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[Dysphagia] Clear fluids
Hi Sharon,
I'm really sorry for my misunderstanding. English is not my language
obviously.
In Quebec (Canada), it's not the SLP that can prescribe the diet (by law).
We don't separate texture (rheology) from the chemical property of food.
SLP are involved in dysphagia assessment and rehab only. RDs also assesse
dysphagia along with the nutritional status to determine the whole diet.
Since we always work together, everything that everyone says in a
multidisciplinary team will be considered by everyone's decisions. Even MDs
don't prescribe most of the diets here. Legally, we have the responsibility
of any food, supplements, diet, enteral and parenteral nutrition
prescription. Texture and consistency of food are obviously part of that.
Personally (and 95% of my RD colleagues in Quebec), I don't agree with the
national dysphagia diet description. Nutritional treatment of dysphagia is
not as simple as it's explained there. Clear liquid diet, thin liquid, can
be confusing as long with texture vs consistency vs viscosity of food. All
of them have very different definitions.
About the choice of the consistency of the liquid diet (thin, nectar, honey
and pouding witch is not puree), you have to consider many things in your
assessment before you do your recommendations as the literature in
dysphagia has shown so far:
1-: the preference of the patient concerning the consistency of liquid
(don't waist you time even thinking about it if the patient tell you that
he won't drink any thickened liquid).
2- the discomfort of the patient with clear liquids
3- the nutritional status
3- the presence of CHF, COPD and other lungs disease
4- the immune system status
5- the oral hygiene status
6- the autonomy of drinking and feeding
7- the cough capacity (reflex)
8- the risk of spillage (vellum / lingual closure)
9- the aspiration confirmed by a VFS
10- a real study that clearly says that thickened liquids are safer than
thin liquids (for aspiration pneumonia)!!!?
So far, I have never found any studies that clearly conclude that thickened
liquids could prevent aspiration pneumonia. It has been discussed over and
over anyway on that list serve.
Langmore and al. 1998 is the best reference for me so far. When she
repeated her study in 2002, for me, the methodology was not as good as the
one in 1998 but the conclusions are not far.
Hope that it can help.
Michel Sanscartie RD MS
"Sharon Manders"
<sharon.manders@g
mail.com> A
Envoy? par : "Michel Sanscartier"
dysphagia-bounces <m.sanscartier@videotron.ca>
@b9.com cc
dysphagia@b9.com
Objet
05-10-2006 00:00 Re: Re: [Dysphagia] Clear fluids
Hi Michel,
I didn't say that lactose changed the texture (nor did the RD). I was
asking why people (SLPs) even order clear liquids in the first place.
As far as I am concerned, clear liquids and regular liquids are
practically the same thing texture wise (rheology aside).
I also think people may have misunderstood my initial question. Only
surgeons order clear liquids as a diet. I was asking about clear
fluids in addition to a food texture. SLPs in my facility and others
that I have been in, order a food texture and a liquid texture. I am
referring to the liquid part of the diet order.
Sorry for not expressing myself clearly initially [one would think as
an SLP I would be able to! :) ]
My question is: What liquid textures do other SLPs order? I have read
the National Dysphagia Diet (from the US) and according to that, there
are 4 textures: thin, nectar thick, honey thick and pudding (isn't
that pureed?) Does anyone add an additional "level" i.e. clear
liquids? If so, why?
In addition, my RDs are *always* involved re: nutrition status, but we
are the ones who are involved with the texture. I would never even
dream of ordering a diabetic or healthy heart or renal diet - that is
not my job. I order the texture, they order the rest of the diet.
I hope that clarifies things a little.
I do appreciate the comments though and welcome any further comments
from other people (RDs and SLPs).
Thanks,
Sharon
On 10/4/06, Michel Sanscartier <m.sanscartier@videotron.ca> wrote:
>
> Since when lactose is changing any liquid's consistency?
>
> Is that exactly what the RD you work with told you?
