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[Dysphagia] RE: polymyositis/Sjogren's
Hello. I'm interested in knowing what management and/or treatment
interventions might be appropriate for a lady with polymyositis and
Sjogren's. AND she is now s/p anterior cervical neck fusion surgery and
will be wearing a hard c-collar for several months.
A MBS done in the acute care setting even before surgery showed
significant pharyngeal retention due to poor hyolaryngeal excursion,
with laryngeal penetration on every texture that did not clear during
the study. Patient reports premorbid history of difficult chewing, slow
eating, etc. but no history of respiratory difficulty. Based on acute
care study and physician rec., she now has a PEG.
I'm seeing her now in an inpatient rehab setting. NPO with therapeutic
feeding only. She's getting extra water via the PEG and is not quite so
thirsty, but secretions are somewhat sticky. Clinically, she has poor
tongue movement for bolus propulsion, and some throat clearing following
swallow attempts. She's somewhat fearful as well, probably based on
past discomfort with eating and maybe what she was told in acute care.
I'm wondering where to head next. Any experiences you can share would
be helpful. Thank you!
Karen
**************************************
"No snowflake ever falls in the wrong place." ~Zen saying
-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf Of Irene Campbell-Taylor
Sent: Thursday, September 14, 2006 9:14 AM
To: Michel Sanscartier; dysphagia@b9.com
Subject: Re: [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
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
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>
>
> --
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>
Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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