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[Dysphagia] Esophageal dysphagia
Michel Sanscartier <m.sanscartier@videotron.ca> wrote: Dear Irene,
What I don't agree, it's what I see here since many
days that nutrition therapy must be given by SLPs.
*** You are absolutely correct and I would not dream of infringing on the expertise of a dietitian. Pam, however, makes the relevant point that patients must be managed and that RDs are often simply not available in many NHs and other institutions - at least not on a full time basis. I am horrified by the lack of understanding of nutrition and hydration issues that I encounter all too often in SLPs. As Pam says, having an understanding of something is not the same as thinking one can manage it but I would like to see SLPs have at least an understanding of dehydration, its serious consequences and stop suggesting approaches that exacerbate an already serious problem, particularly in the elderly and in the very young. "NPO" recommendations and thickened fluids all too often lead to very serious results when a consultation a dietitian would avoid them. I have to be able to read and understand the chart re nutrition/hydration status as well as recognize the signs from a
clinical exam e.g. dry tongue, thick ropy saliva etc. The next move is to consult the physician and/or the dietitian.
Nutrition is not as simple as it looks like.
*** It certainly is not but if even the mini exam were applied by each SLP as it often is by nursing, the patient would be better managed
Even you, since you
have all that knowledge, would you be ready to replace me in my job?
*** Of course not. I always consult with a dietitian since the entire purpose of managing dysphagia is to maintain or improve nutrition/hydration.
I would be the
first to not feel safe to do that. SLPs take 4 years of university here and
I respect your knowledge.
*** I am not an SLP and it took eleven years of post graduate education to achieve my current status as well as ongoing education, required of any professional. If nutrition/hydration could be adequately managed by physicians, we would not have dietitians and I would hope that all who work with dysphagic patients have the proper respect for the knowledge and education of the RD - and use it consistently!
----- Original Message -----
From: "Irene Campbell-Taylor"
To:
Sent: Thursday, September 14, 2006 7:18 AM
Subject: [Dysphagia] Esophageal dysphagia
> Michel wrote:
>
> I really don't want to insult anyone but : what is the link between
> speech and esophageal dysphagia?
>
> *** Of course there is no connection between speech and esophageal
> dysphagia but there is a clear and unbreakable connection between
> oropharyngeal and esophageal dysphagia. I know that you took my course
> some years ago - and, clearly, I failed to make this point adequately.
> The deglutition mechanism is one functional unit from lips to duodenum
> (and probably farther). See Dua as well as Triadofilopoulos and others.
> That is not to say that a dietitian should not be involved whenever
> possible - of he/she should be intimately involved in the management of
> dysphagic patients but, often, there is not an RD around in NH etc.so that
> whoever is involved must have some working knowledge of the whole anatomy
> and physiology.
> As to University courses covering this - well, we all know the problems
> there. There are, however, many who have educated themselves, some with
> direct teaching after graduation so that I would not automatically assume
> a lack of knowledge on the part of all SLPs.
>
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
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Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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