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[Dysphagia] Esophageal disorders and oropharyngeal dysphagia
I have been reading to the last messages about esophageal dysphagia.
I'm really amazed by the diagnosis and the treatments that you all exchange
with each other considering the SLP's limited knowledge in that field.
I have not seen one comment from a RD.
I can't believe that I'm the only one here.
I really don't want to insult anyone but : what is the link between speech
and esophageal dysphagia?
Does any university in the world give an extensive knowledge to SLP about
the digestive tract?
I would love to see the faces of SLPs that would read RDs exchanging about
diagnosis and treatment of aphasia, stammering or dyslexia. You would
probably feel like me right now.
I'm a nutritionist from Canada (RD in the US) that knows a lot about any
esophageal dysphagia problem. I learned it from the first year at the
university and have had internship in that field. After that, I had to work
with patients that have those problems since 16 years, almost everyday. I
can't believe that any RD anywhere else in the world, has a totally
different profile.
Those patients ARE taking care of by RDs since we started our profession.
If you see one patient that have this problem and don't have any RD in the
chart, please make a comment to the MD so he will think about giving a
consultation to the expert.
Excuse my English, I'm French speaking from Montr?al.
Michel
----- Original Message -----
From: "Julie Speech" <speechhuffman@nc.rr.com>
To: <Dysphagia@b9.com>; "Alexandra Mitchell" <pawprint1980@yahoo.com.au>
Sent: Wednesday, September 13, 2006 12:28 PM
Subject: Re: [Dysphagia] Esophageal disorders and oropharyngeal dysphagia
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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