>
> If it is, unfortunately, she didn't express herself correctly. She meant
> that after some surgery, the GI tract is very sensitive and the secretion
of
> lactase can lower and we often see lactose intolerance for some days. A
> "Clear" diet, chemically speaking is without any substance that could
cause
> irritation of the GI tract. There's absolutly no link with dysphagia.
> Rheologicaly speaking, clear liquid has another definition. If we speak
> about consistency, the consistometer is the tool to determine if a liquid
is
> clear or not (? 24 cm). If we speak about the viscosity, some authors has
> defined clear if ? 50 cP (witch don't make any sense to me). There's a
lot
> of work to do in research to establish the link between rheology and
> dysphagia. In the mean time, I would suggest that the nutritional and
> medical status is discuss with the RD before you give any suggestion for
the
> diet.
>
>
>
> Michel Sanscartier RD, MS
>
>
--
"Death is caused by swallowing small amounts of saliva over a long
period of time."
- George Carlin
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----- Original Message -----
From: "Sharon Manders" <sharon.manders@gmail.com>
To: "Michel Sanscartier" <m.sanscartier@videotron.ca>
Cc: <dysphagia@b9.com>
Sent: Thursday, October 05, 2006 12:00 AM
Subject: Re: Re: [Dysphagia] Clear fluids
> Hi Michel,
>
> I didn't say that lactose changed the texture (nor did the RD). I was
> asking why people (SLPs) even order clear liquids in the first place.
> As far as I am concerned, clear liquids and regular liquids are
> practically the same thing texture wise (rheology aside).
>
> I also think people may have misunderstood my initial question. Only
> surgeons order clear liquids as a diet. I was asking about clear
> fluids in addition to a food texture. SLPs in my facility and others
> that I have been in, order a food texture and a liquid texture. I am
> referring to the liquid part of the diet order.
>
> Sorry for not expressing myself clearly initially [one would think as
> an SLP I would be able to! :) ]
>
> My question is: What liquid textures do other SLPs order? I have read
> the National Dysphagia Diet (from the US) and according to that, there
> are 4 textures: thin, nectar thick, honey thick and pudding (isn't
> that pureed?) Does anyone add an additional "level" i.e. clear
> liquids? If so, why?
>
> In addition, my RDs are *always* involved re: nutrition status, but we
> are the ones who are involved with the texture. I would never even
> dream of ordering a diabetic or healthy heart or renal diet - that is
> not my job. I order the texture, they order the rest of the diet.
>
> I hope that clarifies things a little.
>
> I do appreciate the comments though and welcome any further comments
> from other people (RDs and SLPs).
>
> Thanks,
>
> Sharon
>
> On 10/4/06, Michel Sanscartier <m.sanscartier@videotron.ca> wrote:
>>
>> Since when lactose is changing any liquid's consistency?
>>
>> Is that exactly what the RD you work with told you?
>>
>> If it is, unfortunately, she didn't express herself correctly. She meant
>> that after some surgery, the GI tract is very sensitive and the secretion
>> of
>> lactase can lower and we often see lactose intolerance for some days. A
>> "Clear" diet, chemically speaking is without any substance that could
>> cause
>> irritation of the GI tract. There's absolutly no link with dysphagia.
>> Rheologicaly speaking, clear liquid has another definition. If we speak
>> about consistency, the consistometer is the tool to determine if a liquid
>> is
>> clear or not (? 24 cm). If we speak about the viscosity, some authors has
>> defined clear if ? 50 cP (witch don't make any sense to me). There's a
>> lot
>> of work to do in research to establish the link between rheology and
>> dysphagia. In the mean time, I would suggest that the nutritional and
>> medical status is discuss with the RD before you give any suggestion for
>> the
>> diet.
>>
>>
>>
>> Michel Sanscartier RD, MS
>>
>>
>
>
> --
> "Death is caused by swallowing small amounts of saliva over a long
> period of time."
> - George Carlin
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
>
>
> --
> No virus found in this incoming message.
> Checked by AVG Free Edition.
> Version: 7.1.407 / Virus Database: 268.12.10/459 - Release Date:
> 2006-09-29
>
>
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