[Dysphagia] recommendations requested

[kvasquez21 at yahoo.com (Keri Vasquez)]

To all the gurus:
   
  New admit to my sub-acute facility, 86 yo male who was hospitalized w/ chief complaint of progressive dysphagia over 3 weeks( solids >liquids).  Pt had subjective complaints of "food getting stuck and coughing food up." 
   
  During hospitalization pt had VFSS and esophogram.
   
  Report for the VFSS:
  Pt. only given nectar and honey thick barium w/ aspiration of nectar and ineffective cough.  Chin tuck does not prevent aspiration.  With honey thick barium, pt has mod residue in vall. and piriform that is partially cleared w/subsequent swallows but no evidence of laryngeal pen/asp.  There is cricopharyngeal prominence.
   
  Report for esophogram:
  There is exaggerated contraction of the UES w/ adjacent small outpouching, likely representing a Zenkers.  There is a lack of normal esophageal peristalsis w/extensive tertiary contractions.  Contrast flows into the stomach without any evidence of obstruction.  
   
  This pt. was recommended NPO by the hospital SLP in which he refused.  He was admitted here on a puree diet and honey-thick consistency.  Pt. refused EGD.  KUB was negative.  Pt denies any relfux symptoms and is currently taking pepcid.  
   
  1. What should I do with this patient?  I feel the VFSS is incomplete and lacks appropriate information.  Uncertain why no swallow maneuvers were introduced and the drastic conclusion to make this pt NPO.  
  We have the mobile VFSS available and contemplating to have a repeat study to obtain a full and complete report.
   
  Any comments/suggestions are greatly appreciated!
   
  Keri Miloro, MS, CCC-SLP
  Boston, MA
   
   

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