FW: [DYSPHAGIA] blue dye causing deaths? Really

[GuptaJ@sesahs.nsw.gov.au (Jai Gupta)]

Dear Katie,
I fully agree with you ..I have already voiced my concern to the ENT surgeon
and have documented the facts and advised the same (trachy/Filter) long time
back when the incident took place .....Following that I think temporarily
they have given up on TEP as the TE puncher was not retained once he pulled
out is TEG tube.....  We are have trouble keeping anything on this man ...be
just keeps of pulling out everything ...IV, NG,Trachy, even his dress he
does not like on himself ..very natural man in true sense of the word. His
insight and memory is terrible has severe dyslexia prob. post hypoxia thus
cannot communicate in writing ( which he could initially but has demented
rapidly) and he is so frail and dyspraxic that servox would be not feasible,
teaching him any new skill is not possible. Fortunately now all the fistula
have healed and no aspiration is noted... lets hope the surgeon takes note
of putting HME filter ... but you know thinks are not so simple...    
Jai Gupta M.Sc (S.H.) C.P.S.P.,M.S.P.A.
Manager, Speech Pathology Department
The Sutherland Hospital Caringbah
Taren Point 2229 NSW. Australia
Tel 602-95407111 Fax 602-9540 7717
Email: guptaJ@sesahs.nsw.gov.au

> ----------
> From: 	KATIE DIETRICH[SMTP:KDIETRIC@gbmc.org]
> Sent: 	06 October, 2000 11:34 PM
> To: 	Jai Gupta
> Subject: 	Re: FW: [DYSPHAGIA] blue dye causing deaths? Really
> 
> Based on what you've written I 'd be very concerned about this patient
> having any type of traditional or Indwelling voice prosthesis! I have had
> some success with demented patients and a Servox. Surpisingly, the device
> acted as its own visual cue. However, the patient's family did have to do
> substantial supervision of this patient as she frequently would misplace
> the device. By the way... she did have a primary indwelling device which
> started to malfunction within 2 months of D/C. This allowed liquid to
> freely enter her stoma (It took quite some time for her family to figure
> out where the stains on her shirts were comming from). So....After inital
> debate (with physician) about the appropriateness of a voice prosthesis
> and after the subsequent aspiration pneumonia, the prosthesis tract was
> allowed to close. (There are  more examples of demented patients and the
> bad things that I have observed with voice prosthesis that I will not bore
> you with at this time)
> 
> I have been reading all the postings from yesterday , so I may be a bit
> confused but is this man aspirating due to - not the fistula (which is
> healed) but from actually putting material into his stoma?
> 
> Have you considered using a HME filter? This would at least cover the
> stoma and make putting things into it (albeit a suction catheter or saline
> dropper) more difficult.
> 
> I have many possible follow-up questions about this patient and hope you
> will keep us posted.
> 
> Good Luck
> 
> -Katie 
> 
> 
> Katie Dietrich, M.S., CCC-SLP
> Senior Speech Pathologist
> The Milton J. Dance, Jr. Head & Neck Rehabilitation Center
> Baltimore, MD
> 
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