To: dysphagia@b9.com
>Message-ID: <20061003114127.19013.qmail@web30206.mail.mud.yahoo.com>
>Content-Type: text/plain; charset=iso-8859-1
>
>At our facility we find Scopolomine to be the best medication for
>management of saliva. Our Respiratory Therapists recommend this before
>any other medication for excessive saliva.
>
>*** There are several caveats. while it does dry the mouth, it should not
>be used in anyone with ir with a tendency toward reflux or any form of
>esophageal dysmotility. Also, drying the saliva leads over time to tooth
>decay along the gum line. The drug is highly toxic and has to be used in
>minute doses. An overdose can cause delirium, delusions, paralysis, stupor
>and death.
>
>
>Dr I Campbell-Taylor
>Clinical Neuroscientist
>Exclusive Distributor:
>www.interactivetherapy.com
>
>------------------------------
>
>Message: 7
>Date: Tue, 3 Oct 2006 04:49:02 -0700 (PDT)
>From: Irene Campbell-Taylor <eripley@yahoo.com>
>Subject: [Dysphagia] Cough
>To: Cindy.Reynolds@vch.ca, dysphagia@b9.com
>Message-ID: <20061003114902.32177.qmail@web30212.mail.mud.yahoo.com>
>Content-Type: text/plain; charset=iso-8859-1
>
>
> The client then went on to say that her 4 year old daughter
>still
>drools and her own mother had commented that my client drooled for most
>of her childhood.
> *** Possibly familial form of GERD.
>
>My questions to you are as follows. Has anyone seen a similar
>presentation? (My understanding is that most people with diabetes have
>a higher cough threshold) . Is there anything we could suggest apart
>from smaller and more frequent meals to help her? Why is she coughing
>with the bolus well into her esophagus? Do you think it may be her
>body's attempt to clear food by opening up her LES? Or???
> See:
> Supraesophageal manifestations of gastroesophageal reflux disease.
>
> Semin Gastrointest Dis 1999 Jul;10(3):113-9
>
> Al-Sabbagh G; Wo JM
>
> An increasing amount of evidence indicates that gastroesophageal reflux
>disease (GERD) is a contributing factor to hoarseness, throat clearing,
>throat discomfort, chronic cough, and shortness of breath. The association
>between GERD and these supraesophageal symptoms may be elusive. Heartburn
>and regurgitation are absent in more than 50% of patients. Acid reflux
>should be considered if signs of GERD are present, symptoms are
>unexplained, or symptoms are refractory to therapy. The diagnosis of GERD
>may be unclear, despite a careful history and initial evaluation. A high
>index of suspicion is required to make the diagnosis. An empiric trial of
>antireflux therapy is appropriate when GERD is suspected. Multiprobe
>ambulatory pH monitoring is currently the diagnostic test of choice, but
>the level of sensitivity and specificity for supraesophageal manifestations
>of GERD is uncertain. Response to antireflux therapy is less predictable
>than typical GERD. More intensive acid
> suppression and longer treatment duration are usually required.
>
>
>
>Thank you for any insights you may have
>
>
>
>
>
>Cindy Reynolds, M.H.Sc.,
>
>Manager, Speech-Language Pathology
>
>Lions Gate Hospital
>
>Assistant Clinical Professor, UBC
>
>604-984-5747
>
>
>
>
>
>
>
>Dr I Campbell-Taylor
>Clinical Neuroscientist
>Exclusive Distributor:
>www.interactivetherapy.com
>
>------------------------------
>
>Message: 8
>Date: Tue, 03 Oct 2006 09:36:45 -0400
>From: Bartcyn@cs.com
>Subject: RE: [Dysphagia] FEES course
>To: adebin@bigpond.net.au (Aviva Debinski), dysphagia@b9.com
>Message-ID: <3164AD22.7000209B.0015B7D3@cs.com>
>Content-Type: text/plain; charset=iso-8859-1
>
>We are in the process of organizing another Crary/Mann 2 day Hands on
>Endoscopy Practicum in Florida, Jan 2007. More info to come this week.
>Cindy
>Aviva Debinski <adebin@bigpond.net.au> wrote:
>
> >Is anyone aware of FEES course in NEw York around DEc 13 2006?
