[Dysphagia] Response to Jonathan Bennett 2

[eripley at yahoo.com (Irene Campbell-Taylor)]

  The first question was whether or not I believe that thickened fluids are ever necessary. The short answer is, no, I do not. My reasons have little or nothing to do with the presence or absence of evidence. There is increasing evidence that they lead to dehydration as has been my clinical experience for over 25 years. Having tried several times to get through a day on my own with nothing but thickened fluids,  I can readily testify to that. I find a singular lack of logical thought and creativity in ensuring adequate hydration. It is accepted as fact (except by a few) that one must be upright at all times while drinking. This is not so. Think of the physics of the act and read 
  Barkmeier, Julie M., Steve Bielamowicz, Naoya Takeda, and Christy L. Ludlow. Laryngeal activity during upright vs. supine swallowing.  J Appl Physiol 93: 740?745, 2002. ?Simultaneous electromyographic recordings were obtained from the submental complex (SMC) and the right and left thyroarytenoid (TA) muscles. Regardless of body position, the timing, amplitude, and duration of the TA muscles did not vary relative to the SMC. Therefore, the sequence of TA muscle activation relative to the SMC during swallowing appeared unaffected by gravitational influences.)
  And, bolus size? How about giving the patient the appropriate size of bolus rather than diet by J. Alfred Prufrock? Also, I resent attempts at persuasion being made by pharmaceutical and other companies that have millions invested in thickeners while, because of truth in advertising, being forced to admit that there is no proof that they are of any more use than a chocolate teapot.
  The effects of dehydration are devastating. They are probably worse in children because, given their small body size, dehydration occurs very quickly. In the elderly they can be lethal and seldom recognized. The common picture is this: Reduced thirst because of age to begin with. Thickened fluids not supplying enough of that essential nutrient: WATER.  Changes in blood pressure, often orthostatic hypotension because of hypovolemia leading to falls, leading to head injuries, hip fractures, leading to acute care admission, immobility etc. pneumonia and death.
Contd




Dr I Campbell-Taylor
Clinical Neuroscientist
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