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[Dysphagia] Upper GI question
YOu may want to check that it was presented through G-tube or was the upper
esophagus intubated to bypass the pharynx? Usually an UGI study looks at
the esophagus first and if there is risk for aspiration, they can bypass the
pharynx.... Julie
----- Original Message -----
From: "Dolinger, Eric" <EDolinger at christianacare.org>
To: "Rob Melchionna" <robmelch70 at hotmail.com>; <dysphagia at b9.com>
Sent: Friday, March 09, 2007 8:27 AM
Subject: Re: [Dysphagia] Upper GI question
All you know at this point is that during the barium study, no reflux was
observed. Just like in any swallow study - there may still be reflux (or
other abnormality) not witnessed at that particular time.
All you can assume from the FEEST is exactly what you know at this
point...something came up.
The same list of questions persist ?dysmotility/GER/stricture/Zenkers/CP
dysfunction, etc.
This patient does need some kind of imaging from pharynx to stomach - Ba++
swallow or EGD depending on presumed aspiration risk. If the pharyngeal
swallow was reasonably safe, I would prefer the former.
Good luck
eric
Eric Dolinger, MA CCC-SLP
Senior Speech Pathologist
Christiana Care Health System
Phone 302-733-1015
Fax 302-733-1061
edolinger at christianacare.org
-----Original Message-----
From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com] On Behalf
Of Rob Melchionna
Sent: Thursday, March 08, 2007 11:05 PM
To: dysphagia at b9.com
Subject: [Dysphagia] Upper GI question
I have a patient, NPO with tube feed s/p severe CVA 11/06, recently had a
FEESST to help determine possibility of restarting PO feeds (sorry I don't
have more PMH handy, Im typing this from home and memory). FEESST showed
functional pharyngeal swallow but swallowed material was reported to come
back into camera view and the SLP who did the test questioned esophageal
strictures or motility issues, with recommendation for upper GI series.
Patient went out to have the upper GI, and during the test, instead of
allowing the patient to swallow the barium, it was presented via G tube with
patient put into Trendelenburg position. Results were a simple "no reflux".
My problem is.. I still have no idea about the functioning of the esophagus,
right? The way they did the test, I still don't know if the patient has
esophageal motility issues, or if there are strictures? Should the patient
be scheduled for a full Ba swallow? An EGD? If she does have an EGD, and
there are no strictures, can i assume (+) motiliity issues based on the
FEESST report (I wasn't present for the FEESST).
Thanks,
Rob Melchionna MS CCC-SLP
>From: "Rob Melchionna" <robmelch70 at hotmail.com>
>To: dysphagia at b9.com
>Subject: Re: [Dysphagia] I am fed up
>Date: Thu, 08 Mar 2007 22:47:50 -0500
>
>I also have learned a lot from Irene's posts.
>I also think she comes across as having disrespect for the SLP profession.
>I hope that's not her intent, but that's the way she comes across.
>Rob Melchionna MS CCC-SLP
>
>
>>From: "Lawrence Grall" <lhgrall at hotmail.com>
>>To: lobsterpam at aol.com, dysphagia at b9.com
>>Subject: Re: [Dysphagia] I am fed up
>>Date: Thu, 08 Mar 2007 19:54:20 +0000
>>
>>As someone who has followed the list serve for several years I have
>>witnessed several seasons of turbulence and controversey, often
>>culminating in perceived and often overt disrespect and hostility. I
>>suspect this will not be the last time and as always, we will learn from
>>this and go on. Irene has often been accused of "talking down" or
>>appearing condescending to those on the listserve (especially new
>>participants who are not familiar with her direct responses) and I really
>>appreciated Pam's perspective of her interactions with Irene. Perhaps
>>some of Irene's tone is simply based on sheer frustration, and the passion
>>she possesses for this insidious field of dysphagia....having to convey
>>and address over and over the basic principles and foundations necessary
>>to even broach this field...and despite the redundancy of questions from
>>new listservers, she continues to do it. I submit that it is Irene who
>>has led the way in illuminating what information is really out there and
>>most importantlly what is not...and in essence played a (if not "the")
>>leading role in changing the whole paradigm of clinical assessment and
>>perspective; pulling many of us out of a micro focused "MBS" view and into
>>a comprehensive multidisciplinary approach where encompassing all
>>approriate areas of medical knowledge is paramount. I have often emailed
>>Irene personally for specific information and I can testify there has not
>>been one instance where she has not provided me her complete attention and
>>service to locating the information I request and may need in support of
>>my patient's welfare.
>>
>>And although I have witnessed many attacks on Irene's character, it is not
>>very often where I witness any correspondence on the listserve directly
>>thanking her for the time, effort, and dedication to this listserve. I
>>have experienced times where she has been insulted to the point of
>>withdrawing; and trust me her insight and experience has been overtly and
>>greatly missed. Fortunately she has always come back.
>>
>>So with that, I (and I know there are a great many others) want to
>>publicly and personally thank you Irene!...thank you for your dedication,
>>your perseverence, and sheer passion to helping those with dysphagia...as
>>well as those who treat it. I myself think you have a very purposeful and
>>rewarding life!
