[Dysphagia] VFSS

[hillivie423 at comcast.net (kathleen wright)]

Fear of infection at the site of insertion is the only reason I've been able to get.
  ----- Original Message ----- 
  From: Irene Campbell-Taylor 
  To: kathleen wright ; dysphagia at b9.com 
  Sent: Friday, August 24, 2007 7:33 AM
  Subject: Re: [Dysphagia] VFSS


  I'd be interested in knowing the reason. I've heard some truly absurd ones over yje years but since its use appears in several guidelines, particularly in the elderly and it is recognized by Medicare, I can only infer either ignorance or greed.

  kathleen wright <hillivie423 at comcast.net> wrote: 
    Our facility refuses to even discuss the use of clysis.
    ----- Original Message ----- 
    From: "Irene Campbell-Taylor" 
    To: 
    Sent: Thursday, August 23, 2007 3:15 PM
    Subject: [Dysphagia] VFSS


    There seems to be a misunderstanding about VFSS and real meals. It's not 
    that it's only a moment in time, it's that in NO WAY does it reflect what 
    happens when a meal is being eaten. It doesn't matter how many trials you 
    have of how many consistencies, it will never show what happens in real 
    life. This has been shown repeatedly by Groher, Jones and Donner, Dua and 
    others and is what leads to false positives as well as false negatives. As 
    to what one does with the patient who coughs on thin liquids,. At the 
    risk of being repetitive, clysis is the usual answer to fluid maintenance in 
    the rest of the world: See:
    Guidelines for the administration of subcutaneous fluids (hypodermoclysis) 
    to adult patients in the community (Please note: in the community)
    http://www.leedspct.nhs.uk/archive/east/attachment/00000000abc3a292817efac1a68ba2a4/0000000077869cd00183e189f3a5caad/PL+010+SUBCUT+Fluids+Guideline.pdf_
    _AND___
    _____http://www.leedspct.nhs.uk/archive/northeast/attachment/00000000edcf3591017443e65dddbba8/000000006f897f618d249b47cf5e73f0/PL010+Sc+Guideline.pdf________________________________________________________
    Age and Ageing 2005; 34: 215-217
    Hypodermoclysis-a victim of historical prejudice
    PRANOY BARUA, BIMAL K. BHOWMICK
    Abstract
    Hypodermoclysis (HDC) had fallen into disrepute after adverse clinical 
    incidents that were obviously the result of improper use of an ingenious 
    technique. HDC has clear advantages over alternative parenteral routes. It 
    has stood the rigor of scientific
    scrutiny but failed to regain its past glory. This is possibly because of 
    our ignorance and inability to detach ourselves from an age-old prejudice. 
    This is an attempt to demystify some of the myths that surround it. The hope 
    is that older people are not denied an element of health care that they are 
    perhaps most well suited to.
    _____AND one of the guidelines I cited yesterday:
    GUIDELINE TITLE
    Dehydration and fluid maintenance.
    BIBLIOGRAPHIC SOURCE(S)
    American Medical Directors Association (AMDA). Dehydration and fluid 
    maintenance. Columbia (MD): American Medical Directors Association (AMDA); 
    2001. 28 p. [15 references
    GUIDELINE OBJECTIVE(S)
    To improve the quality of care delivered to patients in long-term care 
    facilities
    To guide the identification and management of dehydration and 
    fluid/electrolyte imbalance in older adults residing in the long-term care 
    settings
    To present approaches that attempt to minimize the occurrence of 
    dehydration and fluid/electrolyte imbalance
    Management of specific deficits and imbalances, as indicated, such as 
    fluid and electrolyte replacements or fluid restrictions. Fluid replacement 
    may be by various routes, including oral, hypodermoclysis, nasogastric or 
    gastrostomy tube or intravenous

    AND re VFSS and meals:
    Dua KS; Ren J; Bardan E; Xie P; Shaker R. Coordination of deglutitive 
    glottal function and pharyngeal bolus transit during normal 
    eating.Gastroenterology, 112:73-83 1997
    AND
    Groher M. The detection of aspiration. Dysphagia, 9; 147. 1994
    Martin-Harris ; Logemann et al. The clinical utility of the modified 
    barium swallow. Dysphagia 15; 2000. 136.
    JonesB, Donner M. Normal and abnormal swallowing, Springer 1999.



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