[Dysphagia] Esophageal disorders and oropharyngeal dysphagia

[speechhuffman at nc.rr.com (Julie Speech)]

The reason for soft is to avoid tough, fibrous foods that might elicit a food-bolus obstruction if not broken down enough prior to swallowing when having a significant amount of spasm (i.e. steakhouse syndrome)  Julie
  ----- Original Message ----- 
  From: Alexandra Mitchell 
  To: Julie Speech 
  Sent: Wednesday, September 13, 2006 12:00 AM
  Subject: Re: [Dysphagia] Esophageal disorders and oropharyngeal dysphagia


  Dear Julie,

  You recommend the patient with eosophageal dysphagia being given a soft diet with the thin fluids. Don't soft foods end up as a PUREE consistency once chewed (this is equivalent to a grade 3 TF consistency - pudding)?

  Thanks for you comprehensive reply to my last email!!

  Alex

  Julie Speech <speechhuffman@nc.rr.com> wrote:
    Alexandra,

    There is a lot of education and recommendations we can provide patient's 
    that have various esophageal disorders. Many, but not all, will have 
    concomitant changes in oropharyngeal stage as a result.

    The main problem in our discipline is being able to identify primary 
    oropharyngeal vs. esophageal dysphagia so we can make the correct clinical 
    decisions and recommendations. This is a HUGE problem since ignoring the 
    esophagus means potential for negatively impacting our patients QOL, risking 
    misdiagnosis, making bogus recommendations, risking litigation, increasing 
    health care costs, etc, etc. I find the majority of clinicians are not 
    knowledgeable about the esophagus/ GI issues (the "its not our body part" 
    argument!) I certainly tailor my recommendations to the patient's medical 
    diagnoses, test results and subjective complaints, but generally speaking, 
    the recommendations I suggested may be helpful for various esophageal 
    disorders. The major mistake made along the way with the gentleman in 
    question was assuming the oropharyngeal dysphagia was primary, new onset, 
    and that the aspiration seen was detrimental. In his case, the 
    recommendations of NPO, thickened liquids, etc completely ignore what was 
    found on his esophagram and the patient's complaints.

    In regard to your question marks below, a reflux diet is one that limits or 
    avoids foods that either are more offensive coming back up, increase 
    transient relaxations of the LES or are slow to digest and therefore more 
    likely to come up (i.e spicy, acidic, peppermint, chocolate, caffeine, fried 
    foods, dairy...). By pharyngeal exercise program I meant exercises that 
    would maximize the strength of say, the tongue base if the patient has lots 
    of vallecular residue.

    I hope that answers your question!

    Julie

    ----- Original Message ----- 
    From: "Alexandra Mitchell" 
    To: 
    Sent: Saturday, September 09, 2006 8:08 PM
    Subject: [Dysphagia] Esophageal disorders and oropharyngeal dysphagia


    > Dear Julie,
    >
    > In regards to your email, in response to Keri's, re: eosphageal disorder 
    > (resulting in aspiration of solids, some liquids).
    >
    > Re: the recommendations that you mentioned (eg: soft diet with thin 
    > liquids, avoiding cold fluids, pharyngeal exercise program (?), reflux 
    > diet (?), crushing medications and taking these with plenty of water to 
    > clear the esophageal residue); are those the recommendations that you 
    > would have for a patient with an esophageal disorder that is impacting on 
    > their oropharyngeal swallowing?
    >
    > I would love to do the breakfast workshop that you teach on this also. I 
    > do have a particular interest in learning in this area: and seem to have 
    > "plateaued" in what I can effectively teach myself from written materials. 
    > I would interested to know when the next workshop on this topic is.
    >
    > Thanks for your interesting email (thorough not lengthy!)
    >
    > Kind regards,
    >
    > Alexandra
    >
    >
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