[Dysphagia] severe esophageal/pharyngeal dysfunction

[pressmah at sjhmc.org (pressmah@sjhmc.org)]

Pts. with esophageal CA usually have significant difficulties both with
nourishment and with progression of disease.  What you are seeing, however,
may not be progression of disease but rather the effects of surgery and
radiation.  The radiation effects often get worse over time.  Meticulous
oral hygiene will have to be an essential part of his daily routine to
reduce the bacteria in the secretions that he is aspirating.  

-----Original Message-----
From: ppollywogger@juno.com [mailto:ppollywogger@juno.com]
Sent: Friday, March 04, 2005 6:54 PM
To: dysphagia@b9.com
Subject: [Dysphagia] severe esophageal/pharyngeal dysfunction



i am seeing a patient in the nursing home 58 yr old male who was treated for
lower esophageal cancer about 2yrs ago with radiation (to the lower portion)
and later had part of the esophagus removed - including the crico-esophageal
sphincter - the remaining portion of the esophagus was stretched upward...
pt & spouse report normal swallow function until recently, though he has had
~120# wt loss since the original surgery... mbs reveals 0 epiglotic
movement, poor pharyngeal constriction & absent esophageal relaxation (go
figure). needless to say he aspirates everything, including his own
secretions... in the past month he's been treated for aspiration pneumonia &
received a j-tube. he is being suctioned prn d/t asp. of secretions.
obviously he's verrry fragile. has anyone seen anything like this? my gut
tells me there is little hope for this fella - but i wanted to post this in
case someone has some magic beans for me.

thanks in advance - margaret
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