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[Dysphagia] Upper GI question
Was through the tube.. I clearly remember that from the report...
>From: "Speech Julie" <speechhuffman at nc.rr.com>
>To: "Dolinger, Eric" <EDolinger at christianacare.org>, "Rob
>Melchionna" <robmelch70 at hotmail.com>, <dysphagia at b9.com>
>Subject: Re: [Dysphagia] Upper GI question
>Date: Sat, 10 Mar 2007 15:05:03 -0500
>
>YOu may want to check that it was presented through G-tube or was the upper
>esophagus intubated to bypass the pharynx? Usually an UGI study looks at
>the esophagus first and if there is risk for aspiration, they can bypass
>the
>pharynx.... Julie
>
>----- Original Message -----
>From: "Dolinger, Eric" <EDolinger at christianacare.org>
>To: "Rob Melchionna" <robmelch70 at hotmail.com>; <dysphagia at b9.com>
>Sent: Friday, March 09, 2007 8:27 AM
>Subject: Re: [Dysphagia] Upper GI question
>
>
>All you know at this point is that during the barium study, no reflux was
>observed. Just like in any swallow study - there may still be reflux (or
>other abnormality) not witnessed at that particular time.
>
>All you can assume from the FEEST is exactly what you know at this
>point...something came up.
>The same list of questions persist ?dysmotility/GER/stricture/Zenkers/CP
>dysfunction, etc.
>
>This patient does need some kind of imaging from pharynx to stomach - Ba++
>swallow or EGD depending on presumed aspiration risk. If the pharyngeal
>swallow was reasonably safe, I would prefer the former.
>
>Good luck
>eric
>
>Eric Dolinger, MA CCC-SLP
>Senior Speech Pathologist
>Christiana Care Health System
>Phone 302-733-1015
>Fax 302-733-1061
>edolinger at christianacare.org
>
>
>-----Original Message-----
>From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com] On Behalf
>Of Rob Melchionna
>Sent: Thursday, March 08, 2007 11:05 PM
>To: dysphagia at b9.com
>Subject: [Dysphagia] Upper GI question
>
>
>I have a patient, NPO with tube feed s/p severe CVA 11/06, recently had a
>FEESST to help determine possibility of restarting PO feeds (sorry I don't
>have more PMH handy, Im typing this from home and memory). FEESST showed
>functional pharyngeal swallow but swallowed material was reported to come
>back into camera view and the SLP who did the test questioned esophageal
>strictures or motility issues, with recommendation for upper GI series.
>Patient went out to have the upper GI, and during the test, instead of
>allowing the patient to swallow the barium, it was presented via G tube
>with
>patient put into Trendelenburg position. Results were a simple "no
>reflux".
>My problem is.. I still have no idea about the functioning of the
>esophagus,
>right? The way they did the test, I still don't know if the patient has
>esophageal motility issues, or if there are strictures? Should the patient
>be scheduled for a full Ba swallow? An EGD? If she does have an EGD, and
>there are no strictures, can i assume (+) motiliity issues based on the
>FEESST report (I wasn't present for the FEESST).
>Thanks,
>Rob Melchionna MS CCC-SLP
>
>
> >From: "Rob Melchionna" <robmelch70 at hotmail.com>
> >To: dysphagia at b9.com
> >Subject: Re: [Dysphagia] I am fed up
> >Date: Thu, 08 Mar 2007 22:47:50 -0500
> >
> >I also have learned a lot from Irene's posts.
> >I also think she comes across as having disrespect for the SLP
>profession.
> >I hope that's not her intent, but that's the way she comes across.
