[DYSPHAGIA] need help with requirements

[GlendaMyersSLP@aol.com (GlendaMyersSLP@aol.com)]

Please help!!!!!!  I am an SLP in Cape May County New Jersey.  I've only been 
in this area for 2 years, but am shocked at the lack of knowledge about 
aspiration and the need for objective testing.

Currently, I have a resident who was hospitalized with bibasilar infiltrates. 
 He had a bronchoscopy during hospitalization, and the pulmonary specialist 
who performed the bronchoscopy stated in his report that "is most likely 
aspiration related" and that "there was no cough reflex elicited when 
endoscope was passed through the vocal folds."

My feeling is that this man is at high risk for aspiration.  Since he did not 
have cough reflex when the endoscope was passed through the vocal folds, I am 
thinking that he has reduced pharyngeal/laryngeal sensation, placing him at 
risk for silent aspiration.  Am I off base here?

The local hospital has been a nightmare.  They do not do any objective 
swallowing tests, and the hospital SLP does not feel that objective testing 
is necessary.  When I request objective testing, it is refused by the 
physician over 90% of the time.

In this most recent case, I was just screamed at by the physician who stated, 
"why can't you talk to Joe (SLP at the hospital)?  He doesn't need this test, 
am I'm not ordering it, so just forget about it!"

What can I do to bring them out of the dark ages?  I'm about at my wits end.  
Can't the hospital therapist be in trouble if this was ever investigated?  I 
would appreciate your help and guidance.  I would especially appreciate 
articles and/or official guidelines that substantiate the necessity of 
objective testing?

Glenda Myers   MS,CCC/SLP
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