Modified Monday: When something is just not right

A few months ago, our Wisconsin team had a patient that seemed pretty straightforward… on paper. He had a history of GERD, some throat clearing post swallow, and complained of some pain with swallowing. History also of mild dementia. Facility SLP requested the MBS study, stating (accurately) on her clinical evaluation that the symptoms the patient presented with were “nonspecific” to oropharyngeal dysphagia vs esophageal concerns.

It only took a few seconds for our team SLP to recognize that there were some structural anomalies in the hypopharynx/proximal esophagus. You can see the bolus divert around something as it travels through the PE segment. The clip here also has a slowed down video at the very end so you can see this diverted bolus flow.

Our team recommended a rapid follow up to both the primary care physician and a GI consult to further assess. Our team physician also called the PCP to relay the findings quickly. Our team SLP stayed in contact with the facility SLP over the next several weeks as the patient underwent further assessment, biopsy and ultimately was unfortunately diagnosed with cancer. He chose to initiate radiation therapy and PEG tube placement, and the facility SLP remains in contact and plans to refer again when appropriate.

The MBS study is, of course, first and foremost an assessment of the swallow physiology and structures, but can also often be the study that necessitates a referral based on other findings, like the structural anomaly caught here. Knowing how the anatomy SHOULD look is critical to comprehensive assessment and timely referrals.

This is also a great reminder of how important collaboration can be-between our physician calling the PCP, our team obtaining images for the oncologist, and the extended follow up between our team SLP and the treating SLP-this was an all around team effort to ensure that this patient had the best possible assessment and appropriate plan of care.

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