This week I have been preparing for my two oral seminars that I will be presenting in person at the ASHA Convention, and this video that I am using in one session was worth a look back. This patient has always stuck with me-not only because it was one of the first cases of achalasia that I saw, but also because finally getting the instrumental made such an impact on her course of care.
The patient presented clinically with coughing post swallow as well as multiple swallows per bite/sip… the bedside swallow eval noted “suspected residues”. The diet was changed to puree, then nectar, then honey… all while completing therapy to “improve the strength of swallow”. The patient eventually developed pneumonia and the MBS was ordered. What we found was not poor base of tongue retraction or residues… but fairly significant achalasia. Achalasia is the dysfunction of the lower esophageal sphincter (LES), which prevents the food from entering the stomach normally. You can see in this patient when they turn to face forward that the food and liquid they took is filling the esophagus, with the classic “bird’s beak” appearance at the distal esophagus where the LES remains tightly closed.
We immediately referred the patient to GI and she was eventually treated with medication, then botox. (These treatments are less effective and short term, so there’s a good chance she eventually needed surgical intervention, but we lost track of her).
Getting the chance to see rare findings, and being the one to figure out the cause of symptoms and dysphagia is by far one of the most rewarding parts of being a mobile MBS SLP. I am happy and honored to say that I will be presenting an oral seminar on interesting swallow studies at the ASHA Convention, hope to see some of you there, virtually or in person!
I will be presenting “Interesting Swallow Studies (and what to do if you see one)” on Thursday, November 18, 4:00-5:00 in Ballroom A, session 1118