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[Dysphagia] Dysphagia Digest, Vol 39, Issue 25
If 50% H202 or chlorhexidine gluconate is part of the oral hygiene program, how long can it be used without decreasing the natural integrity of the mucosa? And once the oral hygiene is improved consistently, can brushing with toothpaste, flossing, and rinsing sufficient with the water protocol?
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Today's Topics:
1. belching (Julie Ennis)
2. Re: 4 day Swallowing Workshop (Heather Hughes)
3. 20 yr old pt s/p craniotomy for ruptured R-thalamic AVM
(malindam at samhealth.org)
4. Chlorhexidine (Irene Campbell-Taylor)
5. Dysphagia Management suggestions (Irene Campbell-Taylor)
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Message: 1
Date: Wed, 21 Feb 2007 17:18:18 -0500
From: "Julie Ennis"
Subject: [Dysphagia] belching
To:
Message-ID:
Content-Type: text/plain; charset="iso-8859-1"
I have a patient.... I have my own ideas with her, but thought I would throw her situation out there to see if anyone has any other thoughts or input....sorry for the long posting...
58 year old female. history of MS (1998) and CVA (2000).
The past 2 years she has developed a constant belching (with and without food/liquid). This only occurs when she is awake. (not when she is sleeping, despite the fact she snores). She initially reported that she felt as though she had "something" stuck in her throat, that only a belch would clear (throat clear, cough, etc would not get rid of this feeling she had). At the end of the conversation, she recanted this statement, staying she didn't feel like there was anything in her throat. She reported that if she did not belch, she felt as though she would have to vomit. She has been on Reglan and proton pump inhibitors without success in decreasing or eliminating the belching. She reported that she can stop the belch if she takes a deep breath when she feels the belch coming.
She has had a full GI workup: endoscopy was negative. upper GI was positive for spontaneous reflux, dilation of the esophagus without typical findings seen in achalasia. (the doctor does not feel it is achalasia), and hypoperistalsis. a motility study revealed very weak peristalsis with only 2 episodes of peristalis (despite the continuous swallows). the lower esopahgeal sphincter is reportedly "OK" (per MD verbal report). The GI doc has given her a diagnosis of nonspecific moderate-severe esophageal motility disorder.
Watching her breathe, she did occasionally "gasp" for air as she talked on little air and spoke in very long sentences. I reviewed possible strategies/techniques for aerophagia with her and she is to get back with me. (shot in the dark)
At this point, I feel as though she might have initially started the belching as a compensatory strategy to all of her GI issues, and now, it has become more of a habit.
any other thoughts? Thank you.
Julie Ennis, M.Ed, CCC-SLP
Sarasota Memorial HealthCare System
941-917-1395
________________________________
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Message: 2
Date: Wed, 21 Feb 2007 22:41:22 +0000
From: "Heather Hughes"
Subject: Re: [Dysphagia] 4 day Swallowing Workshop
To: dysphagia at b9.com
Message-ID:
Content-Type: text/plain; format=flowed
4 Day Swallowing Workshop
Chicago, IL
2007 Dates:
March 26-29
May 1-4
July 30-Aug 2
Oct 1-4
Presented by:
Jerilynn Logemann, Ph.D.
Carrie McBreen
Sharon Veis
Kristin Larsen
Cory Atkinson
Julie Farquharson
This workshop is designed to provide:
--knowledge and hands on experience with radiographic and clinical
techniques for evaluation of swallowing problems in a variety of patients
(including neurological and cancer patients)
--strategies for knowing when and how to implement interventions during
radiographic studies and in therapy
--Guidelines for discontinuing alternate feeding techniques (gastrostomy and
nasogastric)
--observation and participation in evaluation of treatment of patients.
Extensive review of video-taped x-ray swallowstudies will be provided.
--Accepted on a first come basis
--Advanced registration is required ($535.00)
--Deadline to register is 3 weeks prior
Includes 2.8 CEUs, extensive course syllabus, certificate of attendance and
continental breakfast
Please contact Trinklette Stokes
Northwestern University Voice, Speech and Language Service and Swallowing
Center
phone: 312.926.3705
fax: 312.926.3706
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Message: 3
Date: Wed, 21 Feb 2007 16:42:33 -0800
From:
Subject: [Dysphagia] 20 yr old pt s/p craniotomy for ruptured
R-thalamic AVM
To:
Message-ID:
Content-Type: text/plain; charset="iso-8859-1"
I'm posting this for fellow SLP in SNF.