>>
>>Sincerely,
>>
>>Lawrence Grall
>>
>>
>>
>>>From: lobsterpam at aol.com
>>>To: EThompson at mountnittany.org
>>>CC: dysphagia at b9.com
>>>Subject: Re: [Dysphagia] I am fed up
>>>Date: Thu, 08 Mar 2007 11:12:44 -0500
>>>
>>>
>>> I expect that the example of the graduate student who was woefully
>>>prepared for a medically based internship is repeated in many settings
>>>across the country. It is a situation we do our best to avoid. I'd be
>>>willing to bet that it's a big reason some SLPs don't want to take
>>>students. Although in our idealism we like to think that "someone did
>>>this for you, so you should be willing to do it for them," the reality is
>>>that a less-than-prepared student can be more work than benefit. They can
>>>require SO much time and energy that your own productivity suffers more
>>>than the department is able to absorb. After all, health care is a
>>>business.
>>>
>>> Our second years (they'll graduate in May) started their second half
>>>placements this week, a week which always makes me a bit nervous, because
>>>it is their medical assignment. I hope I did my job well enough so that
>>>our SLP supervisors, whom we need and value SO much, can still do theirs
>>>We want the experience with our students to be a benefit, not a burden.
>>>That's the goal... time always will be the best judge of how we did.
>>>
>>> And yes, Elana, I'll be at PSHA. Come to "Scary Videos" on Friday!
>>>
>>> Pam Smith
>>> Bloomsburg University
>>> Bloomsburg, PA
>>>
>>> -----Original Message-----
>>> From: EThompson at mountnittany.org
>>> To: lobsterpam at aol.com; dysphagia at b9.com
>>> Sent: Thu, 8 Mar 2007 10:43 AM
>>> Subject: RE: [Dysphagia] I am fed up
>>>
>>> That is very well said, Pam, and is the culmination of many things I
>>>was
>>>considering writing in my own response. (Now, I don't need to!!)
>>>I will say this, though....
>>>Last fall I had a graduate student, supposedly a semester away from
>>>graduation,
>>>who came to do a 12-week internship with me in an adult acute care
>>>hospital.
>>>She had had NO practical adult eval or therapy experience at her school
>>>and was
>>>expecting to spend just 12 weeks with me and gain independence in the
>>>skills
>>>required of an acute care SLP. Her grade was based on the level of
>>>independence
>>>she achieved during the internship. She failed.
>>>In ALL health care settings, the SLP really should be proficient in ALL
>>>areas
>>>Pam mentioned prior to independently seeing patients and grad schools
>>>should be
>>>teaching it to us just like it is taught to an RN, PA-C, or CRNP. We are
>>>involved with patients on that level. You cannot understand swallowing,
>>>cognition, and general recovery processes without understanding those lab
>>>values, etc. I never really understood all of that until the past 5
>>>years, but
>>>since then I have been trying very hard to gain proficiency in all those
>>>areas.
>>>
>>>SLP's might not like to hear it, but in health care settings, we are
>>>medical
>>>professionals, not just rehab professionals. That is probably why it is
>>>alarming to some people that an SLP already in those settings would need
>>>an
>>>introductory level course. However, if you need them, take them and I
>>>hope they
>>>are great!
>>>
>>>In Pam's words: Here's to getting the knowledge base, using your
>>>inquisitive
>>>open mind, accessing information, and thickening your skin!!
>>>
>>>Sincerely,
>>>
>>>Elana Thompson, MS,CCC-SLP
>>>
>>>See you at PSHA, Pam?
>>>
>>>-----Original Message-----
>>>From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com]On
>>>Behalf Of lobsterpam at aol.com
>>>Sent: Thursday, March 08, 2007 7:33 AM
>>>To: dysphagia at b9.com
>>>Subject: Re: [Dysphagia] I am fed up
>>>
>>>
>>> This isn't directed at the 'introductory course' topic specifically,
>>>but is a
>>>more global comment simply offered for consideration. My thoughts on the
>>>introductory course is that if someone needs the training, go get it. But
>>>recognize the larger less personal point that dysphagia education in our
>>>profession in general needs work. Those of us in universities know that
>>>and are
>>>we working hard to improve it. The ASHA Knowledge and Skills documents
>>>speak for
>>>themselves, and Division 13 has many excellent resources available for
>>>members.
>>>
>>> That said, I think it's very unhealthy for professionals - or members
>>>of a
>>>professional discussion lists - to stop questioning the practices of the
>>>profession. NO profession improves unless it is constantly examining
>>>itself. The
>>>whole concept of evidence based practice requires continual objective
>>>evaluation
>>>of the evidence supposedly supporting what we do. If list serve
>>>participants
>>>only wish to support each other with "atta boy!" comments, no one grows
>>>as a
>>>professional. Would we rather have an attorney ask some of the questions
>>>that
>>>are asked here? How do you feel when a smart and savvy family member
>>>questions
>>>what you are doing? Or when a physician won't order your services? In the
>>>litigious society in which we find ourselves, it's best we get used to
>>>people
>>>asking us the "why" questions about our field, and be prepared to state
>>>objectively and from an evidence base - not defensively - why we are
>>>doing what
>>>we are doing.
