[Dysphagia] celiac disease

[marthac at noln.com (Martha Carbone)]

Thanks everyone for your thoughts on the case of the 90 year-old female 
with celiac disease suspected of aspirating. Her daughter did not want 
her to have anything invasive and so I did not pursue trying to arrange 
a FEES. SLPs typically don't do FEES around here in PA.

We ended up using the powdered barium (EZ-PAQUE from EZ EM) as the 
daughter felt the ingredients were less offensive than what was in the 
Varibar products. I mixed it in with foods she could tolerate and did 
the VFSS this morning. I used homemade applesauce (from the daughter) 
and mashed potatoes (from the hospital kitchen) as thickeners for the 
liquids, which worked well.

The VFSS results were not good. She demonstrated very weak 
oropharyngeal musculature/poor propulsion. Aspirated thin liquids with 
delayed, weak and ineffective cough. Deep penetration with all other 
consistencies. Residue left behind with all consistencies--additional 
swallows did not clear. CP seemed to open fine but she was only getting 
small amounts through secondary to poor propulsion.

The daughter and physicians have decided to use a PEG tube for her. She 
will be going to a SNF as soon as medically stable.  She is totally 
worn out from lack of nutrition, pneumonia, cough.

Thanks again for all the input.

Martha Carbone, MS, CCC-SLP