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[Dysphagia] Conditioned dysphagia
I imagine that there is more to this situation than at first appears. I wonder what the real underlying anxiety is since it doesn't appear to be sufficient for a 17 year old to be so traumatized. If all clinical signs are normal I would suggest a psychiatric referral NOT behavioral psychology.
BTW, I haven't received anything from the list in over a week.
"Gregore, Dale" <DGregore at Christianacare.org> wrote:
Resending as it did not post the first time. Please see below.
-----Original Message-----
From: Gregore, Dale
Sent: Friday, December 01, 2006 4:39 PM
To: dysphagia at b9.com
Subject: Conditioned dysphagia
Need suggestions for this case I just evaluated yesterday:
13 months ago, a 17 year old patient observed his sister choking on a soft
pretzel: she required the Heimlich from Mom, scary situation but no damage
done, sister is fine. One week after this choking incident, he was
reclining, had "about 8" gummy shacks in his mouth> choked: spit everything
out. Scary situation for him
Since then, he initially refused to eat for fear of choking: then liquids
only; existed on tomato soup, cream of wheat and milk/ ice cream pretty much
until recently. (+) eats ice cream at school for lunch. Limits his eating
in public. Expresses fear of choking, states it is beyond his control. Very
anxious.
Anxiety meds and ADD meds have been stopped due to the fact that they
affected his appetite, per mom
He eats crispy crunchy snacks no problem. Avoids any meats and puddings
(interesting texture disparity there)
Sitting and eating a meal with family is difficult. Parents are very
supportive. He initially lost 20# then gained it back w/ liquid
supplements. did have a Upper GI: normal; clinical swallow function normal
Patient is seeing a behavioral therapist. He was receptive when I spoke
about the factors one can 'control' during eating: rate, quantity and
position (referring to his reclining position intake while wolfing gummy
snacks) for the evaluation, he chose cheez its, soda and ice cream and
exhibited xerostomia - related food adherance of the cheezits in oral cavity
and an effortful swallow ("it 's dry); no other overt dysphagia symptoms on
direct examination and/ or when attention was diverted (talking, putting
puzzle together) nice kid seeking absolutes, "you mean I cant choke when
I'm sitting up?" to which I just couldn't say 'yes'.
Anyone have a similar case before? I would appreciate suggestions for
treatment planning/ approach, etc....thanks.
Dale R. Gregore, M.S. CCC SLP
Christiana Care Health System
Delaware, USA
Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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