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[Dysphagia] Logemann results and MBS
Very well said. I hope we can all agree on those *facts*...
----- Original Message -----
From: "Irene Campbell-Taylor" <eripley at yahoo.com>
To: "Shadd Lagrandeur" <slagrandeur at lrgh.org>;
<Jai.Gupta at SESIAHS.HEALTH.NSW.GOV.AU>; <dysphagia at b9.com>
Sent: Thursday, May 10, 2007 9:37 AM
Subject: Re: [Dysphagia] Logemann results and MBS
>
>
> Shadd Lagrandeur <slagrandeur at lrgh.org> wrote:
> One cannot help but extrapolate from the evidence provided during an
> MBS....that is what we get paid to do. \
> *** On the contrary. What one is paid to do is identify the cause of the
> problem - and saying, for example-that the patient had a stroke is
> insufficient, and thence formulate goals and management plans for the
> individual patient (emphasis on individual) with follow up. It has been
> shown over and over that VFSS does NOT duplicate a real meal. Indeed it
> cannot duplicate a real meal because of the situation and the materials
> provided. The VFSs is was only ever meant to identify the dynamics of the
> swallow and has been so demonstrated as far back as the late 1980's.
>
> We know we get plenty of false negatives, however if a patient
> silently aspirates thin barium during the MBS, you can safely extrapolate
> that they aspirate thin fluids.
> *** Absolutely not. There is no evidence to support such a conclusion.
> It depends on so many variables that such a homology is invalid.
>
> If a patient keeps getting aspiration pneumonias despite our
> interventions, then we try more interventions, put in a PEG tube, or let
> the
> patient eat as they wish and die.
>
> *** Is it really an accepted notion that aspiration leads inevitably to
> death? Nothing could be further from the truth. As repeatedly shown in
> the medical literature, the hazards of aspiration depend on four main
> variables, to be considered together:
> What is being aspirated, how much, over how long a period and, most
> importantly, what is the patient's resistance/immune response. Please read
> Marek on Pneumonia and Pneumonitis, NEJM 2000 I believe. It explains this
> very clearly as well as the near drowning literature.
>
> What are the practical implications of these discussions...no one has
> talked
> about how this should actually change how we view, diagnose, treat, and
> make
> recommendations for dysphagic patients.
> *** I think the practical implications couldn't be clearer. What has been
> taken as received wisdom is often if not always wrong. Other means of
> gaining hydration are available - drinking water, hypodermoclysis,
> drinking in different positions etc. etc. These need to be learned and
> used more extensively.
>
> In the end this is all evidence that despite our best attempts at
> prolonging
> some of these people's unfortunate existences, nature still takes its
> course!
> *** Nature will always take its course. All we can do with respect to
> swallowing impairment is to try to improve or maintain nutrition and
> hydration for as long as possible in a manner that is comfortable,
> efficient and acceptable to the patient.
>
>
>
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
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