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[Dysphagia] Myasthenia Gravis

Hi Lucy

I have been involved in the "treatment" of several MG patients. Treatment 
really focuses more on education and mgmt rather than tx. MG patients are 
usually given mestinon.  You should find that swallow function is best when 
the mestinon is at a peak therapeutic level about, 30 to 45-min PO and 
shorter when IV. This of course needs to be coordianted with the  ordering 
neurologist.  If the pt is in a really bad exacerbation period it may take 
many different kinds of tx to resolve the exacerbation (prednisone, 
solumedrol, cellcept and even plasmopharesis are some of the ones I have 
seen used) When  the patient's are unable to take PO I would suggest a 
dobhoff tube for a few days until the exacerbation can be controlled. 
Exercises are not indicated with this disease. It is usually best to limit 
activity before meals so that swallowing function is optimal.
Other general swallowing compensatory techniques of ; alternating liquids 
and solids , small bites, small sips and PO supplement to maximize calories 
in the least number of swallows are usually helpful. Diets of mechanical 
soft or pureed seem best due to chewing fatigue . I have not really 
recommended thickener with these patients as thickened liquids are somewhat 
harder to swallow for this group.
Hope you find this information helpful.

Patti Larghi MS, CCC-SLP

>From: "Lucy Reed" <reed78 at comcast.net>
>To: <dysphagia at dysphagia.com>
>Subject: [Dysphagia] Myasthenia Gravis
>Date: Tue, 17 Jul 2007 23:28:30 -0400
>Does anyone have experience treating dysphagia in patients with Myasthenia
>Gravis? Is there any research published on treatment outcomes? I did a
>search and was unable to find any.
>I have my first patient with the disease. She's on a soft diet, since
>excessive chewing fatigues her muscles. She sometimes experiences her
>swallow function "freezing up", especially in the middle of the night. When
>this happens she has trouble swallowing her saliva. Does anyone have any
>insight into this?
>Lucy Reed
>Lucy Reed, MA, CCC-SLP
>Certified VitalStim Provider
>Certified Wilson Reading Program Instructor
>  <mailto:lucyreed at iname.com> lucyreed at iname.com
>  <mailto:reedlu at winslow-schools.com> reedlu at winslow-schools.com
>  <mailto:reedlu at winslow-schools.com>
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