[Dysphagia] oral cancer patient

[GuptaJ at SESAHS.NSW.GOV.AU (Jai Gupta)]

You really have limited option....and as in real life there are no easy solutions ....it is sad...in her case,I think the pt and the health team has to weigh what are her best option ...
If aspiration is going to be ongoing issue ...then that has to be dealt with...as she will get sick of chest infection soon and the antibiotics she has to consume ... mind you aspiration from PEG is not uncommon..at this very moment ..I have 2 pt one in ICU really bad aspiration and other in Resp ward ..both post PEG.
....I cannot understand how effective her speech is ???..... after extensive surgeries of BOT and tongue ?? use of PM spk valve or VP will not make much difference...alternative communication mtd ...again visual problem becomes a issue ..
If secretion is the issue there is medical as well as alternative/herbal ways to deal with it ...but side effects have to be considered too.
Sorry cannot help you much..we have to accept that we have our limits too and empathy the instrument to easy the suffering

Jai Gupta. M.Sc.(S.H.) CPSP MSPA
Manager, Speech Pathology Services.
The Sutherland Hospital


-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of Allison Bartlett
Sent: Wednesday, 15 September 2004 3:59 PM
To: Dysphagia@b9.com; Jai Gupta
Subject: RE: [Dysphagia] oral cancer patient


Unfortunately VP will not be an option because of her extremely limited tongue movement- she will not be able to articulate sufficiently for a VP/ TEP, not to mention the ongoing maintainence and cleaning, (I forgot to mention she is blind in one eye) . Also limited (almost nonexistent) tongue movement means the best she could do in regard to eating (if she were to have a laryngectomy) is 'dump and swallow' of a liquid diet. So I really don't want to take her voice away from her as well when the consensus these days seems to be that you can aspirate your secretions provided mouth cares are being taken care of.




Allison Bartlett
Speech Pathologist
Ipswich Hospital

07 3810 1308

Allison_Bartlett@heath.qld.gov.au

>>> "Jai Gupta" <GuptaJ@SESAHS.NSW.GOV.AU> 09/15/04 03:30pm >>>

I think she will be better off with laryngectomy ...after all the removals she has had ....I am surprised they did not gave her the option at all .... she can get TEP(transesophageal prosthesis) inserted that should give her speech and Servox is not needed and aspiration can be taken care of so also PEG can be eliminated and I think over all she will have better quality of life if she can eat and drink what she wants ...??? it is just my opinion ...I have seen few of them.


Jai Gupta. M.Sc.(S.H.) CPSP MSPA
Manager, Speech Pathology Services.
The Sutherland Hospital


-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of Allison Bartlett
Sent: Wednesday, 15 September 2004 2:06 PM
To: Dysphagia@b9.com
Subject: [Dysphagia] oral cancer patient



I'm hoping someone can give me some suggestions regarding the management of a patient,
68 y o woman with extensive lingual cancer, surgical removal of total tongue base, resection of left side of tongue, removal of one hypoglossal nerve, partial epiglottis removal, partial hyoid removal.

This lady has extremely reduced tongue range of movement, has a PEG inserted as well as a trache (with swedish nose attached), copious amounts of secretions are being suctioned via the trache, the patient is also able to cough secretions out of the trache. Since the operation the pt has had one aspiration pneumonia but in the 2 weeks since, chest has been clear, she is now 4 weeks post. This pt also has previous history or XRT to the mouth/neck area.

Any suggestions for reducing the amount of secretions, would removing the trache help to reduce secretions? Would a Passy-Muir speaking valve be better than a swedish nose?
Her ENT is pushing for laryngectomy to prevent aspiration but I have advised against this as patient will be unlikely to achieve effective communication with servox or VP due to poor movement of what remains of the tongue. Patient is able to be understood when speaking although there is obvious dysarthria.
Patient is unable to swallow her saliva, or various consistencies of thickened fluids due to severe oral dysphagia, and is unlikely to eat/drink orally.

Any suggestions would be appreciated,

Allison Bartlett
AUSTRALIA




***********************************************************************************
This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s).  This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error.

Any unauthorised use, alteration, disclosure, distribution or review of this email is prohibited.  It may be subject to a statutory duty of confidentiality if it relates to health service matters.

If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone or by return email.  You should also delete this email and destroy any hard copies produced.
***********************************************************************************


_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia

SOUTH EAST HEALTH CONFIDENTIALITY NOTICE

This email,  and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of
the incorrect addressing.

This email message has been virus-scanned. Although no computer viruses were detected, South East Health accepts no liability for any consequential damage resulting from email containing any computer viruses.





***********************************************************************************
This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s).  This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error.

Any unauthorised use, alteration, disclosure, distribution or review of this email is prohibited.  It may be subject to a statutory duty of confidentiality if it relates to health service matters.

If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone or by return email.  You should also delete this email and destroy any hard copies produced.
***********************************************************************************


_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia

SOUTH EAST HEALTH CONFIDENTIALITY NOTICE

This email,  and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of
the incorrect addressing.

This email message has been virus-scanned. Although no computer viruses were detected, South East Health accepts no liability for any consequential damage resulting from email containing any computer viruses.