[Dysphagia] Logemann results

[vkargerslp at mac.com (Vera Karger)]

Patient #2: Saw on 6/14, a 94 year old female originally diagnosed  
with pneumonia, and a history of atrial fibrillation, fecal  
impaction, hypertension. Initial visit revealed patient with head- 
forward posture (probable osteoarthritis) in wheelchair, fed pureed  
food and nectar thickened liquids. However, this texture modification  
was initiated about 3 years prior not by medical order, but by  
husband's decision, based on fact that a dev. delayed grown son was  
on that diet, and wife has almost no dentition, so he made that  
decision. (Still, the intake stated diet to be regular soft.)

Patient's dentition in very bad shape; perhaps a half dozen in mouth  
are broken and blackened. This is a middle class family that could  
afford dental work, but the patient has refused for many years.

At first session also patient's voice barely above a whisper; feeds  
self pureed food slowly; gets thickened liquids by sips, straw or  
spoon, but thickening of liquids is inconsistent. (Very commonly  
found.) All caregivers were instructed and educated re thickening of  
liquids in a consistent manner, also reviewed possibility of water  
protocol, and clarified food textures, using NDD as guideline. RN on  
case concerned about keeping pt. hydrated.

2nd session canceled when pt. went into hospital for urosepsis  
(enterococcus) and aphasia.

2nd session took place 7/2. Patient displayed no voice whatsoever,  
mouthed 2-3 word responses, judged to comprehend light conversation  
and light humor. Appeared to be dozing much of the time, same  
posture, weakly and barely lifted head. RN concerned whether peg tube  
needed, and/or hospice to be considered.

At this 2nd session introduced water protocol as a strict structure  
for this patient. Spoke with doctor and explained all, and agreed  
with his statement that "she's on her way out." At 3rd session two  
days later, reviewed and reinforced protocol. Spouse reported patient  
coughing less, but at this stage I'm not viewing that as a sign   
either positive or negative.

Any comments appreciated.

Vera	 Karger, M.S., CCCS
Monroe, CT
vkargerslp at mac.com