December 2008 Newsletter



Consultants in Dysphagia Evaluation and Management
817-514-MBS1 or 1-888-514-MBS1
Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
May this season bless you with peace, love and inner joy.
We wish everyone a glorious holiday season
and a very Merry Christmas!

DiagnosTEX Christmas treats to our SLPs –  This is just a token of our appreciation for your support and friendship.  We are also celebrating our 5th year in business, and everyone at DiagnosTEX thanks you for the honor of being part of your dysphagia management team and trusting us with all of your patients! 

DiagnosTEX 2008 December Holiday Schedule –    DiagnosTEX will operate ½ day only on Christmas Eve. We will be closed Thursday, Christmas Day and Thursday, New Year’s Day. Friday, the day after Christmas will be determined as the pending schedule dictates, and we will run all 3 vans the Friday after New Year’s.  We want to meet all of your MBSS needs as we know PO feeding becomes very important on several levels to many patients around the holidays. We must also be considerate to all of our DiagnosTEX employees, their families and our own families.  Please keep these holiday schedules in mind when scheduling your MBSS in December!  ******Please take note and  keep in  mind that during this busy time of year for us, specific requests for specific times and days become extremely more difficult  to accommodate.  We may be unable to quickly schedule your patient with specific time and day requests. Please notify your staff, patients, and families of this. ******

IT’S TIME AGAIN for the DiagnosTEX 2009 Dysphagia Calendar   Be sure to get your new DiagnosTEX 2009 Dysphagia Calendar this month and our latest handout, “Dysphagia During the Holidays.”

Facility Travel Fee for studies not completed –  Most travel fees apply to facilities and home health 50 miles or more from our corporate office.  In January of 2009, we must begin implementing a travel fee for any study in which we actually arrive at the facility to do and the patient refuses to participate, cancels once we arrive, is unable to be positioned for the study, or is unable to get up for the study in a timely manner before we have to move on and continue our pre-scheduled day.  The travel fee is to offset expense for our time at the facility, staff and physician participation and effort in attempting the study, and gas expense traveling to the facility with no study being completed.  The cancellation fee billed to the facility will be $25.00 per cancelled patient, which is typical for most physicians’ practices. If our staff has contact with the patient, then we have initiated patient care and we will leave documentation of our efforts to complete the study for the medical record. A memo will be distributed to the all facilities of this new policy prior to January 1, 2009.

Extra Copies of DVDs –  When we complete multiple studies at a facility, the technician will ask if you want all the studies on 1 DVD or on separate DVDs. Most of the time, the facility would like them all on 1 DVD for space-saving purposes. We have had many recent requests for these studies to be on separate DVDs weeks after the study is completed or for additional copies to be sent to the facility.  The facility will be charged at a rate of $10.00 per DVD starting in January 2009 (to help defray the extra cost of the DVD, the time taken by staff to locate the patient on the master DVD, to re-record the study, and for postage required to send the new DVD).
Positioning for a MBSS –   Positioning is of critical importance for completing a Modified Barium Swallow Study.  Please examine this aspect of your patient’s ability to participate before scheduling the MBSS exam.  If the DiagnosTEX SLP is unable to see the vocal cords, pyriform sinuses or the posterior wall of the vestibule they have been advised and trained not to complete the MBSS, due to inability to r/o penetrations and aspiration. This is a liability safeguard issue for us as a company and all the staff involved (including you). Please evaluate whether your patient can sit upright in a chair with shoulders down, and the ability to lift their head to get full view of the throat. Often with max assist with an upright position, we can perform the MBSS, but can the facility sit the patient up this same way for all PO?  This is something to take into serious consideration. Please know when we make a PO recommendation on the MBSS, this recommendation is made with the patient in the position in which we assessed them.  The PO recommendation will not be for bed eating, reclined in a neuro chair, etc.

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Dysphagia Tidbit – Effects of Menthol on the Swallow Reflex
Department of Geriatric and Respiratory Medicine – Takae, Ebihara, Br J Clin Pharmacol. 2006 September 1; 62 (3) 369-371
The study was to investigate the effect of menthol on swallowing reflex sensitivity in elderly patients with dysphagia.  Patients with mild to moderate dysphagia were chosen due to the potential risk of increased aspiration in patients with very severe dysphagia. The study showed menthol has a similar effect to that of a cold temperature on triggering a swallow reflex and restores some sensitivity to triggering a swallow reflex in dysphagia patients. Hence, letting a lozenge containing menthol dissolve in the mouth of elderly patients with dysphagia (before meals) may improve the sensitivity of the swallow reflex, since applying the lozenge is much easier than a constant procedure of thermal stimulation during a meal. Interestingly, menthol is also known to lower cough reflex sensitivity for those with a hypersensitive cough reflex. Obviously not a method you would use with silent aspirators!