>>>
>>> The management of patients with dysphagia is a multidisciplinary field,
>>>and any
>>>SLP who believes he or she can do it himself/herself has a lot of reading
>>>to do
>>>and additional academic degrees to obtain. A discussion list that
>>>welcomes the
>>>contributions of other professionals only helps us to appreciate what
>>>these
>>>other professionals know. If we are intimidated by that, nothing is
>>>gained by
>>>telling these people to get out of our sandbox. Have the people who find
>>>themselves angry ever located and read the information Irene has posted?
>>>A
>>>number of years ago I argued openly on this list with Irene, and her tone
>>>was
>>>directed right at me, and of course I didn't appreciate it. Then I
>>>finally read
>>>the literature that was posted (Irene was the first one who I had ever
>>>heard of
>>>mentioning the contribution of reflux or oral secretions to pneumonia,
>>>and I'd
>>>been practicing for close to 10 years at that point.)
>>>
>>> Individuals have their own manner of conveying their thoughts; some
>>>people just
>>>don't sugarcoat things. The written word doesn't provide the complete
>>>pragmatic.
>>>That's a limitation of email communication and it needs to be accepted if
>>>one is
>>>going to use this medium. Sure, people could be nicer, but I remember a
>>>colleague who could be nicer, too. It's a shame if people choose not to
>>>interact
>>>because of personality differences. Wasn't it Eleanor Roosevelt who said
>>>no one
>>>can make you feel inferior without your consent? Anyway, eventually I
>>>realized
>>>that my angst wasn't really about Irene. It was easy to blame this person
>>>who
>>>was faceless and only showed up in my email inbox with abstracts that
>>>showed she
>>>had a lot of information at her fingertips that I didn't have, and who
>>>wrote
>>>things in a way that made me realize that I was missing some very basic
>>>information that I SHOULD know. There are and were choices here - to get
>>>angry
>>>and defensive, or to suck it up and learn thing!
>>> s. My issues were that I knew practically nothing about lab values,
>>>dietary
>>>requirements, respiratory physiology or infectious diseases, and yet here
>>>I was
>>>working with patients with these very problems. My issues were coming to
>>>terms
>>>with the fact that some of the interventions I had been doing for years
>>>had the
>>>potential to do as much harm as the underlying problem I was trying to
>>>help.
>>>
>>> Whenever students ask me about why practices are so inconsistent, and
>>>why they
>>>must continue to read research and understand evidence when they are
>>>finished
>>>with school, I tell them that not so many hundred years ago, doctors used
>>>to
>>>bleed people to cure them of disease, and that's what killed George
>>>Washington.
>>>Someone questioned the practice, and someone had to be the first to
>>>suggest that
>>>maybe bloodletting wasn't the best way to go.
>>>
>>> Working in health care requires a knowledge base, an inquisitive open
>>>mind,
>>>access to information, and a thick skin.
>>>
>>> Pam Smith, Ph.D.
>>> Bloomsburg University
>>> Bloomsburg, PA
>>>
>>>
>>> -----Original Message-----
>>> From: cohoe at uci.net
>>> To: vickycox at yahoo.ca; dysphagia at b9.com
>>> Sent: Wed, 7 Mar 2007 11:52 PM
>>> Subject: Re: [Dysphagia] I am fed up
>>>
>>> I vote for a kindler, gentler listserve as well. Can we stop wit the
>>>questioning of others and simply be supportive? If we fear posting for
>>>the
>>>ridicule of one member we allow her to win. Let's ask those beginner
>>>questions and let's advertise those courses. This listserve is for
>>>SLP's;
>>>let's take it back.
>>>
>>>-----Original Message-----
>>>From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com] On
>>>Behalf
>>>Of Vicky Cox
>>>Sent: Wednesday, March 07, 2007 7:42 PM
>>>To: dysphagia at b9.com
>>>Subject: [Dysphagia] I am fed up
>>>
>>>Hello all,
>>>
>>> I am an SLP and proud to say that I am attending "beginner" workshops
>>>even
>>>though I have been practising for a long time. I suppose I never think I
>>>am
>>>a perfect SLP, and guess what, I may even learn something from the new
>>>grads, who as someone put it, should already know everything form their
>>>masters program.
>>>
>>> I posted a question a few years back when I was a new grad, and a
>>>particular person posted a reply and made me look like a total idiot (the
>>>same person who normally does this). I feel saddened to say that I have
>>>been
>>>afraid of posting since then. But reading all of these replies, I am glad
>>>that others can see how toxic this list serve can be.
>>>
>>> Its a shame really, because there are some really great SLPs who post
>>>here
>>>(all in fact), and I am sorry I had such a bad experience in the past.
>>>
>>> Thanks,
>>> Vicky
>>>
>>>
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>>>
>>>
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>>
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>
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>
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