[Dysphagia] Re: FEES

[eripley@yahoo.com (Irene Campbell-Taylor)]

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Good grief!!!! No assessment of swallow, be it clinical or objective should ever be done with an NG tube in place as the presence of the tube has been shown to interfere with the available lumen of the esophagus.Some residue in the valleculae? I find a disturbing number unable to tell the difference between residue and coating! And that applies equally to barium and dyed material. 
To make this a reason for continuing with enteral feeding is absurd! 
I have a short series of questions that I use to test radiologists for CMEs after a course that I give to them re VFSS. They all pass it but I have yet to find a clinician from any other profession who comes close (apart from those who also take the same instruction). The implications for lack of knowledge of the anatomy and physiology is extremely disturbing and it seems that this is what you're dealing with in this case, albeit FEES and not VFSS - the same basic principles apply. I guess the only thing you can do as a supervisor is to set your student straight.

Judy Johnson <judjohn@siue.edu> wrote:
As part of a course I teach I discuss instrumental options and have 
videos showing different assessment procedures for dysphagia. I also 
send my students out to medical sites to observe MBSs, and if possible 
FEES. I have read about and taken workshops, but I have not had clinical 
experience with the FEES. I also have talked to a couple of SLPs in the 
area that do them. My concern is that one of my students had the 
opportunity to observe an actual FEES where the SLP conducted it without 
a doctor present. The individual had an NG tube in and an esophageal 
ulcer. The student indicated that the SLP stated how they had to be 
careful as to not make the NG tube move and irritate the ulcer. The 
final recommendation, according to my student, was NPO based on residue 
(blue dye) in the valleculae. My concern is that given the NG tube and 
the ulcer - would not a MBS be more appropriate? The site has it 
available. And isn't recommending NPO based on pooling the valleculae a 
little too restrictive without more evidence?? My student is very savvy, 
and I know she may not have all the info, but based on this what do some 
of you folks think?? Thanks!
Dr. Judy Johnson CCC/SLP

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Dr I Campbell-Taylor
Clinical Neuroscientist
Suite 209, 134 Lawton Blvd
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416-932-1443
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<DIV>Good grief!!!! No assessment of swallow, be it clinical or objective should ever be done with an NG tube in place as the presence of the tube has been shown to interfere with the available lumen of the esophagus.Some residue in the valleculae? I find a disturbing number unable to tell the difference between residue and coating! And that applies equally to barium and dyed material. </DIV>
<DIV>To make this a reason for continuing with enteral feeding is absurd! </DIV>
<DIV>I have a short series of questions that I use to test radiologists for CMEs after a course that I give to them re VFSS. They all pass it but I have yet to find a clinician from any other profession who comes close (apart from those who also take the same instruction). The implications for lack of knowledge of the anatomy and physiology is extremely disturbing and it seems that this is what you're dealing with in this case, albeit FEES and not VFSS - the same basic principles apply. I guess the only thing you can do as a supervisor is to set your student straight.<BR><BR><B><I>Judy Johnson &lt;judjohn@siue.edu&gt;</I></B> wrote:</DIV>
<BLOCKQUOTE style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #1010ff 2px solid; WIDTH: 100%">As part of a course I teach I discuss instrumental options and have <BR>videos showing different assessment procedures for dysphagia. I also <BR>send my students out to medical sites to observe MBSs, and if possible <BR>FEES. I have read about and taken workshops, but I have not had clinical <BR>experience with the FEES. I also have talked to a couple of SLPs in the <BR>area that do them. My concern is that one of my students had the <BR>opportunity to observe an actual FEES where the SLP conducted it without <BR>a doctor present. The individual had an NG tube in and an esophageal <BR>ulcer. The student indicated that the SLP stated how they had to be <BR>careful as to not make the NG tube move and irritate the ulcer. The <BR>final recommendation, according to my student, was NPO based on residue <BR>(blue dye) in the valleculae. My concern is that given the NG tube and <BR>the ulcer
 - would not a MBS be more appropriate? The site has it <BR>available. And isn't recommending NPO based on pooling the valleculae a <BR>little too restrictive without more evidence?? My student is very savvy, <BR>and I know she may not have all the info, but based on this what do some <BR>of you folks think?? Thanks!<BR>Dr. Judy Johnson CCC/SLP<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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