> >Rob Melchionna MS CCC-SLP
> >
> >
> >>From: "Lawrence Grall" <lhgrall at hotmail.com>
> >>To: lobsterpam at aol.com, dysphagia at b9.com
> >>Subject: Re: [Dysphagia] I am fed up
> >>Date: Thu, 08 Mar 2007 19:54:20 +0000
> >>
> >>As someone who has followed the list serve for several years I have
> >>witnessed several seasons of turbulence and controversey, often
> >>culminating in perceived and often overt disrespect and hostility. I
> >>suspect this will not be the last time and as always, we will learn from
> >>this and go on. Irene has often been accused of "talking down" or
> >>appearing condescending to those on the listserve (especially new
> >>participants who are not familiar with her direct responses) and I
>really
> >>appreciated Pam's perspective of her interactions with Irene. Perhaps
> >>some of Irene's tone is simply based on sheer frustration, and the
>passion
> >>she possesses for this insidious field of dysphagia....having to convey
> >>and address over and over the basic principles and foundations necessary
> >>to even broach this field...and despite the redundancy of questions from
> >>new listservers, she continues to do it. I submit that it is Irene who
> >>has led the way in illuminating what information is really out there and
> >>most importantlly what is not...and in essence played a (if not "the")
> >>leading role in changing the whole paradigm of clinical assessment and
> >>perspective; pulling many of us out of a micro focused "MBS" view and
>into
> >>a comprehensive multidisciplinary approach where encompassing all
> >>approriate areas of medical knowledge is paramount. I have often emailed
> >>Irene personally for specific information and I can testify there has
>not
> >>been one instance where she has not provided me her complete attention
>and
> >>service to locating the information I request and may need in support of
> >>my patient's welfare.
> >>
> >>And although I have witnessed many attacks on Irene's character, it is
>not
> >>very often where I witness any correspondence on the listserve directly
> >>thanking her for the time, effort, and dedication to this listserve. I
> >>have experienced times where she has been insulted to the point of
> >>withdrawing; and trust me her insight and experience has been overtly
>and
> >>greatly missed. Fortunately she has always come back.
> >>
> >>So with that, I (and I know there are a great many others) want to
> >>publicly and personally thank you Irene!...thank you for your
>dedication,
> >>your perseverence, and sheer passion to helping those with
>dysphagia...as
> >>well as those who treat it. I myself think you have a very purposeful
>and
> >>rewarding life!
> >>
> >>Sincerely,
> >>
> >>Lawrence Grall
> >>
> >>
> >>
> >>>From: lobsterpam at aol.com
> >>>To: EThompson at mountnittany.org
> >>>CC: dysphagia at b9.com
> >>>Subject: Re: [Dysphagia] I am fed up
> >>>Date: Thu, 08 Mar 2007 11:12:44 -0500
> >>>
> >>>
> >>> I expect that the example of the graduate student who was woefully
> >>>prepared for a medically based internship is repeated in many settings
> >>>across the country. It is a situation we do our best to avoid. I'd be
> >>>willing to bet that it's a big reason some SLPs don't want to take
> >>>students. Although in our idealism we like to think that "someone did
> >>>this for you, so you should be willing to do it for them," the reality
>is
> >>>that a less-than-prepared student can be more work than benefit. They
>can
> >>>require SO much time and energy that your own productivity suffers more
> >>>than the department is able to absorb. After all, health care is a
> >>>business.
> >>>
> >>> Our second years (they'll graduate in May) started their second half
> >>>placements this week, a week which always makes me a bit nervous,
>because
> >>>it is their medical assignment. I hope I did my job well enough so that
> >>>our SLP supervisors, whom we need and value SO much, can still do
>theirs
> >>>We want the experience with our students to be a benefit, not a burden.
> >>>That's the goal... time always will be the best judge of how we did.
> >>>
> >>> And yes, Elana, I'll be at PSHA. Come to "Scary Videos" on Friday!
> >>>
> >>> Pam Smith
> >>> Bloomsburg University
> >>> Bloomsburg, PA
> >>>
> >>> -----Original Message-----
> >>> From: EThompson at mountnittany.org
> >>> To: lobsterpam at aol.com; dysphagia at b9.com
> >>> Sent: Thu, 8 Mar 2007 10:43 AM
> >>> Subject: RE: [Dysphagia] I am fed up
> >>>
> >>> That is very well said, Pam, and is the culmination of many things I
> >>>was
> >>>considering writing in my own response. (Now, I don't need to!!)
> >>>I will say this, though....
> >>>Last fall I had a graduate student, supposedly a semester away from
> >>>graduation,
> >>>who came to do a 12-week internship with me in an adult acute care
> >>>hospital.
> >>>She had had NO practical adult eval or therapy experience at her school
> >>>and was
> >>>expecting to spend just 12 weeks with me and gain independence in the
> >>>skills
> >>>required of an acute care SLP. Her grade was based on the level of
> >>>independence
> >>>she achieved during the internship. She failed.
