[Dysphagia] Dehydration and falls 2

[Jai.Gupta at SESIAHS.HEALTH.NSW.GOV.AU (Jai Gupta)]

Hi Vera
I think we have established that fact in the profession that swallowing
is not a simple system and we all know it will be ignorant on our part
to think on those lines esp. with all the information we have on
dysphagia ...what I dislike is undermining a tool which has it's place
in the assessement and management of dysphagia...it's like arguing FEES
is better then MBS ...they have their specific values adv and
disadv.....selection of right tool to answer your clinical question to
understand and resolve the problem...is clinical excellence..I have had
discussions with leaders in our field like Dr Crary, Dr Mann, Dr
Logemann Dr Langmore, etc. ..nobody has ever said VFSS or FESS are
useless tools....we know one episode or case or sample does not
represent the population or the person but it is a part of the whole.
Ta

Jai Gupta. 
The Sutherland Hospital



 

  _____  

From: Vera Karger [mailto:vkargerslp at mac.com] 
Sent: Thursday, 23 August 2007 10:34
To: Jai Gupta
Cc: Irene Campbell-Taylor; apdfried at juno.com; dysphagia at b9.com
Subject: Re: [Dysphagia] Dehydration and falls 2


Of course I can't speak for Irene, but to me her statement that "there
are multiple other variables involved" does not exclude VFSS as a useful
tool, but does not elevate it to the end-all and be-all. 

Vera  Karger, M.S., CCCS
Monroe, CT
vkargerslp at mac.com



On Aug 22, 2007, at 7:07 PM, Jai Gupta wrote:


	Irene said
	  *** May I refer you to Groher, Logemann and others as to the
fact that
	VFSS never shows what happens in real life.  One can never say
that one
	intervention e.g.thickened fluids, causes anything or, more
importantly,
	prevents anything as 1) it is scientifically impossible to prove
a
	negative and 2) there are multiple other variables involved. 

	Why do we do VFSS??? If it does not give us insight into what is
	happening, Is the goal not to understand the neurophysiology and
	biomechanics of swallow and trial appropriate
intervention/strategies??
	And see they work or not ....I find hard to swallow that a
single
	episode is not sufficient to make objective, imporatant and
logical
	clinical decisions...is it different to any other examinations
like CT,
	Chest Xray or blood test....I think to me even that one
visualization of
	swallow is always better then just observation. I do not deny
that one
	cannot make with experience good decisions but we should not
undermine
	the imporatance of VFSS. Caution yes ...undermine VFSS no...

	Jai Gupta.  
	The Sutherland Hospital 




	-----Original Message-----
	From: dysphagia-bounces at dysphagia.com
	[mailto:dysphagia-bounces at dysphagia.com] On Behalf Of Irene
	Campbell-Taylor
	Sent: Wednesday, 22 August 2007 23:53
	To: apdfried at juno.com
	Cc: dysphagia at b9.com
	Subject: Re: [Dysphagia] Dehydration and falls 2



	"apdfried at juno.com" <apdfried at juno.com> wrote:    I work in
acute care
	hosp. and I'm on the  Falls Committee.  We have researched falls
for one
	year & the most common cause of falls is slow response to call
lights
	related to needing the bathroom.  

	  *** I believe I made the point that the orthostatic
hypotension
	involved in falling when getting out og bed is frequently the
culprit.
	perhaps your Falls committee should look at
	hypovolemia/dehydration/falls as these have been identified
multiple
	times as causing such accidents, often with lethal results. Or
check the
	Merck Manual of Geriatrics on both falls and orthostatic
hypotension.

	  Dehydration was not listed as a cause in any of the reports we
saw.
	Poor falls hx was the second largest cause since most fallers
are repeat
	offenders.

	  *** Indeed it is - and dehydration, among other causes, is a
constant.

	  As far as thickening liquids goes I definitely think more is
not
	better and for years I have told students and other ST's honey
thick is
	as bad as no liquid at all as most people dehydrate.  I'm not
ready tho
	throw out the baby however as less thick alternatives can reduce
	aspiration as clearly seen on videos

	  *** May I refer you to Groher, Logemann and others as to the
fact that
	VFSS never shows what happens in real life.  One can never say
that one
	intervention e.g.thickened fluids, causes anything or, more
importantly,
	prevents anything as 1) it is scientifically impossible to prove
a
	negative and 2) there are multiple other variables involved.




	Dr I Campbell-Taylor
	Clinical Neuroscientist
	Exclusive Distributor:
	www.interactivetherapy.com
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