[Dysphagia] Growing concern

[Paula.Leslie at newcastle.ac.uk (Paula Leslie)]

Hello Irene

I agree whole heartedly with the symptom/diagnosis concerns.  Dysphagia is not 
a medical diagnosis although the NHS here does have it as primary diagnosis 
code for hospital episode stats, generally for doctor/surgeons.  That may be 
useful for tracking the symptom independent of the disorder but you may then 
lose #s that should be registered to the disease.  And I don't know how often 
drs record this when they have a medical diagnosis anyway.  Hospital stats and 
SLP stats here can be very messy.

I do think there is a place for "dysphagia" courses though.  Perhaps, as I go 
on and on about, courses in "SWALLOWING and what can go wrong".  A person must 
know what the signs of a disordered swallow are.  Then work back to what the 
medical diagnosis ie, underlying cause is/might be.  Sometimes there is no 
diagnosis but we can begin the investigation process.  It is quite possible, 
I've seen it, that the clinical team are so focussed in on the primary 
diagnosis of eg CVI that they presume that is the cause of the swallowing 
disorder, and miss the actual cause eg meds, progressive (but undiagnosed) 
condition etc.  There is a danger of being mislead by the primary diagnosis.

In fact my boss just received this emailed from a surgical colleague in a 
distant district:

"I have a 62 year old gentleman who suffered from a stroke causing ischaemia 
in the right side of his brainstem. He then developed aspiration and 
dysphagia. This has been progressive over the last 3 months and he now cannot 
swallow anything at all and is on PEG.There is no history of any significant 
medical problem apart from dyspepsia in the past."

The few tests they've done are negative and they want to go for surgery - 
WHOA!!  We said.  Hold that knife.  Get to neuro and an SLP maybe.

I think perhaps there is something else going on...?

Without doubt, to know how a diagnosed condition affects the swallow and how 
it will progress, is essential.  And this is one of the first things that 
should be taught on a "dysphagia" course but SLT/Ps are usually generic and 
need to work across all medical diagnoses.  They also need to know about 
aspects that can be diagnosis independently eg hydration, nutrition, 
environment, psychosocial factors, and the HEALTHY swallow process.  So I 
think we do need "swallowing and when it goes wrong courses" but not the 
"dysphagia" title perhaps??

Paula


>===== Original Message From Irene Campbell-Taylor <eripley@yahoo.com> =====
>While doing some online research I came across the following that was 
presented at a state SHA meting (I won't mention which one as I don't want to 
embarass anyone). It was sponsored by Novartis, for obvious reasons but the 
notion expressed sums up a fundamental and extremely important problem in the 
fireld of swallowing disorders - one that the Italians have dubbed 
"deglutology"
>
>Introduction
>
>? In the past ?dysphagia? was a secondary
>
>diagnostic category
>
>? As a primary diagnosis ?dysphagia? crosses
>
>professional practice boundaries.
>
>? As a co-morbidity dysphagia crosses many
>diagnostic categories.
>
>"Dysphagia" has NEVER been a diagnostic category, secondary or otherwise. To 
think of it as such is extremely hazardous to management because it bypasses 
the first and most fundamental aspect of intervention - What is the CAUSE of 
the SYMPTOM called "dysphagia". Without knowing the cause, no VALID 
intervention can take place. To say that the cause is, for example CVA, is 
insufficient. What type, where, how large, involving which nerves, structures 
etc.
> Above, it is referred to a a "comorbidity". Either the author doesn't know 
the meaning of "comorbidity" or somehow the definition of "symptom" changed 
when I wasn't looking.
>
>In medicine, comorbidity describes the effect of all other diseases an 
individual patient might have other than the primary disease of interest.
>
>A symptom is: An indication that a person has a condition or disease. Some 
examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain. 
AND dysphagia.
>
>To have "Courses on dysphagia" and "Texts on dysphagia" makes as much sense 
as "Courses on fever". One can't treat fever without knowing its cause. Of 
course, one can lower fever by various means but this is of little use unless 
its cause is determined: flu, cholera, plague, etc etc. Likewise, one can 
attempt to "treat" dysphagia symptomatically but without knowing the cause, 
the chance of treating effectively or even eliminating it is lost. What, for 
example, would one feel to discover that it had been caused by a medication 
and could be easily "cured" by d/c ing or changing the medication or changing 
the dosage?
>
>Irene.
>
>
>
>
>Dr I Campbell-Taylor
>Clinical Neuroscientist
>Exclusive Distributor:
>www.interactivetherapy.com
>_______________________________________________
>Dysphagia mailing list
>Dysphagia@b9.com
>http://lists.b9.com/mailman/listinfo/dysphagia

Paula Leslie
Degree Programme Director
Surgical and Reproductive Sciences
Faculty of Medical Sciences
University of Newcastle
Newcastle upon Tyne
NE2 4HH
UK
T +44 (0) 191 222 6279
F +44 (0) 191 222 8988
http://www.ncl.ac.uk/sars/postgrad/MSc.htm