> >>>In ALL health care settings, the SLP really should be proficient in ALL
> >>>areas
> >>>Pam mentioned prior to independently seeing patients and grad schools
> >>>should be
> >>>teaching it to us just like it is taught to an RN, PA-C, or CRNP. We
>are
> >>>involved with patients on that level. You cannot understand
>swallowing,
> >>>cognition, and general recovery processes without understanding those
>lab
> >>>values, etc. I never really understood all of that until the past 5
> >>>years, but
> >>>since then I have been trying very hard to gain proficiency in all
>those
> >>>areas.
> >>>
> >>>SLP's might not like to hear it, but in health care settings, we are
> >>>medical
> >>>professionals, not just rehab professionals. That is probably why it
>is
> >>>alarming to some people that an SLP already in those settings would
>need
> >>>an
> >>>introductory level course. However, if you need them, take them and I
> >>>hope they
> >>>are great!
> >>>
> >>>In Pam's words: Here's to getting the knowledge base, using your
> >>>inquisitive
> >>>open mind, accessing information, and thickening your skin!!
> >>>
> >>>Sincerely,
> >>>
> >>>Elana Thompson, MS,CCC-SLP
> >>>
> >>>See you at PSHA, Pam?
> >>>
> >>>-----Original Message-----
> >>>From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com]On
> >>>Behalf Of lobsterpam at aol.com
> >>>Sent: Thursday, March 08, 2007 7:33 AM
> >>>To: dysphagia at b9.com
> >>>Subject: Re: [Dysphagia] I am fed up
> >>>
> >>>
> >>> This isn't directed at the 'introductory course' topic specifically,
> >>>but is a
> >>>more global comment simply offered for consideration. My thoughts on
>the
> >>>introductory course is that if someone needs the training, go get it.
>But
> >>>recognize the larger less personal point that dysphagia education in
>our
> >>>profession in general needs work. Those of us in universities know that
> >>>and are
> >>>we working hard to improve it. The ASHA Knowledge and Skills documents
> >>>speak for
> >>>themselves, and Division 13 has many excellent resources available for
> >>>members.
> >>>
> >>> That said, I think it's very unhealthy for professionals - or members
> >>>of a
> >>>professional discussion lists - to stop questioning the practices of
>the
> >>>profession. NO profession improves unless it is constantly examining
> >>>itself. The
> >>>whole concept of evidence based practice requires continual objective
> >>>evaluation
> >>>of the evidence supposedly supporting what we do. If list serve
> >>>participants
> >>>only wish to support each other with "atta boy!" comments, no one grows
> >>>as a
> >>>professional. Would we rather have an attorney ask some of the
>questions
> >>>that
> >>>are asked here? How do you feel when a smart and savvy family member
> >>>questions
> >>>what you are doing? Or when a physician won't order your services? In
>the
> >>>litigious society in which we find ourselves, it's best we get used to
> >>>people
> >>>asking us the "why" questions about our field, and be prepared to state
> >>>objectively and from an evidence base - not defensively - why we are
> >>>doing what
> >>>we are doing.
> >>>
> >>> The management of patients with dysphagia is a multidisciplinary
>field,
> >>>and any
> >>>SLP who believes he or she can do it himself/herself has a lot of
>reading
> >>>to do
> >>>and additional academic degrees to obtain. A discussion list that
> >>>welcomes the
> >>>contributions of other professionals only helps us to appreciate what
> >>>these
> >>>other professionals know. If we are intimidated by that, nothing is
> >>>gained by
> >>>telling these people to get out of our sandbox. Have the people who
>find
> >>>themselves angry ever located and read the information Irene has
>posted?
> >>>A
> >>>number of years ago I argued openly on this list with Irene, and her
>tone
> >>>was
> >>>directed right at me, and of course I didn't appreciate it. Then I
> >>>finally read
> >>>the literature that was posted (Irene was the first one who I had ever
> >>>heard of
> >>>mentioning the contribution of reflux or oral secretions to pneumonia,
> >>>and I'd
> >>>been practicing for close to 10 years at that point.)
> >>>
> >>> Individuals have their own manner of conveying their thoughts; some
> >>>people just
> >>>don't sugarcoat things. The written word doesn't provide the complete
> >>>pragmatic.
