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[Dysphagia] (no subject)
Might consider getting a sample pack of biotene products to see if any
of these help
www.laclede.com
I also like the idea of using water/ice chips for practice. Swallowing
is the best exercise for swallowing
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 dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com] On Behalf Of JoAnn Eaton
Sent: Tuesday, May 15, 2007 10:19 PM
To: tweetsalong at aol.com
Cc: dysphagia at b9.com
Subject: Re: [Dysphagia] (no subject)
Allie,
I'm sorry if you felt attacked. Remember that the wonder of e-mail is
the
instant response. The problem with e-mail is the quick and direct
communication is easily misconstrued by all communicators. . . a sad
comment
of the communication skills of trained speech language pathologists. The
information you shared in this last e-mail about your patient was the
information you would have been well served to share in your first call
for
advice. It would have saved you from some hurt feelings But, if you
weren't
looking for treatment approaches, what was your question?
Just so you know as a relatively new SLP, Dr. Sonies is one of the most
supportive and knowledgable SLPs I've ever learned from both from this
list
and from her workshops. Many times she will send out a "good job" note.
She's worked in the trenches a long time and does a terrific job at
looking
at the whole person.
That being said, here are some added things I'd incorporate into my
treatment plan if this was my patient.
1. I would not use lemon glycerine swabs. Studies have proved that they
are
drying to the mouth, so you are exacerbating his problem. Instead, after
making sure he has a very clean mouth, I'd use ice chips. Since water is
a
pH neutral, even if he aspirates a small amount, his lungs will handle
it
readily.
2. If you haven't already, I'd ask his doc to order something to help
deal
with the xerostoma. Moisture is critical for moistening the oral
structures.
3. Continue with concentrated exercises focused at laryngeal elevation
and
tongue based retraction. Do some research to see if the specific
exercises
you are using now are the only ones that work or if you should add
others.
There are lots of exercise out there that SLPs are using that aren't as
effective as others for both tongue base retraction and laryngeal
elevation.
Then, when finished with his next certification time, I'd order another
MBS
to see if he could take anything by mouth or if he needs to continue
NPO. In
my experience, if you can't get the swallow to trigger at least at 3
seconds, you probably haven't improved things enough to get him on PO.
This is meant as a supportive e-mail and I hope you take it as one. I've
tried to be thorough in my response, and am not being condescending. I
wouldn't take the time to write this if I didn't care about sharing
information with new SLPs. When I stated my feelings about the use of
the
word "failed MBS" I was talking about seeing it in pt. histories and how
frustrating it is to try to plan treatment from that report.
Good luck!
JoAnn Eaton, M.S., CCC-SLP
----- Original Message -----
From: <tweetsalong at aol.com>
To: <paula.garbin at gmail.com>; <bsonies at comcast.net>
Cc: <eripley at yahoo.com>; <dysphagia at b9.com>
Sent: Tuesday, May 15, 2007 6:29 PM
Subject: Re: [Dysphagia] (no subject)
> Hello everyone!
>
> Thank you to Paula and Lucy for responding without passing judgment.
I
> guess maybe some of you misunderstood (or maybe I stated it wrong)
what I
> was saying...
>
> I understand how to treat a pt who has dysphagia. I understand that
you
> are supposed to treat the actual problem (reduce tongue base ret,
reduced
> larngeal elevation)! I would never tell or document that a patient
has
> failed an MBS. I was using that terminology to present my case to the
> listserv. I just found out the results today (he will continue to be
NPO)
> via a message left on my voicemail from his wife. I am still waiting
for
> the actual results of the study.
>
> On his previous MBS he had (off the top of my head) a 6 sec. delay,
> reduced tongue base retraction, reducecd laryngeal elevation, and
> aspirated every consistency attempted. I have been doing thermal
stim,
> OME's, using lemon glycerin swabs,etc. This pt. has a hx of oral
cancer
> and has a fistula the size of a golf ball in the roof of his mouth and
> wears a prosthesis for this. When the pts cancer was treated, the
> salivary glands in his mouth were burned...SO...the pt has decreased
> saliva and is unable to produce a timely dry swallow (time ranges from
> 5-9sec).
>
> I guess I had a miunderstanding about what the point of this listserv
> is...I thought we could rely on our fellow colleagues to help us out
when
> needed. I will admit that I am a fairly new SLP...haven't you all
been in
> my shoes??
>
> Allie
> -----Original Message-----
> From: paula.garbin at gmail.com
> To: bsonies at comcast.net
> Cc: tweetsalong at aol.com; eripley at yahoo.com; dysphagia at b9.com
> Sent: Tue, 15 May 2007 2:38 PM
> Subject: Re: [Dysphagia] (no subject)
>
>
> Hi Allie,
>
> I can understand what the other ladies were stating. There has to be
> something more specific that you need to focus on with this man's
> treatment. What are the main areas of difficulty? And yes is he
aspirating
> everything? I can understand the use of the word FAIL, but it does
need to
> be qualified. What did this man "fail" to do during this MBS. And I
think
> you should continue to treat him with another MBS at the end. If no
> progress has been made by that time then I would call it. At that
point
> something is working against you.
>
> We are here to help other people and answer questions; not to make
other
> people feel incompetent due to misuse of terminology. Wording and
> presentation is everything.
>
> Please let me know what the outcome ends up being.
>
> ~Paula
>
>
> On 5/15/07, Barbara Sonies <bsonies at comcast.net> wrote:
> No one FAILS an MBS- this is an incorrect interpretation of the
test-what
> do
> you possibly mean by fails??!!! Did he aspirate on all textures, did
he
> have
> pooling for some, did he fail to produce any swallow, was there
reduced
> hyoid elevation or epiglottal lowering, did he penetrate into the
> vestibule,
> did he attempt to clear the pharynx, did some bolus enter the
esophagus???
> These are among the observations one makes to analyze a swallow or set
of
> swallows--he can not FAIL.
> Dr Barbara Sonies, BRS-S
>
>
> On 5/15/07 4:44 PM, "tweetsalong at aol.com " <tweetsalong at aol.com>
wrote:
>
>> Hello everyone-
>>
>> I am looking for a little advice regarding one of my homecare
patients.
>> This
>> gentleman came to me as NPO back in the beginning of March. I have
been
>> seeing him since then and have recertified him for services. Today
he
>> went
>> for a repeat MBS and failed once again. I know that he has made some
>> progress. He is very motivated and practices his exercises 3 times a
>> day. I
>> will continue to see him for the remainder of the certification
period
>> which
>> ends at the beginning of July. Should I recommend another MBS at
that
>> time or
>> do I discharge him and encourage him to continue to pactice? When do
you
>> draw
>> the line as to how long you should continue services (especially if
no
>> progress has been made)? I am waiting for the updated MBS to be
faxed to
>> me
>> to see if anything at all has changed...
>>
>> Any thoughts would be greatly appreciated...
>>
>> Allie
>>
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>
>
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