[Dysphagia] Food and barium

[chris_claire at bigpond.com (Chris and Claire Langdon)]

(Quoting from the Bronwyn Jones text again - she is discussing tailoring the
examination to match the presentation of the patient)

"In general it is best to begin with what is felt to be safest (this
information may be volunteered by the patient or may be decided upon by the
speech-language pathologist following the clinical examination).

For example, if the clinical evaluation suggests that the patient chokes on
liquids, it may be wise to begin with a small volume of puree or a small
volume of thin liquid thather than a large volume of high density
barium."(page 36).

"Remember that patients with a neurological process involving the pharynx
often cannot handle liquids without aspiration and actually may do better
with thicker liquids and/or puree or solids (from the point of view of
aspiration).  However, if there is also pharyngeal paresis or decreased or
absent tongue thrust the thicker boluses may result in increasing retention
in the valleculae and piriform sinuses with the potential for overflow
aspiration." (page 45).

It may be that the practice of giving food + barium was originated by Jeri
Logemann (see Logemann J Evaluation and treatment of swallowing disorders,
Boston College Hill Press 1983), I'm not sure. That's the earliest reference
I can find.......

I'd argue that using solid boluses in VFSS has a place - for example in
evaluating a patient with a "compensated" swallow - where a patient has been
making dietary changes to compensate for a deteriorating swallow ie. avoids
solids and has switched to a pureed diet; and for a patient with a suspected
Zenker's diverticulum.

I agree that the VFSS is completely different to a "real life" meal, and
this needs to be kept in mind in its interpretation.

Claire

----- Original Message -----
From: "Irene Campbell-Taylor" <eripley@yahoo.com>
To: "Chris and Claire Langdon" <chris_claire@bigpond.com>;
<dysphagia@b9.com>
Sent: Sunday, March 13, 2005 12:39 AM
Subject: Re: [Dysphagia] Food and barium


>
>
> Chris and Claire Langdon <chris_claire@bigpond.com> wrote:
> Bronwyn Jones advocates using solid boluses (bread, bagel soaked in
barium;
> barium paste on a cookie or a pill) to evaluate dysphagia for solids ("A
> solid bolus should be given if a subtle stricture, or solid-induced spasm,
> is suspected, or if a patient with symptoms of solid food dysphagia has a
> normal study with liquid barium. A solid bolus, however, should be given
> with caution to the patient with pharyngeal decompensation, especially if
> pharyngeal retention indicating pharyngeal weakness is seen with liquids."
>
> *** The above refers to patients with gastroesophageal problems -
gastroenterologists have used marshmallows, bagel "pills" etc for decades to
identify esophageal obstruction and that's what the above is all about. Yes,
caution should be used with solids i.e. bread pellets etc. in the patient
with oropharyngeal problems because of the risk of asphyxia. If the problem
is with solids only - it is gastroesophageal.
>
> I am talking about the VFSS of the patient with oropharyngeal dysfunction
who is given various foods mixed with barium that, among other things bears
no resemblance to the food alone. Also, as has been stated many times by
Groher among others, VFSS does not reflect the reality of eating a meal and
to give food mixed with barium removes it even further from real life. VFSS
is intended to examine the dynamics of the swallow and to determine whether
various compensatory interventions might be helpful - in real life.
>
>
>
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
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