[Dysphagia] Esophageal disorders and oropharyngeal dysphagia

[Jai.Gupta at SESIAHS.HEALTH.NSW.GOV.AU (Jai Gupta)]

Hi Julie,
You should be careful when you sit on a hot seat. I think you should not comment on other professions then in one you are trained in and never take for granted one persons word esp if they are not Speech Pathologist or even if they are (but comfortable in other areas of speech) as they cannot represent the total knowledge in the field. To quote you "However, as Dr. Campbell-Taylor refers, one cannot identify primary oropharyngeal stage problems, make recommendations or treatment plans without understanding the interrelationships between the oropharynx and esophagus." I think there are better resources in the world to make you understand the complex question you have raised ..and do you need to know as a nutritionist is an important question.....we spend years of life understanding these complex process and you cannot learn these things on a listserve.....we have our intellectually territoriality ... and we should accept our limitations and strengths. I was chatting with one oncologist I don't what to go into details ..but even in medicine treatment does not always imply you know what is wrong at the micro level...you must make a difference between research and clinical question ... we have our background knowledge, logics, rationale and shared professional experience which makes us different from a common man, other professionals or a quack.

Jai Gupta. M.Sc.(S.H.) CPSP MSPA
Manager, Speech Pathology Department
The Sutherland Hospital
* Locked Bag 21, Taren Point  NSW  2229 Australia
* +612 9540 7111 page 594 or Direct +612 9540 7558 
*+612 9540 7717 *+61 0401 373 324
<mailto:Jai.Gupta@ sesiahs.health.nsw.gov.au> 

Thought for the Day

The only difference between stumbling blocks and steppingstones is the way in which we use them.

-Unknown









-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of Julie Speech
Sent: Friday, 15 September 2006 9:20 AM
To: Dysphagia@b9.com; Michel Sanscartier
Subject: Re: [Dysphagia] Esophageal disorders and oropharyngeal
dysphagia


I don't mind being in the hot seat- its really not a bad place to be!  I do
want to clarify my responses in regard to this important topic.  I do not
diagnose nor claim to treat disorders of the esophagus.  However, as Dr.
Campbell-Taylor refers, one cannot identify primary oropharyngeal stage
problems, make recommendations or treatment plans without understanding the
interrelationships between the oropharyx and esophagus.  They can so easily
masquerade as the other.  I would argue that any dysphagia therapist,
whatever the discipline, cannot do their job without this knowledge.  I did
not have this as part of my mainstream formal training, but found
ill-equipped to answer many clinical questions as a result.  I have found
this in other areas as well, i.e. nutritional issues, pulmonary issues,
neuropyschology...I could go on and on.  I don't fault my graduate program
as I gained much fundamental knowledge and the tools to be a life-long
learner.  Whether that be in seeking-out additional course work or
self-educating to complement my skills, I plan to continue learning and
enhancing my ability to treat my patients until I retire!  (and then I have
a whole list of other things I'd like to learn that have nothing to do with
Speech Pathology).  I can assure you I am a great team player and very often
refer/ collaborate with the RD, OT, PT, GI, ENT, etc.   Julie

