[Dysphagia] Liquids, blood pressure etc.

[eripley at yahoo.com (Irene Campbell-Taylor)]

Geriann Jackson wrote:

I have just had too many patients who did well on thickened liquids

to give it up entirely yet.

*** I would be interested in knowing what type of patient and what you mean by ?doing well?. Are they eating and drinking more, gaining weight? 

These individuals are those with whom there is

clinical evidence of penetraiton/aspiration with thin and who have had a

follow-up video or FEES during which they were sufficiently challenged with

the thickend consistency that I am comfortable about their safety.

*** Again, I must point out that VFSS does not tell you what will happen outside of that situation.

 I have not had anyone develop a pneumonia 

*** I think this is another example of the belief that all aspiration is harmful and, one cannot prove a negative. It is scientifically impossible to say that if something happened/was done, something else did not happen.

or have problems with hydration 

*** How do you know? Physicians, I find, are usually looking for hypernatremia as a sign of dehydration. They seldom seem to think of hypovolemia or hyponatremic hypovolemia ? likewise many dietitians.

Sometime their status/disease process changes 

*** Would you share the common situations of change?

This is why my head is

having a hard time wrapping around the "no thickened liquids" idea.

*** Having never used thickeners in many years and not having patients die in copious numbers, I have to stand by the evidence. Just because water may be absorbed adequately from thickened liquids, it does not follow that the patient is adequately hydrated. In addition, the thickeners that are gum based cause a false satiety leading to slow gastric emptying and malnutrition because of a lack of appetite for the food. This probably applies to the starch based ones as well but has not, to my knowledge been proven as has slow gastric emptying with gums and fiber. Geriatric care is extremely complex and an area in which, even more than many other parts of medicine, is individual patient centered.

How can water be a worse aspirate than saliva?

 


Dr I Campbell-Taylor
Clinical Neuroscientist
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