December 2009 Newsletter

Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
December 2009
During the holiday season, our thoughts turn gratefully to those who have made our progress possible. In this spirit we say simply but sincerely, may the gift of peace, joy and happiness be yours at Christmas and throughout the New Year! All of us at DiagnosTEX wish everyone a very Merry Christmas!

The 2010 DiagnosTEX Dysphagia Calendar is arriving this month! Ask for yours next time we see you!

DiagnosTEX Christmas treats to our SLPs – This is just a token of our appreciation for your support and friendship. We are also celebrating our 6th year in business, and everyone at DiagnosTEX thanks you for the honor of being part of your dysphagia management team and trusting us with your patients!

DiagnosTEX 2009 December Holiday Schedule – DiagnosTEX will operate only ½ day on Christmas Eve. We will be closed Friday, Christmas Day and Friday, New Year’s Day. 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, and their 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, specific requests for specific times and days become exponentially 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. ******

CoughAssist – Mechanical Insufflator-Exsufflator
CoughAssist is a noninvasive therapy that safely and consistently removes secretions in patients with an ineffective ability to cough (peak cough flow <270 l/m).
Typical CoughAssist patients include those with the following conditions:
• Amyotrophic Lateral Sclerosis
• spinal muscular atrophy
• Muscular Dystrophy
• Myasthenia Gravis
• spinal cord injuries
• Post-Polio

CoughAssist clears secretions by gradually applying a positive pressure to the airway, then rapidly shifting to negative pressure. The rapid shift in pressure produces a high expiratory flow, simulating a natural cough.

Assistive Dining Equipment The Mealtime Partner assistive dining device (often referred as the Partner) is a battery operated device that allows people to feed themselves without using their arms or hands. The Mealtime Partner increases the user’s independence while lessening their caregiver’s workload. Food is placed in the three bowls that come with the Partner. The bowls rotate until the desired food is located under the spoon. The spoon then dips into the bowl, scoops up the food, and presents a rounded spoonful of food very near the lips of the user. The user must lean forward slightly and remove the food from the spoon. This requires a small amount of neck or upper torso movement. (Around 1.5 inches, the length of the bowl of the spoon.) The Mealtime Partner supports three bowls at one time, although extra bowls of food can be prepared and the bowls quickly interchanged as food is eaten during the meal. Each bowl is clear and is designed to serve one cup (0.24 liters) of food. The depth and shape of the bowl provides the proper placement of food on the spoon as it scoops. The use of the appropriate Bowl Cover controls the quantity of food on the spoon. Bowl covers are available with three different wipe edges: low, medium and high. They accommodate serving diverse food textures and provide for user preferences in the quantity of food served. Users can control the Partner using two adaptive switches, one adaptive switch, or fully automatic (using no adaptive switches), according to their functional and/or cognitive needs. The adaptive switches can be selected and positioned for the individual user. The Mealtime Partner meets the Medicare and Medicaid definitions of Durable Medical Equipment (DME). The United States Food and Drug Administration (FDA) considers the Mealtime Partner to be a Class I type medical device. The Mealtime Partner has successfully met all governmental electrical safety and electro-magnetic compatibility (EMC) compliance testing. http://www.mealtimepartners.com

Cancellation fee – to be implemented 2010: A cancellation fee will be charged 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. This fee is to offset expense for our time at the facility, staff and physician participation and time spent in attempting the study, and gas expense traveling to the facility with no study being completed. The cancellation fee billed to the facility or home health will be $150.00 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.

Dysphagia Tidbit – Refeeding Syndrome – Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished. Renourishment is the process of avoiding refeeding syndrome. The syndrome was first described after the Second World War in prisoners of war taken by Japan. Refeeding syndrome usually occurs within four days of starting to feed. Patients can develop fluid and electrolyte disorders, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications. Most effects result from a sudden shift from fat to carbohydrate metabolism and a sudden increase in insulin levels after refeeding which leads to increased cellular uptake of phosphate. Refeeding increases the basal metabolic rate. Intracellular movement of electrolytes occurs along with a fall in the serum electrolytes including phosphate, potassium, magnesium, glucose, and thiamine. Significant risks arising from refeeding syndrome include confusion, coma, convulsions, and death. Refeeding syndrome can be fatal if not recognized and treated properly. If potassium, phosphate and/or magnesium are low then this should be corrected. Prescribing thiamine, vitamin B complex (strong) and a multivitamin and mineral is recommended. Biochemistry should be monitored regularly until it is stable. From Wikipedia, the free encyclopedia