[DYSPHAGIA] unknown etiology of EXTREMELY focal dysphagia

[kgoertz@pahd.sk.ca (Clarke-Goertz, Kim (PAHD))]

What are we assuming the negative(s) to waiting might be (e.g., what would
happen if you monitored and educated re: positioning, etc. but did not do
dpns for 2 weeks post onset)?

Just a question, here to learn.

Thanks,
Kim

Kim Clarke-Goertz CCC-SLP (C)


-----Original Message-----
From: BETH STAMEY [mailto:bndstamey@prodigy.net]
Sent: Wednesday October 3, 2001 09:56
To: dysphagia@medonline.com
Subject: Re: [DYSPHAGIA] unknown etiology of EXTREMELY focal dysphagia


the patient is approximately 10 days post onset... although dpns is
invasive, i have to say that i have never had a cognitively intact patient
refuse it... for the same reasons people endure things like chemo,
injections, radiation, surgery, and medicine that tastes awful... because
when presented with the choice between medical intervention that might help
and waiting to see what fate and recovery have to offer alone, people often
choose medical intervention...

in many cases, (dpns being one of them) the risks of not accepting therapy
far outweigh the risks of accepting therapy.  my patient is no exception to
this school of thought... right now, she is extremely frustrated that she is
unable to swallow... and if therapy can help bring recovery even one day
sooner... she is all for it.

i guess im just a fan of early intervention all around... regret and
hindsight are just too costly when intervention can only help (when the
intervention has a risk associated with it, i obviously feel that merits
more consideration from therapist and patient) again... just my 2 cents!



----- Original Message -----
From: "Kate Farabaugh" <Kate.Farabaugh@BannerHealth.com>
To: <bndstamey@prodigy.net>; <smhoffm1@students.wisc.edu>
Cc: <dysphagia@medonline.com>
Sent: Wednesday, October 03, 2001 11:38 AM
Subject: Re: [DYSPHAGIA] unknown etiology of EXTREMELY focal dysphagia


I agree with Sara, my other concern is that DPNS is rather noxious, and if
you are inducing a gag etc, and it isn't worth doing because of spontaneous
recovery, well, it would seem rather punitive? Let us know time frames and
sensitivity to this gagging as perhaps she should just be allowed some
recovery time? thanks

Kate Farabaugh, MA, CCC-SLP
Pediatric Rehab Manager
970.350.6155
kate.farabaugh@bannerhealth.com

>>> Sara M Hoffman <smhoffm1@students.wisc.edu> 10/02/01 08:15PM >>>
At 07:30 PM 10/2/01 -0400, you wrote:
>i would like to thank everyone for contributing your insight with my
>patient's case.  it turns out that she had a small medullary cva...

How long ago was her medullary CVA? Lateral medullary CVAs usually begin to
recover on their own within 2 weeks and recover to regular diet in under 3
months. If she is in this time frame DPNS is doing nothing....it's all
natural recovery! These small CVAs are not that rare and there is
literature out there on this common coarse of recovery.

Sara

her
>case is unlike any i have ever seen in the sense that her speech is
>completely normal/intelligible, and although she is unable to initiate a
>swallow reflex, she is able to control saliva and po trials in bringing
them
>from her pyriform sinuses and spitting them up without aspirating. ive
never
>seen anyone have such a severe pharyngeal dysphagia with this type of
>control!  she is receiving dpns and is showing gradual recovery... all good
>things!  thanks again for your insight!
>
>---------------------------------------------------------------------
>To UNSUBSCRIBE from this list, please send an e-mail message to
>majordomo@medonline.com with the following text as a message:
>unsubscribe dysphagia
>---------------------------------------------------------------------

---------------------------------------------------------------------
To UNSUBSCRIBE from this list, please send an e-mail message to
majordomo@medonline.com with the following text as a message:
unsubscribe dysphagia
---------------------------------------------------------------------


---------------------------------------------------------------------
To UNSUBSCRIBE from this list, please send an e-mail message to
majordomo@medonline.com with the following text as a message:
unsubscribe dysphagia
---------------------------------------------------------------------
---------------------------------------------------------------------
To UNSUBSCRIBE from this list, please send an e-mail message to
majordomo@medonline.com with the following text as a message:
unsubscribe dysphagia
---------------------------------------------------------------------