[Dysphagia] Cardiac problems and oral stage difficulties

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

Hi Everyone ....have been following the thread ...it appears to me she has vascular dementia and will not be wondering why she has oral phase problem if there is frontal-temporal component on CT or MRI ..she is probably end stage and carer should make decision how they want to deal ..prolong her life (PEG) or let her go...I would tell them any therapy at this stage will really not help. That is my 2 cents 

Jai Gupta. 

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of melody sheldon
Sent: Saturday, 23 July 1904 12:34 AM
To: malindam@samhealth.org; pressmah@sjhmc.org;
Paula.Leslie@newcastle.ac.uk; dysphagia@b9.com
Subject: Re: [Dysphagia] Cardiac problems and oral stage difficulties


is her heart enlarged?  often one can see that solids build up above the
aortic arch creating perseveratory chewing, difficulty initiating the
transfer phase of the swallow, and early satiety.  with alert and oriented
individuals, i usually tell them to puree foods orally before swallowing.
cycling liquids with solids sometimes helps, but often the pressure of the
liquid on top of the solid can cause cervical-esophageal pharyngeal
regurgitation.  unfortunately with a demented patient, slick solids/mashed
foods work the best as well as six small/frequent meals.


on 2/21/05 10:34 AM, malindam@samhealth.org at malindam@samhealth.org wrote:

> I agree with Hilda that many pt's with dementia demonstrate prolonged chewing
> of solids with failure to initiate the swallow.  I've also seen pt's unable to
> initiate swallowing when the esophageal motility is so poor that solids build
> up in the esophagus.  Sometimes, very small bites alternated with liquids in
> small frequent portions is an adequate compensatory strategy.  But if the
> patient doesn't mind them, liquid suppliments and liquid purees are the
> easiest strategy for adequate oral nutrition.  Doesn't sound like hydration is
> a problem.
>
> Malinda Moore
>
> -----Original Message-----
> From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
> Behalf Of pressmah@sjhmc.org
> Sent: Monday, February 21, 2005 8:34 AM
> To: Paula.Leslie@newcastle.ac.uk; dysphagia@b9.com
> Subject: RE: [Dysphagia] Cardiac problems and oral stage difficulties
>
>
> I see this problem frequently in patients with dementia.  Has she had a
> decline in mental function?  Hilda Pressman
>
> -----Original Message-----
> From: Paula Leslie [mailto:Paula.Leslie@newcastle.ac.uk]
> Sent: Sunday, February 20, 2005 1:05 PM
> To: Dysphagialist
> Subject: [Dysphagia] Cardiac problems and oral stage difficulties
>
>
> Hello All
>
> I have a puzzling (to me) case:
>
> PC:
> 83 year old lady, non smoker, fairly independent, carer visit 1/day
> Can't chew solids or semi solids, liquids OK.  Does not appear to be
> progressive in nature as such.  Lost ++ weight over last 6 months because
> can't eat.  Now stabilised because GP has prescribed "Ensure".  No dietetics
>
> input according to daughter so far.
>
> PMH:
> 1999 CVI: L TACS.  Short term swallow probs resolved, some residual higher
> level language probs
> 1999 Heart failure and ongoing medication
> 2004 (Aug) admitted with heart failure, review of meds
> Nil else reported by physician or client
>
> HPC:
> 2004 (Aug) start of problems with solids, oral stage "can't swallow"
> Not associated with any acute event eg choking, etc except "it started
> around
> the time I went in for my heart"
> NO reported laryngo/pharygno/oesophageal, refluxy type symptoms.
> NO chest infections or other clinical signs of aspiration linked problems,
> rarely coughs on food.  But does have a good cough reflex.
>
> VFSS Summary
> 2004 Nov (not done by me but v detailed report at a good clinic)
> Oral - prolonged holding of liquids in mouth prior to initiating the swallow
> (but this doesn't happen outside of the VF suite)
> - prolonged chewing with some piecemeal swallowing
> Pharyngeal  - "appeared essentially normal"
> Oesophageal - "poor clearance of barium from oesophagus, disordered distal
> oes. contractions with intra-oes. reflux demonstrated during fluoroscopy"
>
> This lady does have shortness of breath linked to cardiac probs but so do
> lots
> of people.  What I don't understand is the severity of her difficulties with
>
> oral stage solids.  She can't tell me what will/might happen if she does
> swallow.  I think there could be a big anxiety component here.  Maybe
> anxiety
> response to physical event and now has developed behaviours in response to
> anxiety.
>
> I've made an urgent referral to community dietetics.  I intend to assess the
>
> lady in clinic (rather than at her home where I first met her) with the
> daughter who is +++ anxious.  Daughter is to encourage trials of more
> "challenging" foods over the next couple of weeks and to note exactly what
> does happen and what the lady feels.  We will go over this and watch the VF
> tape to try to allay fears about an "unsafe swallow".  Address the anxiety
> for
> both mother and daughter.
>
> Have I missed something obvious?  Not really much knowledge of cardiac
> issues.
> Interesting that although VFSS showed reflux problems, there are absolutely
>
> no symptoms reported.  Words of wisdom much appreciated!
>
> Thanks
>
> Paula
>
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