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[Dysphagia] Esophageal disorders and oropharyngeal dysphagia
I don't mind being in the hot seat- its really not a bad place to be! I do
want to clarify my responses in regard to this important topic. I do not
diagnose nor claim to treat disorders of the esophagus. However, as Dr.
Campbell-Taylor refers, one cannot identify primary oropharyngeal stage
problems, make recommendations or treatment plans without understanding the
interrelationships between the oropharyx and esophagus. They can so easily
masquerade as the other. I would argue that any dysphagia therapist,
whatever the discipline, cannot do their job without this knowledge. I did
not have this as part of my mainstream formal training, but found
ill-equipped to answer many clinical questions as a result. I have found
this in other areas as well, i.e. nutritional issues, pulmonary issues,
neuropyschology...I could go on and on. I don't fault my graduate program
as I gained much fundamental knowledge and the tools to be a life-long
learner. Whether that be in seeking-out additional course work or
self-educating to complement my skills, I plan to continue learning and
enhancing my ability to treat my patients until I retire! (and then I have
a whole list of other things I'd like to learn that have nothing to do with
Speech Pathology). I can assure you I am a great team player and very often
refer/ collaborate with the RD, OT, PT, GI, ENT, etc. Julie
> 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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> > _______________________________________________
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> > http://lists.b9.com/mailman/listinfo/dysphagia
>
>
>
>
>
>
> ------------------------------------------------------------------------------
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