[Dysphagia] recommendations requested

[lommen at juno.com (lommen@juno.com)]

Keri,

Why don't you call the therapist at the hospital and ask these questions.
 Before jumping to (negative) conslusions, talk directly with the source;
there may be a good reason(s).  As a profession, we seem to do this a lot
i.e. blame/questions the therapist in another facility.  In my opinion,
we need to do a better job of supporting eachother in this dysphagia
arena or we will all "go down"...

Respectfully,
Gail Lommen

On Fri, 8 Sep 2006 08:29:45 -0700 (PDT) Keri Vasquez
<kvasquez21@yahoo.com> writes:
> To all the gurus:
>    
>   New admit to my sub-acute facility, 86 yo male who was 
> hospitalized w/ chief complaint of progressive dysphagia over 3 
> weeks( solids >liquids).  Pt had subjective complaints of "food 
> getting stuck and coughing food up." 
>    
>   During hospitalization pt had VFSS and esophogram.
>    
>   Report for the VFSS:
>   Pt. only given nectar and honey thick barium w/ aspiration of 
> nectar and ineffective cough.  Chin tuck does not prevent 
> aspiration.  With honey thick barium, pt has mod residue in vall. 
> and piriform that is partially cleared w/subsequent swallows but no 
> evidence of laryngeal pen/asp.  There is cricopharyngeal prominence.
>    
>   Report for esophogram:
>   There is exaggerated contraction of the UES w/ adjacent small 
> outpouching, likely representing a Zenkers.  There is a lack of 
> normal esophageal peristalsis w/extensive tertiary contractions.  
> Contrast flows into the stomach without any evidence of obstruction. 
>  
>    
>   This pt. was recommended NPO by the hospital SLP in which he 
> refused.  He was admitted here on a puree diet and honey-thick 
> consistency.  Pt. refused EGD.  KUB was negative.  Pt denies any 
> relfux symptoms and is currently taking pepcid.  
>    
>   1. What should I do with this patient?  I feel the VFSS is 
> incomplete and lacks appropriate information.  Uncertain why no 
> swallow maneuvers were introduced and the drastic conclusion to make 
> this pt NPO.  
>   We have the mobile VFSS available and contemplating to have a 
> repeat study to obtain a full and complete report.
>    
>   Any comments/suggestions are greatly appreciated!
>    
>   Keri Miloro, MS, CCC-SLP
>   Boston, MA
>    
>    
> 
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