[Dysphagia] VFSS and reality

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

I am not sure the food trail we do when Ax with hospital food realy
represent real life situation either, the smell, environment, strees,
unfamiliar physical setting, textures and taste of food in hospital etc
etc esp for person with Diverse/different cultural background ...can be
true representative of what that client eats and his swallowing status
at home. Any taker on this for future studies ..it is a good research
question. Why some of our pt say I can eat this and drink this at home
no problem ,,.why can't I in the hospital. An elderly lady's cat died
and she had dysphagia it is possible..I can explain why ...its a Zen Qua
for those who cannot ...have a good weekend and think what is real/
reality and what is not ..it is all in the eye of the beholder.   


Jai Gupta.  
The Sutherland Hospital 
 



-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com] On Behalf Of Irene
Campbell-Taylor
Sent: Friday, 24 August 2007 5:16
To: dysphagia at b9.com
Subject: [Dysphagia] VFSS

There seems to be a misunderstanding about VFSS and real meals. It's not
that it's only a moment in time, it's that in NO WAY does it reflect
what happens when a meal is being eaten. It doesn't matter how many
trials you have of how many consistencies, it will never show what
happens in real life. This has been shown repeatedly by Groher, Jones
and Donner, Dua and others and is what leads to false positives as well
as false negatives. As to what one does with the patient who coughs on
thin liquids,.    At the risk of being repetitive, clysis is the usual
answer to fluid maintenance in the rest of the world: See:
  Guidelines for the administration of subcutaneous fluids
(hypodermoclysis) to adult patients in the community (Please note: in
the community)
 
http://www.leedspct.nhs.uk/archive/east/attachment/00000000abc3a292817ef
ac1a68ba2a4/0000000077869cd00183e189f3a5caad/PL+010+SUBCUT+Fluids+Guidel
ine.pdf_
  _AND___
 
_____http://www.leedspct.nhs.uk/archive/northeast/attachment/00000000edc
f3591017443e65dddbba8/000000006f897f618d249b47cf5e73f0/PL010+Sc+Guidelin
e.pdf________________________________________________________
  Age and Ageing 2005; 34: 215-217
  Hypodermoclysis-a victim of historical prejudice
  PRANOY BARUA, BIMAL K. BHOWMICK
  Abstract
  Hypodermoclysis (HDC) had fallen into disrepute after adverse clinical
incidents that were obviously the result of improper use of an ingenious
technique. HDC has clear advantages over alternative parenteral routes.
It has stood the rigor of scientific
  scrutiny but failed to regain its past glory. This is possibly because
of our ignorance and inability to detach ourselves from an age-old
prejudice. This is an attempt to demystify some of the myths that
surround it. The hope is that older people are not denied an element of
health care that they are perhaps most well suited to.
  _____AND one of the guidelines I cited yesterday:
  GUIDELINE TITLE
  Dehydration and fluid maintenance.
  BIBLIOGRAPHIC SOURCE(S)
  American Medical Directors Association (AMDA). Dehydration and fluid
maintenance. Columbia (MD): American Medical Directors Association
(AMDA); 2001. 28 p. [15 references
  GUIDELINE OBJECTIVE(S)
  To improve the quality of care delivered to patients in long-term care
facilities
  To guide the identification and management of dehydration and
fluid/electrolyte imbalance in older adults residing in the long-term
care settings
  To present approaches that attempt to minimize the occurrence of
dehydration and fluid/electrolyte imbalance
  Management of specific deficits and imbalances, as indicated, such as
fluid and electrolyte replacements or fluid restrictions. Fluid
replacement may be by various routes, including oral, hypodermoclysis,
nasogastric or gastrostomy tube or intravenous 
   
  AND re VFSS and meals:
   Dua KS; Ren J; Bardan E; Xie P; Shaker R. Coordination  of
deglutitive glottal function and pharyngeal bolus transit during normal
eating.Gastroenterology, 112:73-83  1997
  AND
  Groher M. The detection of aspiration. Dysphagia, 9; 147. 1994
  Martin-Harris ; Logemann et al. The clinical utility of the modified
barium swallow. Dysphagia 15; 2000. 136. 
  JonesB, Donner M. Normal and abnormal swallowing, Springer 1999.
   


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