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[Dysphagia] Response
irene:
What opportunities are available to learn from you in person? I know you
offer to do site visits for small groups, but do you also speak at
conferences or hold workshops during the year? I am sure many of us would
love to attend! please let us know....
Thank you - I always learn so much for your postings and appreciate the time
you take to formulate thoughtful responses!
Laura
On 6/5/04 8:41 AM, "Irene Campbell-Taylor" <eripley@yahoo.com> wrote:
>
> Lisa,
>
> I undertook to answer your message in more detail but I hardly know where to
> begin. I have been a contributing member of this list for several years. If
> you go back in the archives to my earliest messages, when my e-mail ID was
> ICTTOR, you will see just how long. Initially, I assumed that everyone
> understood that the stomach and esophagus are essential components of the
> whole functional unit of swallowing and referred to GI impairments as part of
> my responses to questions. I was savaged by many list members who insisted
> that ?We don?t need to know about the esophagus? and/or ?That?s not our
> area.?. I am glad to note that this attitude has changed. I can only hope that
> attitudes about other ?givens? re swallowing will also change. This hope is
> the only thing that keeps me banging my head against what seems, at times, to
> be not just a brick, but a solid concrete wall.
>
> I fear that, in your questions, you have done what I beg people never to do
> and that is interpret what they hear or read through the filter of their
> preconceived notions. The issue of whether or not aspiration is harmful can
> never be answered by a simple ?Yes? or ?No?. As I have repeatedly said, it
> must NOT be taken in isolation but as part of a Combination, a mathematical
> construct that goes as follows:
>
> Aspiration of what X how much X over how long a period X the patient?s
> resistance to infection, the last item being possibly, the most important.
> This gives 4! or 1x2x3x4 or 24 possible basic conditions per patient. Add all
> comorbidities, medications, age, gender etc. and it becomes apparent (I hope)
> that it is not a simple situation.
>
> If you check messages over the past few years, you will see that I have not
> said that thickeners should NEVER be used. I have, in fact, indicated that I
> recommend thickening under certain conditions ? although not with commercial
> thickeners. I know very well that I will never be supported by Novartis, Mead
> Johnson et al for seminars or workshops. Not everyone is as willing to shoot
> the cash cow in the interest of education and patient care. What other reason
> could I possibly have for consistently drawing attention to what is known and
> published as opposed to what is believed and promulgated? It certainly isn?t
> money or prestige or popularity.
>
> Recently, I posted a message that said that I don?t care if you thicken
> everything in sight as long as you make sure that the patient receives enough
> water. This is the important point. Patients aspirate thickened fluids, as has
> been proven, but even that, most of the time, doesn?t matter ? it?s the lack
> of water that thickeners cause that does the damage. I would point out here,
> that I have never made a statement of fact without backing it up with, at the
> very least, a reference, usually an abstract and sometimes an entire article.
>
> Your comment about my withholding information continues to baffle me. I have
> met some members of your list of ?experts? at conferences such as ASHA, DRS
> etc. They expressed to me amazement that I give away so much information for
> free, and that they never would.
>
> You know nothing about me, my background, education or experience. Those
> members of this list who have read my C.V. will, I believe, agree that it is
> unusually broad in scope. I hold five degrees, in related fields and my
> publications are, almost exclusively, in medical journals such as the Journal
> of the American Geriatrics Society, Annals of Neurology, NEJM etc. as well as
> Dysphagia.
>
> In 1987, I together with a medical colleague, published the first article (as
> far as I know) that said one should not use tube feeding in terminally ill
> elderly patients but continue with ?careful spoon feeding.? I was savaged for
> that one as well. Recently, Finucane et al, published an article saying
> exactly the same thing, although they did not have the grace to cite me, but
> did use the above phrase as well as some others contained in the 1987 article.
> I live in hope that there will be a paradigm shift in swallowing disorders of
> the same magnitude.
>
> I would be more than pleased to debate any or all of your panel of ?experts?,
> singly or collectively, in public on any issue of their choosing, at any time
> and in any place. I think you could sell tickets for that one.
>
> In the meantime, please re-read my various messages with an open mind and see
> what I have actually said, not what the perception is.
>
> Sincerely,
>
> Irene Campbell-Taylor.
>
>
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
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>
>
--
Laura D Jennings
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