I have a 20 yr old pt s/p craniotomy for ruptured R-thalamic AVM, 12/06, shunt placement 1/07, trach decannulated 1/07, with PEG tube, Rancho level 3-4, deceribrate posture. When arriving at SNF pt demonstrated volitional initiation of swallow upon command. Delay of initiation was aprox 2 sec, with mod reduced laryngeal elevation (to palpation). Only 1 swallow was obtained per day for 3 days when baclophen was increased in attempt to release hyperflexion. Pt was sent back to hosp for baclophen pump trials, unsuccesful, botox injections given in R-arm. Returned to SNF on zanaflex and ativan PRN. Since return pt unable to swallow volitionally. She is being treated for thrush. Using eye blinks for yes/no responses. What can I do for this pt's swallow function?
Malinda Moore, CCC-SLP
Speech-Language Pathologist
Albany General Hospital
541-812-4162
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Message: 4
Date: Wed, 21 Feb 2007 17:25:14 -0800 (PST)
From: Irene Campbell-Taylor
Subject: [Dysphagia] Chlorhexidine
To: dysphagia at b9.com
Message-ID: <570047.83913.qm at web30201.mail.mud.yahoo.com>
Content-Type: text/plain; charset=iso-8859-1
wrote
Can someone provide me with a reference to literature that says that
50%
h2o2 is toxic to the oral mucosa? I've seen it referenced several
times on
the list, but all the research that I ahve read says the
cholorhexedrine or
any alcohol based cleanser is the one to avoid In the last year, we
have
changed our oral care policies and now use 50% h2o2 or the Sage
products
with peroximint
The opposite is true. There are many recommended mouthwashes containing chlorhexidine. The problem with hydrogen peroxide is not that it is ?toxic? but that it changes the pH of the mouth and can, therefore, promote the growth of some pathogens. See:
The following is the information from Glaxo-Smith-Kline, manufacturers of Corsodyl, OTC chlorhexidine product that is, unfortunately, available only in Europe. ?Chlorhexidine gluconate is an antiseptic and disinfectant agent, which is active against various bacteria, viruses, bacterial spores and fungi. It kills the micro-organisms associated with various mouth and throat infections, and other common conditions in the mouth. These include the Candida albicans fungi that causes thrush infection in the mouth, and bacteria that may infect mouth ulcers or other sore areas in the mouth, eg after dental surgery. Infection of these areas increases discomfort and delays healing. Chlorhexidine has also been shown to prevent the formation and build up of plaque on teeth, which helps prevent inflammation of the gums (gingivitis). It can therefore be used as an aid to oral hygiene, particularly in instances where toothbrushing is a problem, eg following dental surgery or in
physically or mentally handicapped people
Oral Decontamination With Chlorhexidine Reduces Risk for Ventilator-Associated Pneumonia CME
News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD, FAAFP
Prevention of Nosocomial Infection in Cardiac Surgery by Decontamination of the Nasopharynx and Oropharynx With Chlorhexidine Gluconate
A Randomized Controlled Trial
Patrique Segers, MD; Ron G. H. Speekenbrink, PhD; Dirk T. Ubbink, PhD; Marc L. van Ogtrop, PhD; Bas A. de Mol, MD, PhD
JAMA. 2006;296:2460-2466.
CHG (Chlorhexidine gluconate) has the potential for fatal ARDS when aspiration occurs following ingestion. There is one such case reported following ingestion and reflux aspiration of 200ml CHG ? far more than is contained in any mouth wash.
Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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Message: 5
Date: Wed, 21 Feb 2007 17:27:32 -0800 (PST)
From: Irene Campbell-Taylor
Subject: [Dysphagia] Dysphagia Management suggestions
To: dysphagia at b9.com
Message-ID: <364406.63675.qm at web30213.mail.mud.yahoo.com>
Content-Type: text/plain; charset=iso-8859-1
Sounds very much like a paraneoplastic syndrome.
Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
------------------------------
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End of Dysphagia Digest, Vol 39, Issue 25
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