[Dysphagia] rumination

[Lucy.Balch at hdmc.dmhmrsas.virginia.gov (Balch, Lucy)]

I have a question regarding rumination. Does anyone else have experience
with a habitual ruminator needing a PEG tube to decrease aspiration risk?
Not eliminate, but decrease? I have a patient whose ruminating behaviors are
triggered when he swallows anything by mouth, even water. When he is being
tube fed there are no ruminating behaviors. Is it correct to say that this
patient is at a higher risk for aspiration because he is ruminating? He has
had aspiration pneumonia on the PEG tube, and aspiration pneumonitis when he
was off the PEG (eating po) and he vomited when too lethargic and aspirated
stomach contents. He gets prn ativan periodically and that, too, places him
at risk for the vomiting/pneumonitis, particularly when he is trying to
ruminate in a lethargic state. I'd like very much to wean him again, but I
fear that the rumination may place him at even greater risk for aspiration
than just having a PEG with GERD. Is this fear rational? I need back up if
it's not, because the staff where I work are very much against weaning this
man again. 

Lucy Balch,SLP

HWDMC

Petersburg, VA