Modified Mondays: Asking questions, then more questions

We have given several examples of the need to be able to complete an esophageal sweep over the last few weeks… and just like magic, we had another great example this week from our Ohio team. Our SLP Malinda had a patient with dementia, with coughing, complaints of not being able to get food down. The facility had downgraded the patient to thick liquids, which seemed to decrease the severity of the coughing, then sent in the referral for our Patheous Health team to complete the MBS.

This happened to be a really difficult patient positioning, but after a lot of work to oblique the wheelchair, the team was able to get a good view of the phaynx and airway-and noted…. a nice swallow. Timely and with good airway protection with good base of tongue retraction and no residues (a little penetration, but a PAS 2). Bolus cleared completely through the UES.

Given the patient’s history, Malinda turned the patient A-P and saw pretty slow motility-taking a fair amount of time to clear though the distal esophagus. This prompted some more questions about the patient’s feeding situation and Malinda discovered that the patient typically was being fed by staff, often somewhat quickly. We made the recommendation to change the order back to thin liquids and came up with a plan of care that included feeding strategies to staff to slow the rate of bolus presentation to allow extra time for the clearance of the distal esophagus, along with a GI consult.

Sometimes the plan of care is not just dysphagia related, but also needs to take into consideration factors like dining habits… it can often be just a matter of asking the right question.

P.S. This patient not only gives us the chance to reiterate the value of the esophageal sweep-but also a good reminder that cough is a common symptom of GERD (which this patient was diagnosed with). In fact, cough is one of the most common complaints for a huge variety of etiologies.