[Dysphagia] XRT to neck

[wwasmith at comcast.net (wwasmith@comcast.net)]

Hello all,

I'm working with a 70ish lady who is s/p XRT to her neck area as well as chemo for lung CA.  Both have recently concluded.  She did not have surgery.  I work in rehab and surprisingly she has not had a swallowing eval as yet (she was admitted for debility following her last chemo, a downhill course after each one, now she can barely walk).  She is suffering from the usual constellation of side effects of both:  feeling lousy, poor appetite, nausea, dry mouth, coughing, retching with oral care and that old ropey mucous problem.    She is managing OK on thin lix and purees, other than her appetite is poor.  No s/s of penetration or aspiration.  No h/o pna.  

I have not treated a patient s/p chemo and RT in a while and am wondering what folks are using lately:  my old tool box included:  papaya enzyme mixed with food to soften the mucous,  synthetic salivas, avoiding milk-based products, and lots of hand-holding.   I recently stumbled on a website for LaClede oral care products:  has anyone found that these are soothing to patients and worth the money?  (I have had one patient who found that a spray bottle of water worked just as well).  I also read an article by Logemann about the need for chronic life-long oral and neck exercises to minimize muscle fibrosis.  Any comments, suggestions?  Thanks for any input,

Wendy