[Dysphagia] Thickened liquids

[Janet.finger at kindredhealthcare.com (Janet.finger@kindredhealthcare.com)]

Thanks Vikki for expressing my 2 cents as well.

Just a couple other comments: I get frustrated with therapists who seem to put all their pts on thickened liquids regardless of what is actually going on. But I do find that some pts do better on the thick liquids, at least initially. My patients are so fragile that we have to be careful; they do not tolerate aspiration well. Of course I am always pushing oral hygiene like crazy. Fortunately for me, my pts almost always have some other form of hydration. They usually come into our facility (LTAC-trach & vent facility) with TPN, a feeding tube, or at least IV. If they do not have another form of hydration, I am more likely to take the risk with thin liquids - but not always. I work very closely with our dietitians & nursing & pt families to reduce their risk of dehydration as much as possible. We also went to the prepackaged, prethickened stuff a few years ago & pts really do much better than with the powder. Because we have such a high population of dysphagia pts we can stock a variety of flavors (our floors are always stocked with prethickened vanilla milkshake, lemon water, iced tea, apple juice, orange juice, and cranberry juice) so there is usually at least one that the pts will tolerate. I work in other hospitals PRN where it is just not practical to stock all that so those pts I manage a little differently. One trick I have figured out is mixing foods & liquids, such as apple sauce & apple juice, to thicken the liquid a little. Again - the majority of my patients do not ever get put on thickened liquids, but some do. Most of those began NPO & will agree that thick liquids are "better than nothing"



-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of Vikki Stefans
Sent: Wednesday, September 28, 2005 4:39 PM
To: chcky619@bellsouth.net
Cc: dysphagia@b9.com
Subject: Re: [Dysphagia] Thickened liquids


???

I wish there was a nice simple way to do the real research on this that
needs done, but I for one am grateful that commercial thickeners are
avialble. I've had too many patients whose respiratory health is improved
by using them, and more than a few who cough terribly on thins but do well
with thickened especially during an early recovery period. I'd certainly
disagree with anyone who was just using them on everyone with dysphagia or
suspected dysphagia, but to say they have no role or use at all is
mind-boggling to me as a pedi rehab doc anyways. Only a few families find
they have the time to use baby cereal or other means of thickening.

Just my $.02.

Vikki Stefans, M.D., pediatric physiatrist (rehab doc for kids) at UAMS
and Arkansas Children's Hospital.  Working Mom of Sarah T. and Michael C.,
and wife of Henry Stefans. Every mom is a working mom!- OK, dads too.

On Thu, 22 Sep 2005 chcky619@bellsouth.net wrote:

> I wonder if there will ever come a day when we no longer support the
> financial pockets of the folks who sell thickened liquids?  What an
> incredibly perpetuated myth!!!!!!  I wonder every day, as I evaluate my
> new admissions, what in the world was this SLP thinking???  And the
> kicker is, the physician goes along with it!  Has the medical community
> lost their way?  I think so.  As I make my way amidst the muck and mire
> of long term care, I am thankful for the sense and sensibility of people
> like Irene who taught me to educate, educate, educate.  Thanks for
> letting me vent.  Patti D., SLP

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