[Dysphagia] Dehydration and falls 2

[kelly_slp at hotmail.com (kelly brewer)]

Greetings from Alaska...
i'm an SLP working in long-term care, and i've been a member of the dysphagia listserv for more years than i care to admit- over the years i've admired your input.  is it wierd to be a middle aged swallowing groupie?  
anyway... my sister and mother live in Sydney, and i will be visiting in October.  i know nothing about where your facility is located, so i don't know if it would be possible to visit your hospital while i'm there... but if it is possible, would you mind a visit?  Mom just moved there this month, and she's becoming more frail as time goes on... i'd like to get a sense of the healthcare system from another provider.thanks for considering it...
kelly

kelly brewer> Date: Thu, 23 Aug 2007 14:46:00 +1000> From: Jai.Gupta at SESIAHS.HEALTH.NSW.GOV.AU> To: vkargerslp at mac.com> CC: dysphagia at b9.com> Subject: Re: [Dysphagia] Dehydration and falls 2> > 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> _______________________________________________> Dysphagia mail list: Normal and disordered swallowing> information> Dysphagia at dysphagia.com Manage subscription:> http://lists.b9.com/mailman/listinfo/dysphagia> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum> > > > > ------------------------------------------------------------------------> ---------------------> > SOUTH EASTERN SYDNEY AND ILLAWARRA AREA HEALTH SERVICE> CONFIDENTIALITY NOTICE> > NB: *** Due to an organisational amalgamation, email addresses> for recipients in this organisation have changed. Please update your> contacts list with the details of the email addresses contained within.> > This email, and the files transmitted with it, are confidential> and 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.> > This email message has been virus-scanned. Although no computer> viruses were detected, South Eastern Sydney and Illawarra Area Health> Service accept no liability for any consequential damage resulting from> email containing any computer viruses.> > _______________________________________________> Dysphagia mail list: Normal and disordered swallowing> information> Dysphagia at dysphagia.com> Manage subscription:> http://lists.b9.com/mailman/listinfo/dysphagia> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum> > > > ---------------------------------------------------------------------------------------------> > SOUTH EASTERN SYDNEY AND ILLAWARRA AREA HEALTH SERVICE CONFIDENTIALITY NOTICE> > NB: *** Due to an organisational amalgamation, email addresses for recipients in this organisation have changed. Please update your contacts list with the details of the email addresses contained within.> > This email, and the files transmitted with it, are confidential and 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.> > This email message has been virus-scanned. Although no computer viruses were detected, South Eastern Sydney and Illawarra Area Health Service accept no liability for any consequential damage resulting from email containing any computer viruses.> _______________________________________________> Dysphagia mail list: Normal and disordered swallowing information> Dysphagia at dysphagia.com> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
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