[DYSPHAGIA] unknown etiology of EXTREMELY focal dysphagia

[bndstamey@prodigy.net (BETH STAMEY)]

i guess that depends on how long you wait... it was posted that spontaneous
recovery is estimated from 2 weeks to a few months in this case.  at any
point along the continuum, the only thing you have to lose by waiting is the
opportunity for faster progress with therapy...and since the loss is in
retrospect, it is difficult to determine its value.  i guess its a
fundamental question of proactive vs reactive... do you give all you can
when it is warranted or do you wait for the situation to verify that it is
warranted? (i believe this argument comes up in cancer treatment all the
time... because there are no guarantees in therapy or recovery... and there
is no way to know what the effects would have been if had not opted out of
treatment)...

but regardless of what we might think as we debate this matter... the final
choice is in our patients hands... i provide education on all the things
that can improve a patients status (time, therapy, healing, and divine
intervention)... and it is only if my patients are in agreement (or
caregiver if the patient is unable to comprehend) that i provide therapy. as
i said earlier, i have never had a patient refuse dpns because if they have
the choice between waiting it out and being proactive, so far they have
consistently chosen to be proactive.


----- Original Message -----
From: "Clarke-Goertz, Kim (PAHD)" <kgoertz@pahd.sk.ca>
To: "'BETH STAMEY'" <bndstamey@prodigy.net>; <dysphagia@medonline.com>
Sent: Wednesday, October 03, 2001 1:58 PM
Subject: RE: [DYSPHAGIA] unknown etiology of EXTREMELY focal dysphagia


> 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!
> >
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