> >>>That's a limitation of email communication and it needs to be accepted
>if
> >>>one is
> >>>going to use this medium. Sure, people could be nicer, but I remember a
> >>>colleague who could be nicer, too. It's a shame if people choose not to
> >>>interact
> >>>because of personality differences. Wasn't it Eleanor Roosevelt who
>said
> >>>no one
> >>>can make you feel inferior without your consent? Anyway, eventually I
> >>>realized
> >>>that my angst wasn't really about Irene. It was easy to blame this
>person
> >>>who
> >>>was faceless and only showed up in my email inbox with abstracts that
> >>>showed she
> >>>had a lot of information at her fingertips that I didn't have, and who
> >>>wrote
> >>>things in a way that made me realize that I was missing some very basic
> >>>information that I SHOULD know. There are and were choices here - to
>get
> >>>angry
> >>>and defensive, or to suck it up and learn thing!
> >>> s. My issues were that I knew practically nothing about lab values,
> >>>dietary
> >>>requirements, respiratory physiology or infectious diseases, and yet
>here
> >>>I was
> >>>working with patients with these very problems. My issues were coming
>to
> >>>terms
> >>>with the fact that some of the interventions I had been doing for years
> >>>had the
> >>>potential to do as much harm as the underlying problem I was trying to
> >>>help.
> >>>
> >>> Whenever students ask me about why practices are so inconsistent, and
> >>>why they
> >>>must continue to read research and understand evidence when they are
> >>>finished
> >>>with school, I tell them that not so many hundred years ago, doctors
>used
> >>>to
> >>>bleed people to cure them of disease, and that's what killed George
> >>>Washington.
> >>>Someone questioned the practice, and someone had to be the first to
> >>>suggest that
> >>>maybe bloodletting wasn't the best way to go.
> >>>
> >>> Working in health care requires a knowledge base, an inquisitive open
> >>>mind,
> >>>access to information, and a thick skin.
> >>>
> >>> Pam Smith, Ph.D.
> >>> Bloomsburg University
> >>> Bloomsburg, PA
> >>>
> >>>
> >>> -----Original Message-----
> >>> From: cohoe at uci.net
> >>> To: vickycox at yahoo.ca; dysphagia at b9.com
> >>> Sent: Wed, 7 Mar 2007 11:52 PM
> >>> Subject: Re: [Dysphagia] I am fed up
> >>>
> >>> I vote for a kindler, gentler listserve as well. Can we stop wit
>the
> >>>questioning of others and simply be supportive? If we fear posting for
> >>>the
> >>>ridicule of one member we allow her to win. Let's ask those beginner
> >>>questions and let's advertise those courses. This listserve is for
> >>>SLP's;
> >>>let's take it back.
> >>>
> >>>-----Original Message-----
> >>>From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com] On
> >>>Behalf
> >>>Of Vicky Cox
> >>>Sent: Wednesday, March 07, 2007 7:42 PM
> >>>To: dysphagia at b9.com
> >>>Subject: [Dysphagia] I am fed up
> >>>
> >>>Hello all,
> >>>
> >>> I am an SLP and proud to say that I am attending "beginner"
>workshops
> >>>even
> >>>though I have been practising for a long time. I suppose I never think
>I
> >>>am
> >>>a perfect SLP, and guess what, I may even learn something from the new
> >>>grads, who as someone put it, should already know everything form their
> >>>masters program.
> >>>
> >>> I posted a question a few years back when I was a new grad, and a
> >>>particular person posted a reply and made me look like a total idiot
>(the
> >>>same person who normally does this). I feel saddened to say that I have
> >>>been
> >>>afraid of posting since then. But reading all of these replies, I am
>glad
> >>>that others can see how toxic this list serve can be.
> >>>
> >>> Its a shame really, because there are some really great SLPs who
>post
> >>>here
> >>>(all in fact), and I am sorry I had such a bad experience in the past.
> >>>
> >>> Thanks,
> >>> Vicky
> >>>
> >>>
> >>>---------------------------------
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> >>>
> >>>
> >>>
> >>>
> >>>_______________________________________________
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> >>
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> >
> >
> >>_______________________________________________
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