[Dysphagia] Re: Alternative food thickeners

[lobsterpam at aol.com (lobsterpam@aol.com)]

The point is that thin liquid aspiration by itself is not sufficient to 
cause pneumonia.  There are plenty of patients who aspirate thin 
liquids who have no negative consequences.    See Langmore et al. 
(1998) Predictors of Aspiration Pneumonia: How Important Is 
Dysphagia?Dysphagia 13:69?81 plus any number of references from the 
pulmonary literature, especially Paul Marik.  What happens all too 
often in long term care is that residents are placed on thickened 
liquids, their bedside water is taken away or thickened, they refuse to 
drink, and then become gradually more weakened, dehydrated, with less 
resistance, with weaker swallows, and then people wonder why they 
decline.

Residents' hydration needs are not always met - dehydration is a huge 
problem in the institutionalized elderly both in the literature and in 
real life.   I followed one gentleman for the 6 hours I was covering in 
his facility.  His hydration protocol was to get thickened liquids with 
his breakfast tray, at AM med pass, at AM activities, at lunch, at PM 
activities, etc. etc.  He got no AM meds.  He did not go to AM 
activities.  His breakfast fluids consisted of one cup of thickened 
coffee.  Lunch added a cup of juice.  On his videofluoroscopy he 
penetrated nectar, so they recommended honey by teaspoon.  I refused to 
change his fluid consistency.  He never had any respiratory symptoms.  
Another right CVA refused all the thick liquids on his tray.  These are 
not isolated cases.  We SLPs need to remember that any diet consistency 
recommendation we make has potential side effects that impact not only 
the quality of life but the health of our residents.  What is seen on 
videofluoroscopy is only one small piece of that patient's clinical 
picture, and if recommendations are made solely based on 
videofluoroscopy, this should be questioned.  I'm not saying that 
aspiration is a wonderful thing, but we need to understand the 
pathophysiology of pneumonia before we start thinking that we are 
preventing it.

Just because we've "always done things one way" doesn't mean that we've 
always been correct.  We need to read the medical literature and 
believe what it says.

Pam Smith, Ph.D.
Bloomsburg University

-----Original Message-----
From: Todd R. Fix <tfix1@cfl.rr.com>
To: 'Irene Campbell-Taylor' <eripley@yahoo.com>
Cc: dysphagia@b9.com
Sent: Tue, 4 Jul 2006 19:15:10 -0400
Subject: RE: [Dysphagia] Re: Alternative food thickeners

   Ms. Campell-Taylor:

Are you suggesting that from experience, that there are no patients that
aspirate on thin liquids that do not also aspirate on thickened liquids?
Regardless of what is in print, I can tell you that I see these 
patients on
an almost-daily basis.  I work in a VERY large trauma hospital and 
complete
anywhere from 7-10 fluorographic swallowing exams daily...all in which I
test effectiveness of compensatory swallow strategies (including
texture/consistency modifications).  Over the years, I have performed
thousands.  To be frank, that is all the evidence I need to convince 
myself
that in some patients, thickening is effective.  During the 
rehabilitative
stage, nursing and medical staff can be, and are effective in patients
meeting hydration needs on modified liquids.

Regards:


Todd R. Fix MA CCC/SLP
636 N Semoran Blvd #5
Winter Park, FL 32792



-----Original Message-----
 From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On 
Behalf
Of Irene Campbell-Taylor
Sent: Tuesday, July 04, 2006 6:05 PM
To: dysphagia@b9.com
Subject: [Dysphagia] Re: Alternative food thickeners

Just curious. Since there is no evidence whatsoever that thickening has 
any
effect (see Robbins et al) why would one want alternatives?  Or is 
there a
lack of awareness that thickening has not been shown to be beneficial 
even
by the manufacturers of thickening products? And what are the ethical
considerations of leading patients to believe that there is a beneficial
effect rather than the tendency to dehydration that is becoming more and
more apparent?



Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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