> >Aviva Debinski
> >Ph: +61 3 95762116
> >Fx: +61 3 95096021
> >Email: adebin@bigpond.net.au
> >_______________________________________________
> >Dysphagia mailing list
> >Dysphagia@b9.com
> >http://lists.b9.com/mailman/listinfo/dysphagia
> >
>
>
>------------------------------
>
>Message: 9
>Date: Tue, 3 Oct 2006 11:01:34 -0400
>From: "Sharon Manders" <sharon.manders@gmail.com>
>Subject: [Dysphagia] Clear fluids
>To: dysphagia@b9.com
>Message-ID:
> <d87e41c40610030801o1ace802bq5001f723bf1ee4ef@mail.gmail.com>
>Content-Type: text/plain; charset=ISO-8859-1; format=flowed
>
>I just had a discussion with one of the dietitians that I work with. She
>asked why we order clear fluids for a patient. In our facility, there is
>the
>surgical 'clear fluids' which includes Ensure (apparently it doesn't have
>lactose, so it's 'clear'), and the 'speech' clear fluids which is water,
>black tea and/or coffee and apple juice and ginger ale. I was told once
>that
>clear fluids is more of a transition to regular liquids. The justification
>was that the lack of sugar (!) and milk products would reduce the chance of
>bacteria forming in the lungs if those liquids were aspirated. Once the SLP
>was comfortable that the patient was managing the clear fluids well for a
>while, they then get upgraded to regular liquids.
>
>I haven't ordered clear fluids for some time because I don't really think
>it
>is necessary, either they can drink or they can't, and all my patients get
>water (except temporarily for a patient with a brand new stroke who is
>having +++ trouble).
>
>What do other people do out there? I'd like to get a sense of how common
>this is. Do you even have a 'clear fluid' or 'thin, clear liquid' option?
>Is
>it justified or is it a waste of time? We'd be very interested in the
>responses.
>
>Thanks in advance,
>
>Sharon
>
>--
>"Death is caused by swallowing small amounts of saliva over a long period
>of
>time."
>- George Carlin
>
>
>------------------------------
>
>Message: 10
>Date: Tue, 3 Oct 2006 08:46:38 -0700 (PDT)
>From: Irene Campbell-Taylor <eripley@yahoo.com>
>Subject: [Dysphagia] Clear fluids
>To: sharon.manders@gmail.com, dysphagia@b9.com
>Message-ID: <20061003154638.37170.qmail@web30201.mail.mud.yahoo.com>
>Content-Type: text/plain; charset=iso-8859-1
>
>Medically speaking, clear fluids are those that leave minimal residue in
>the GI tract. That?s why they?re ordered before and after certain
>surgeries etc. There is, however, disagreement among anesthesiologists as
>to what, exactly, constitutes ?clear liquids.? A clear liquid diet is not
>adequate in calories and nutrients. It should not be used for more than
>five days unless high-protein gelatin or other low-residue supplements are
>added. A good rule of thumb for a clear liquid is anything you can see
>through. For example, apple juice is a clear liquid; milk is not.
> One would have to aspirate an great deal of sugar/lactose containing
>material before it would make the slightest difference. Again, one?s own
>saliva is the greatest hazard.
>What?s wrong with seeing how the patient manages with water? If they can
>drink water, they can drink anything.
>
>Dr I Campbell-Taylor
>Clinical Neuroscientist
>Exclusive Distributor:
>www.interactivetherapy.com
>
>------------------------------
>
>Message: 11
>Date: Tue, 3 Oct 2006 08:58:03 -0700 (PDT)
>From: Irene Campbell-Taylor <eripley@yahoo.com>
>Subject: [Dysphagia] Cancer and ALS
>To: dysphagia@b9.com
>Message-ID: <20061003155803.9594.qmail@web30206.mail.mud.yahoo.com>
>Content-Type: text/plain; charset=iso-8859-1
>
>I'm trying to find some information for a research project I'm currently
>involved in.
> Has anyone on this list ever had a patietn with both ALS and cancer, at
>the same time?
>
>
>Dr I Campbell-Taylor
>Clinical Neuroscientist
>Exclusive Distributor:
>www.interactivetherapy.com
>
>------------------------------
>
>_______________________________________________
>Dysphagia mailing list
>Dysphagia@b9.com
>http://lists.b9.com/mailman/listinfo/dysphagia
>
>
>End of Dysphagia Digest, Vol 35, Issue 3
>****************************************
|
|