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[Dysphagia] Dehydration and falls 2
Again I feel compelled to reiterate that, though I can't ~ and don't
~ speak for Irene, I interpret her statements to mean that VFSS is
just a piece of the puzzle, a part of decision-making for each
patient, and shouldn't be regarded as the end-all and be-all.
Vera Karger, M.S., CCCS
Monroe, CT
vkargerslp at mac.com
On Aug 23, 2007, at 9:15 AM, Paula Garbin wrote:
> I agree with everything that you have stated Jai... because what
> are we supposed to utilize then to make an accurate assessment? I
> always do MULTUPLE trials, as much as the Rad will allow me, esp.
> if I know the pt. is going to fatigue. We know that the VFSS is not
> representative of the entire meal, this is a given. But even a
> moment in time can elude us to a final conclusion and
> recommendation in terms of what is appropriate for the patient.
>
> Irene... do you propose that we rely on our clinical decision
> making at the bedside to reach a final recommmendation of a least
> restrictive diet consistency? I think there is more liability doing
> that than anything else.
>
>
> On 8/22/07, Jai Gupta <Jai.Gupta at sesiahs.health.nsw.gov.au> wrote:
> 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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> CONFIDENTIALITY NOTICE
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> NB: *** Due to an organisational amalgamation, email addresses for
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> contacts list with the details of the email addresses contained
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> intended solely for the use of the individual or entity to whom
> they are addressed. If you are not the intended recipient, you are
> not permitted to distribute or use this email or any of its
> attachments in any way. We also request that you advise the sender
> of the incorrect addressing.
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> This email message has been virus-scanned. Although no computer
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> resulting from email containing any computer viruses.
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