[Dysphagia] RE: Enteral feeding and PSP

[jvzlvz at hotmail.com (Linda Vande Zande)]

At this point we are continuing to feed this pt orally as long as she is 
alert, gives visual attention, and opens her mouth to accept the food.  She 
is coughing on about 10% of swallows.  Thank You Dr. Taylor-Campbell.


>From: dysphagia-request@b9.com
>Reply-To: dysphagia@b9.com
>To: dysphagia@b9.com
>Subject: Dysphagia Digest, Vol 24, Issue 10
>Date: Tue, 8 Nov 2005 12:06:38 -0700
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>Today's Topics:
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>    1. Re: Enteral feeding and PSP (Irene Campbell-Taylor)
>    2. Re: Dysphagia Digest, Vol 24, Issue 9 (Irene Campbell-Taylor)
>    3. Tracheostomy care communication tool (Joanna Brown)
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>
>----------------------------------------------------------------------
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>Message: 1
>Date: Tue, 8 Nov 2005 05:02:09 -0800 (PST)
>From: Irene Campbell-Taylor <eripley@yahoo.com>
>Subject: [Dysphagia] Re: Enteral feeding and PSP
>To: dysphagia@b9.com
>Message-ID: <20051108130209.77133.qmail@web30206.mail.mud.yahoo.com>
>Content-Type: text/plain; charset=iso-8859-1
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>
>  Some considerations include: 1.
>we can continue to feed her despite her struggle with oral feeding
>(difficult for everyone involved and will likely result in infection ... 
>and
>should we have a nurse standing by ready to suction?) 2. We limit the
>amount of time given to feeding (one hour/3x/day) despite the limited 
>amount
>she will be able to take in (or do we ask a CNA to continually feed her?) 
>3.
>We stop oral feeding and provide medication for comfort (when?). Any
>guidance on this is appreciated. THank you! lindav
>
>
>
>*** It sounds as though this patient is approaching end stage and the 
>consensus of opinion is that enteral feeding is contraindicated as being of 
>no particular benefit and of significant risk of damage e.g. aspiration 
>pneumonitis, in particular in a disease such as PSP in which 
>gastroesophageal motility is a prominent feature. Palliative care demands 
>maximum comfort that is not the case with enteral feeding. Such patients 
>are offerred preferred foods as desired and may require hypodermoclysis for 
>hydration of deemed appropriate for comfort and/or the administartion of 
>medications when necessary, mainly analgesics.
>
>
>
>
>
>
>
>
>Dr I Campbell-Taylor
>Clinical Neuroscientist
>Exclusive Distributor:
>www.interactivetherapy.com
>
>------------------------------
>
>Message: 2
>Date: Tue, 8 Nov 2005 05:05:26 -0800 (PST)
>From: Irene Campbell-Taylor <eripley@yahoo.com>
>Subject: [Dysphagia] Re: Dysphagia Digest, Vol 24, Issue 9
>To: dysphagia@b9.com
>Message-ID: <20051108130526.60026.qmail@web30202.mail.mud.yahoo.com>
>Content-Type: text/plain; charset=iso-8859-1
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>
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>
>I was wondering if you may be able to assist. I am currently reviewing our 
>videofluoroscopy protocol and was looking for some data to support the need 
>to use the method of gradually introducing larger bolus' (e.g Logemann 
>method but data OTHER than Logemann) or contrary data supporting the use of 
>larger bolus' initially to improve sensory feedback (as was reinforced in a 
>recent cervical ascultation course I attended).
>
>
>
>*** The use of boluses larger than 1-3ml is demanded by the fact these are 
>far too small. The larger the bolus, the more efficient the swallow (see 
>Kahrilas, Logemann, Dent, Shaker and many others). The VFSS is already so 
>far from a normal meal that to add the absurditiy of tiny boluses makes its 
>validity highly questionable. To approach normal intake, normal boluses 
>must be given.
>
>
>
>Dr I Campbell-Taylor
>Clinical Neuroscientist
>Exclusive Distributor:
>www.interactivetherapy.com
>
>------------------------------
>
>Message: 3
>Date: Tue, 8 Nov 2005 09:27:54 -0800 (PST)
>From: Joanna Brown <joannabrown_slp@yahoo.com>
>Subject: [Dysphagia] Tracheostomy care communication tool
>To: Dysphagia@b9.com
>Message-ID: <20051108172754.52715.qmail@web54111.mail.yahoo.com>
>Content-Type: text/plain; charset=iso-8859-1
>
>Does anyone use a multi-disciplinary communication tool for tracheostomy 
>care in their facility?  We are trying to develop a tool where suctioning, 
>inner cannula changes, trach cleaning, etc would all be documented in the 
>same place regardless of the care provider.  If any one uses such a tool, 
>would you be willing to forward on to me?  Thanks in advance!
>
>Joanna Brown, MS, CCC-SLP
>Parkland Health &  Hospital System
>Dallas, TX
>
>
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>End of Dysphagia Digest, Vol 24, Issue 10
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