[Dysphagia] (no subject)

[tweetsalong at aol.com (tweetsalong at aol.com)]

Hello everyone!
 
Thank you to Paula and Lucy for responding without passing judgment.  I guess maybe some of you misunderstood (or maybe I stated it wrong) what I was saying...
 
I understand how to treat a pt who has dysphagia.  I understand that you are supposed to treat the actual problem (reduce tongue base ret, reduced larngeal elevation)!  I would never tell or document that a patient has failed an MBS.  I was using that terminology to present my case to the listserv.  I just found out the results today (he will continue to be NPO) via a message left on my voicemail from his wife.  I am still waiting for the actual results of the study.  
 
On his previous MBS he had (off the top of my head) a 6 sec. delay, reduced tongue base retraction, reducecd laryngeal elevation, and aspirated every consistency attempted.  I have been doing thermal stim, OME's, using lemon glycerin swabs,etc.  This pt. has a hx of oral cancer and has a fistula the size of a golf ball in the roof of his mouth and wears a prosthesis for this.  When the pts cancer was treated, the salivary glands in his mouth were burned...SO...the pt has decreased saliva and is unable to produce a timely dry swallow (time ranges from 5-9sec).
 
I guess I had a miunderstanding about what the point of this listserv is...I thought we could rely on our fellow colleagues to help us out when needed.  I will admit that I am a fairly new SLP...haven't you all been in my shoes??
 
Allie 
-----Original Message-----
From: paula.garbin at gmail.com
To: bsonies at comcast.net
Cc: tweetsalong at aol.com; eripley at yahoo.com; dysphagia at b9.com
Sent: Tue, 15 May 2007 2:38 PM
Subject: Re: [Dysphagia] (no subject)


Hi Allie,
 
I can understand what the other ladies were stating. There has to be something more specific that you need to focus on with this man's treatment. What are the main areas of difficulty? And yes is he aspirating everything? I can understand the use of the word FAIL, but it does need to be qualified. What did this man "fail" to do during this MBS. And I think you should continue to treat him with another MBS at the end. If no progress has been made by that time then I would call it. At that point something is working against you. 
 
We are here to help other people and answer questions; not to make other people feel incompetent due to misuse of terminology. Wording and presentation is everything.
 
Please let me know what the outcome ends up being.
 
~Paula

 
On 5/15/07, Barbara Sonies <bsonies at comcast.net> wrote: 
No one FAILS an MBS- this is an incorrect interpretation of the test-what do
you possibly mean by fails??!!! Did he aspirate on all textures, did he have 
pooling for some, did he fail to produce any swallow, was there reduced
hyoid elevation or epiglottal lowering, did he penetrate into the vestibule,
did he attempt to clear the pharynx, did some bolus enter the esophagus??? 
These are among the observations one makes to analyze a swallow or set of
swallows--he can not FAIL.
Dr Barbara Sonies, BRS-S


On 5/15/07 4:44 PM, "tweetsalong at aol.com " <tweetsalong at aol.com> wrote:

> Hello everyone-
>
> I am looking for a little advice regarding one of my homecare patients.  This
> gentleman came to me as NPO back in the beginning of March.  I have been 
> seeing him since then and have recertified him for services.  Today he went
> for a repeat MBS and failed once again.  I know that he has made some
> progress.  He is very motivated and practices his exercises 3 times a day.  I 
> will continue to see him for the remainder of the certification period which
> ends at the beginning of July.  Should I recommend another MBS at that time or
> do I discharge him and encourage him to continue to pactice?  When do you draw 
> the line as to how long you should continue services (especially if no
> progress has been made)?  I am waiting for the updated MBS to be faxed to me
> to see if anything at all has changed...
> 
> Any thoughts would be greatly appreciated...
>
> Allie
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