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[Dysphagia] puzzling case??
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Monique
Given her history, I would be very surprised if she were adequately nourished. Has she lost a significant amount of weight, is she dehydrated, is anyone following this?
Secondly, with NIDDM, the probability of GER and aspiration thereof is so high that she very likely has the pneumonitis leading to pneumonia scenario that is common but underidentified.
To put someone with diabetes and GER on enteral feeding increases the always present risk of aspiration and pneumonia that goes along with all forms of enteral feeding.Also, the patient frequently has to go on insulin because of the difference of dietary content.
I would start with an examination of her nutrition/hydration status as this is what offers the best resistance to pneumonia before making any management alterations.
Monique Frank <talk2me@speechtherapist.net> wrote:
I come to all of you for assistance with a lady I have a long history with..She is a 46 yr old woman /c hx of brain injury following arrest after a heroin OD late last year. At that time she had a trach and PEG, in a coma, and it was felt she was terminal so she was given hospice and sent home from the hospital. She awoke from her coma and I saw her on Home Health for dysphagia rx.She failed first MBSS, silently aspirated on all consistencies..Repeat MBSS in May revealed silent aspiration on thin and nectar but tolerating honey and solids..When visited pt at home again, family not thickening liquids. Well she is back in the hospital. Now she has of course pnuemonia --left upper lobe--Repeat MBSS again-----this time she silently aspirated before the swallow on thin, nectar and honey.she aspirated on residues following the swallow on pudding..I rec NPO /c alt means of nutrition, /c ENT consult..THe ENT eval revealed normal VFs.Her primary MD wants me to start dysphagia Rx--bu!
t for her to continue honey thickened liquids and solids..HE doesn't feel her aspiration is contributing to her pneumonia since it is resolving..What do ya'll think???I know it's possible to aspirate /s developing pneumonia but with her extensive hx of NIDDM, Hep C, prolapse rectum, narcotic abuse, chronic obstructive lung disease I feel PO ntake is risky..Please help!-Sorry so long!
Monique
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<DIV>Monique</DIV>
<DIV>Given her history, I would be very surprised if she were adequately nourished. Has she lost a significant amount of weight, is she dehydrated, is anyone following this?</DIV>
<DIV>Secondly, with NIDDM, the probability of GER and aspiration thereof is so high that she very likely has the pneumonitis leading to pneumonia scenario that is common but underidentified.</DIV>
<DIV>To put someone with diabetes and GER on enteral feeding increases the always present risk of aspiration and pneumonia that goes along with all forms of enteral feeding.Also, the patient frequently has to go on insulin because of the difference of dietary content.</DIV>
<DIV>I would start with an examination of her nutrition/hydration status as this is what offers the best resistance to pneumonia before making any management alterations.<BR><BR><B><I>Monique Frank <talk2me@speechtherapist.net></I></B> wrote:</DIV>
<BLOCKQUOTE style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #1010ff 2px solid; WIDTH: 100%">I come to all of you for assistance with a lady I have a long history with..She is a 46 yr old woman /c hx of brain injury following arrest after a heroin OD late last year. At that time she had a trach and PEG, in a coma, and it was felt she was terminal so she was given hospice and sent home from the hospital. She awoke from her coma and I saw her on Home Health for dysphagia rx.She failed first MBSS, silently aspirated on all consistencies..Repeat MBSS in May revealed silent aspiration on thin and nectar but tolerating honey and solids..When visited pt at home again, family not thickening liquids. Well she is back in the hospital. Now she has of course pnuemonia --left upper lobe--Repeat MBSS again-----this time she silently aspirated before the swallow on thin, nectar and honey.she aspirated on residues following the swallow on pudding..I rec NPO /c alt means of nutrition, /c ENT
consult..THe ENT eval revealed normal VFs.Her primary MD wants me to start dysphagia Rx--bu!<BR>t for her to continue honey thickened liquids and solids..HE doesn't feel her aspiration is contributing to her pneumonia since it is resolving..What do ya'll think???I know it's possible to aspirate /s developing pneumonia but with her extensive hx of NIDDM, Hep C, prolapse rectum, narcotic abuse, chronic obstructive lung disease I feel PO ntake is risky..Please help!-Sorry so long!<BR><BR>Monique<BR><BR><BR>_____________________________________________________________<BR>Low Cost Internet Access for SLP's!<BR>http://slpworld.net<BR>Unmetered service for $9.99 <BR>Less than 1/2 the price of Aol, Earthlink, or MSN.<BR>http://SLPWorld.net for the SLP community.<BR><BR>_______________________________________________<BR>Dysphagia mailing list<BR>Dysphagia@b9.com<BR>http://lists.b9.com/mailman/listinfo/dysphagia</BLOCKQUOTE><BR><BR>Dr I Campbell-Taylor<br>Clinical Neuroscientist<br>Suite 209,
134 Lawton Blvd<br>Toronto, ON, M4V 2A4<br>416-932-1443<br>Exclusive Distributor:<br>www.interactivetherapy.com
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