[Dysphagia] dysphagia and Muscular Dystrophy

[pressmah at sjhmc.org (Pressman, Hilda)]

In all likelyhood the difficulty with solids is that she is not able to chew them adequately.  I would suggest soft to chew solids with meats such as beef stew chopped  Hilda Pressman

-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com]On Behalf Of
mbrueckner at zoomtown.com
Sent: Tuesday, May 22, 2007 8:13 PM
To: dysphagia at dysphagia.com
Subject: [Dysphagia] dysphagia and Muscular Dystrophy


Input appreciated:

69 yo female with 10 year hx of dysarthria and 2-3 year hx of globus sensation who was recently diagnosed 10/07 with an "atypical progressive muscular dystrophy" mainly involving the muscles of the face and neck.  She is now having difficulty getting up from a seated position, falling and experiencing extreme fatigue.  

She came to our facility for an outpatient MBS because globus sensation increasing and EGD with dilation performed 12/06 did not provide improvement as before with previous dilation.  She also reports "tickle" while eating and coughing throughout her meals.  Per patient  "solids are the hardest to swallow, but thin liquids cause me to cough".  

With all consistencies there was a delayed swallow response with pooling to the pyriforms, significant bilateral vallecular & pyriform stasis and penetration to the true vocal cords.  The epiglottis did not deflect at all, forward hyoid movement was minimal and there was decreased pharyngeal peristalsis.  Compensatory strategies were not effective.  Pt could expel penetrated material off cords when cued to cough, but it would re-enter airway during dry swallow.  Clearing of vallecular and pyriform stasis was minimal with 2-3 swallows.  Pt reported no weight loss or recent pneumonia, but does state swallowing has been more difficult and slower the past month.  

1)  What would be your diet recommendations/plan of care?
2)  Given MD and fatigue issue, is traditional swallowing therapy or vital stim contraindicated?  

Neurologist is unsure of disease process and was surprised by severity of swallowing problems despite involvement of face/neck muscles....Hmm

Thanks,
Michelle
   
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