[Dysphagia] hyperosmolar fluids and yogurt

[dysphagiadude at mailcan.com (dysphagiadude@mailcan.com)]

Hi, Irene,

I know that aspiration alone cannot be the driving force in a care plan.
 The physiatrist knows that I feel this way, and further knows that I
believe the patient in question IS aspirating and has not demonstrated
any clearly related ill effects:  No increased confusion, no lower
respiratory problems, nothing that I've ever read could represent a
serious consequence of aspiration.  

Further, I believe that the patient in question is "out of the woods" in
terms of her immunity status.  Before she came to us she was much weaker
and had been in and out of the hospital several times.  When she was
first admitted to the SNF where I work, she was still very sick.  Part
of her care plan includes good mouth care, and the patient is an active
participant in this plan.  

Her endurance is much better these days, her strength improved and her
spirits great.

So, okay, I do not believe the patient who initially generated this
question is currently at risk for any serious consequences of
aspiration.  Our physiatrist disagrees, and seems to have a special
agenda where yogurt is concerned.  At some point, her philosophy is
going to impact my treatment of others.  Some of the patients in this
setting are very sick.

Dannon yogurt DOES report that it has live cultures, but I'm not sure
whether this is significant in patients with diminished immunity.  The
physiatrist thinks so, but I wonder whether she's stuck on a fact that
is less significant than she imagines.  Does yogurt represent a greater
health risk than say, cream of wheat in such patients?  


On Tue, 7 Sep 2004 09:09:36 -0700 (PDT), "Irene Campbell-Taylor"
<eripley@yahoo.com> said:
> 
> 
> dysphagiadude@mailcan.com wrote:
>  a different sort of threat to those with
> impaired immunity because it contains live cultures
> 
> ***If you look at most commercially available yogurts, you find that they
> do not contain live cultures. It is quite difficult to obtain yogurts
> that do. As to aspiration of yogurt, hyperosmolar fluids and anything
> else, I must repeat what I have said many times - the fact of aspiration
> alone cannot be the deciding factor in management. It must be considered
> only as part of a combination: How much/how often/over how long a
> period/in relationship to the patient's immune response. It is highly
> doubtful that aspiration of anything during a meal could constitute a
> sufficient amount as to be hazardous since much of the inhaled material
> probably never reaches the lungs. The greatest potential hazard remains
> aspiration of significant amounts of stomach contents, followed by
> aspiration of saliva which. of course, cannot be prevented except by
> radical surgery.
> 
> .
> 
> 
> 
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
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