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[Dysphagia] Logemann results
As you can see, I save the most interesting discussions in my
Dysphagia mailbox, which gives me an opportunity to review and
compare and comment, so here goes.
Patient #1: 64 year old male with Right CVA end of 2006, now
ambulatory by cruising walls and furniture till he reaches his
walker. This man lives with his wife in a project of a large city.
He lacks dentition of any kind and has for at least a few years. He
eats whatever he wants, including steak, though it's been shown that
he aspirates.I doubt he eats steak too often.
His doctor referred for the second time because the patient is not
compliant with airway protection measures and dietary modifications.
As it turns out, he does often (though probably not always) use a
chin tuck and head turn for his swallow. He will not use thickened
liquids. There's a history of alcohol abuse (or ETOH as it's stated
by acronym.)
This time around I've instructed him in the water protocol, brought
him a special size polycarbonate "glass," and having explained all to
the doctor, freed him of feeling guilt (and animosity) about not
using thickened liquids.
He has a strong, quick reflexive cough and equally strong cough upon
request. He shows signs and symptoms of aspiration risk; I've asked
his significant other to pleasantly ask him to cough and clear when
she hears this voice change. I've asked him not to take umbrage when
she does this.
I'll be monitoring him. All comments are welcome. I'll regard them as
a peer review. Patient #2 to follow.
Many thanks.
Vera Karger, M.S., CCCS
Monroe, CT
vkargerslp at mac.com
On May 9, 2007, at 6:45 PM, Irene Campbell-Taylor wrote:
> These are the patients most often found in LTC ? and the
> Parkinson?s with dementia is actually the parkinsonian stage of
> dementing illness. I don?t believe anyone has made general
> statements about all dysphagic patients ? simply that, contrary to
> popular belief, thickened fluids are aspirated, the thicker more
> than the thinner (as Perlman proved years ago), and, as the authors
> say, it is probable that the lungs? ciliary motion cannot clear the
> gum-based thickener used. If so, this would apply to all since lung
> function is not affected by dementing illness.
> The importance of the findings is mainly to point out that the
> almost universl belief that thickening prevents aspiration is false
> and that dehydration is a constant danger.
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
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