> I have not seen one comment from a RD.
>
> I can't believe that I'm the only one here.
>
>
>
> I really don't want to insult anyone but : what is the link between speech
> and esophageal dysphagia?
>
> Does any university in the world give an extensive knowledge to SLP about
> the digestive tract?
>
>
>
> I would love to see the faces of SLPs that would read RDs exchanging about
> diagnosis and treatment of aphasia, stammering or dyslexia. You would
> probably feel like me right now.
>
>
>
> I'm a nutritionist from Canada (RD in the US) that knows a lot about any
> esophageal dysphagia problem. I learned it from the first year at the
> university and have had internship in that field. After that, I had to
> work with patients that have those problems since 16 years, almost
> everyday. I can't believe that any RD anywhere else in the world, has a
> totally different profile.
>
>
>
> Those patients ARE taking care of by RDs since we started our profession.
>
> If you see one patient that have this problem and don't have any RD in the
> chart, please make a comment to the MD so he will think about giving a
> consultation to the expert.
>
>
>
> Excuse my English, I'm French speaking from Montr?al.
>
>
>
> Michel
>
>
> ----- Original Message -----
> From: "Julie Speech" <speechhuffman@nc.rr.com>
> To: <Dysphagia@b9.com>; "Alexandra Mitchell" <pawprint1980@yahoo.com.au>
> Sent: Wednesday, September 13, 2006 12:28 PM
> Subject: Re: [Dysphagia] Esophageal disorders and oropharyngeal dysphagia
>
>
> The reason for soft is to avoid tough, fibrous foods that might elicit a
> food-bolus obstruction if not broken down enough prior to swallowing when
> having a significant amount of spasm (i.e. steakhouse syndrome)  Julie
>  ----- Original Message -----
>  From: Alexandra Mitchell
>  To: Julie Speech
>  Sent: Wednesday, September 13, 2006 12:00 AM
>  Subject: Re: [Dysphagia] Esophageal disorders and oropharyngeal dysphagia
>
>
>  Dear Julie,
>
>  You recommend the patient with eosophageal dysphagia being given a soft
> diet with the thin fluids. Don't soft foods end up as a PUREE consistency
> once chewed (this is equivalent to a grade 3 TF consistency - pudding)?
>
>  Thanks for you comprehensive reply to my last email!!
>
>  Alex
>
>  Julie Speech <speechhuffman@nc.rr.com> wrote:
>    Alexandra,
>
>    There is a lot of education and recommendations we can provide
> patient's
>    that have various esophageal disorders. Many, but not all, will have
>    concomitant changes in oropharyngeal stage as a result.
>
>    The main problem in our discipline is being able to identify primary
>    oropharyngeal vs. esophageal dysphagia so we can make the correct
> clinical
>    decisions and recommendations. This is a HUGE problem since ignoring
> the
>    esophagus means potential for negatively impacting our patients QOL,
> risking
>    misdiagnosis, making bogus recommendations, risking litigation,
> increasing
>    health care costs, etc, etc. I find the majority of clinicians are not
>    knowledgeable about the esophagus/ GI issues (the "its not our body
> part"
>    argument!) I certainly tailor my recommendations to the patient's
> medical
>    diagnoses, test results and subjective complaints, but generally
> speaking,
>    the recommendations I suggested may be helpful for various esophageal
>    disorders. The major mistake made along the way with the gentleman in
>    question was assuming the oropharyngeal dysphagia was primary, new
> onset,
>    and that the aspiration seen was detrimental. In his case, the
>    recommendations of NPO, thickened liquids, etc completely ignore what
> was
>    found on his esophagram and the patient's complaints.
>
>    In regard to your question marks below, a reflux diet is one that
> limits or
>    avoids foods that either are more offensive coming back up, increase
>    transient relaxations of the LES or are slow to digest and therefore
> more
>    likely to come up (i.e spicy, acidic, peppermint, chocolate, caffeine,
> fried
>    foods, dairy...). By pharyngeal exercise program I meant exercises that
>    would maximize the strength of say, the tongue base if the patient has
> lots
>    of vallecular residue.
>
>    I hope that answers your question!
>
>    Julie
>
>    ----- Original Message -----
>    From: "Alexandra Mitchell"
>    To:
>    Sent: Saturday, September 09, 2006 8:08 PM
>    Subject: [Dysphagia] Esophageal disorders and oropharyngeal dysphagia
>
>
>    > Dear Julie,
>    >
>    > In regards to your email, in response to Keri's, re: eosphageal
> disorder
>    > (resulting in aspiration of solids, some liquids).
>    >
>    > Re: the recommendations that you mentioned (eg: soft diet with thin
>    > liquids, avoiding cold fluids, pharyngeal exercise program (?),
> reflux
>    > diet (?), crushing medications and taking these with plenty of water
> to
>    > clear the esophageal residue); are those the recommendations that you
>    > would have for a patient with an esophageal disorder that is
> impacting on
>    > their oropharyngeal swallowing?
>    >
>    > I would love to do the breakfast workshop that you teach on this
> also. I
>    > do have a particular interest in learning in this area: and seem to
> have
>    > "plateaued" in what I can effectively teach myself from written
> materials.
>    > I would interested to know when the next workshop on this topic is.
>    >
>    > Thanks for your interesting email (thorough not lengthy!)
>    >
>    > Kind regards,
>    >
>    > Alexandra
>    >
>    >
>    > ---------------------------------
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>
>
>
>
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