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[Dysphagia] Esophageal disorders and oropharyngeal dysphagia
RD = Registered Dietician in the US = clinical nutritionists in some
provinces in Canada.
Since Autralia is a lot like Canada for the health care system, I would hope
that you have any kind of specialists in nutrition?
In the US and in Canada, the SLPs are not thought anything below the
cricopharyngeal sphincter unless they have some kind of continuing education
courses. BUT, the digestive system can't be learned in a one or 2 days
conferences nor dysphagia as you all know.
I have looked in a lot of Universty's programs across America and I have not
seen one University that gives any kind of teaching in the treatment of the
digestive system. I know for facts that in Canada, most colleges and
associations obliged the SLP to have at least a master degree to be part of
them. But, the master is allowed to many kind of background (like teachers,
linguists, psycho education, . and of course, bachelor degree in speech
pathology). Those background have no teaching in the digestive system and
nothing about the nutrition therapy. I know that in the French Europe, they
don't have any specialist in nutrition but the MD. In fact, except for
Belgium, they don't even have SLP. The MD are doing everything!!
With all the respect that I have for the knowledge of SLPs in speech and
dysphagia, I'm just saying that nutrition therapy for any conditions,
including dysphagia, you need to work with a nutritionists and or the
equivalent in your country. Nutrition is a lot more complicated that it
seems. You can arm someone easily and even kill if you go too far.
In my hospital, we received a patient in rehabilitation that came from the
acute hospital. The SLP told the patient that he shouldn't drink water
because of his dysphagia. The nutritionist didn't have time to see the
patient before he got to our hospital. He's diabetic. He was drinking 2
litters of water a day to help him with his constipation. He changed it to
thickened juice!!! His glycemia went from 4,8 in average to 11,2 in average.
Then I came! I told the patient to not do that anymore along with many other
nutrition therapy for the dysphagia and his diabetes and his HBP and his CHF
and his medication for the stroke he just had and . . What do we look like?
Both of us? The patient went confuse and asked the MD to tell him what to
do. The MD told him that I was the expert in nutrition therapy since I'm a
nutritionist and the SLP was the specialist in speech therapy.
I'm just saying PLEASE, for the sake of the patient's health, work in team
with the RD or any kind of specialist in nutrition you have in your
facility. Nutrition is NOT AS SIMPLE as it looks like. I could say that
apraxia, aphasia, dyslexia is so simple that I could treat them along with
my nutrition therapy but I don't cause I know it's a lot more complicated
that it looks like. From an outsider, science could look easy in some cases
but for what I know, nutrition therapy is not.
With all my respect to SLPs, please take that message for the sake of the
patients health and for a big welcome to work together.
Michel Sanscartier RD, MS
---- Original Message -----
From: "Havlis, Jana (DFC)" <Havlis.Jana@saugov.sa.gov.au>
To: "Michel Sanscartier" <m.sanscartier@videotron.ca>
Sent: Wednesday, September 13, 2006 10:08 PM
Subject: RE: [Dysphagia] Esophageal disorders and oropharyngeal dysphagia
Hi
Just reading your message, and would like to know what is an RD?, and what
is your role/job description? I am not sure if we have them in Australia.
>From my experience often we are felt to comment about this in our assessment
as there is no one else that does in the initial stages.
-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On Behalf
Of Michel Sanscartier
Sent: Thursday, 14 September 2006 10:36 AM
To: Julie Speech; Dysphagia@b9.com; Alexandra Mitchell
Subject: Re: [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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