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[Dysphagia] (no subject)
Allie,
I'm sorry if you felt attacked. Remember that the wonder of e-mail is the
instant response. The problem with e-mail is the quick and direct
communication is easily misconstrued by all communicators. . . a sad comment
of the communication skills of trained speech language pathologists. The
information you shared in this last e-mail about your patient was the
information you would have been well served to share in your first call for
advice. It would have saved you from some hurt feelings But, if you weren't
looking for treatment approaches, what was your question?
Just so you know as a relatively new SLP, Dr. Sonies is one of the most
supportive and knowledgable SLPs I've ever learned from both from this list
and from her workshops. Many times she will send out a "good job" note.
She's worked in the trenches a long time and does a terrific job at looking
at the whole person.
That being said, here are some added things I'd incorporate into my
treatment plan if this was my patient.
1. I would not use lemon glycerine swabs. Studies have proved that they are
drying to the mouth, so you are exacerbating his problem. Instead, after
making sure he has a very clean mouth, I'd use ice chips. Since water is a
pH neutral, even if he aspirates a small amount, his lungs will handle it
readily.
2. If you haven't already, I'd ask his doc to order something to help deal
with the xerostoma. Moisture is critical for moistening the oral structures.
3. Continue with concentrated exercises focused at laryngeal elevation and
tongue based retraction. Do some research to see if the specific exercises
you are using now are the only ones that work or if you should add others.
There are lots of exercise out there that SLPs are using that aren't as
effective as others for both tongue base retraction and laryngeal elevation.
Then, when finished with his next certification time, I'd order another MBS
to see if he could take anything by mouth or if he needs to continue NPO. In
my experience, if you can't get the swallow to trigger at least at 3
seconds, you probably haven't improved things enough to get him on PO.
This is meant as a supportive e-mail and I hope you take it as one. I've
tried to be thorough in my response, and am not being condescending. I
wouldn't take the time to write this if I didn't care about sharing
information with new SLPs. When I stated my feelings about the use of the
word "failed MBS" I was talking about seeing it in pt. histories and how
frustrating it is to try to plan treatment from that report.
Good luck!
JoAnn Eaton, M.S., CCC-SLP
----- Original Message -----
From: <tweetsalong at aol.com>
To: <paula.garbin at gmail.com>; <bsonies at comcast.net>
Cc: <eripley at yahoo.com>; <dysphagia at b9.com>
Sent: Tuesday, May 15, 2007 6:29 PM
Subject: Re: [Dysphagia] (no subject)
> 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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>
>
> _______________________________________________
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> _______________________________________________
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