December 2018 Newsletter

As we turn 15 years old on December 3rd, our thoughts turn gratefully to those who have made our success here in D/FW possible. We know you have options and we appreciate your trust and support of our service and staff over the years.  DFW area is a big place but small at heart and the friendships we have developed over the years mean the most to us! This holiday’s season, we wish all of you the priceless gift of peace that surpasses all understanding, as well as indescribable joy, quality health, and blessings of prosperity at Christmas and throughout all of 2019.

Everyone at DiagnosTEX wishes ALL of you a very Merry Christmas!

Happy Birthday DiagnosTEX – We have reached another milestone and Pam and I would like to thank not only our customers and those have supported us all these years in DFW! We would also like to thank all of our employees for the years of friendship, laughs, and memories that swell our hearts! We truly love each and every one of you and are blessed to have you a part of our lives! Thank you for your hard work and commitment to what DiagnosTEX stands for!

It’s a Giving time of year!  It is better to give than to receive and we enjoy giving back to you for teaming with us every year!  The 2019 DiagnosTEX Dysphagia Calendar will be ready this month, get yours next time you see us along with Christmas goodies to make the season sweeter!

DiagnosTEX December Holiday Schedule -   This year Christmas and New Year’s fall on Tuesdays.  DiagnosTEX will be closed Monday, December 24th and Tuesday the 25th for Christmas, as well as Monda,y January 1 and Tuesday, January 2 and we, will operate Wednesday-Friday both of those weeks following those dates. We want to meet all of your MBSS needs; we know PO feeding becomes very important on several levels to many patients and their families around the holidays. The days prior to the holidays are long for us as we work very hard to get everyone’s requests completed.  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 during this busy time of year******

ASAP requests often cannot be accommodated to the satisfaction of those requesting it.

Specific requests for specific times and/or days become exponentially difficult to accommodate and therefore, we may be unable to quickly schedule your patient with any specific time and day requests.

Please notify your staff, patients, and families as such.

Being mobile allows the convenience of the service coming to you – not for the customized flexibility of schedules and times. We are a venue option for an MBSS and we must schedule our mobile clinics for efficiency and cost-effectiveness. .If you or the patient and family require a specific time and/or day with limited flexibility, please consider a free-standing outpatient facility (e.g., a hospital).

Does your patient have NTSP or Care N Care and others? – We are now providing patients with this particular insurance some negotiated rates, for the rest of 2018, with DTEX, so we can get your patient’s MBSS completed for the holidays! Call us first before sending them out.

DiagnosTEX is an official donation site for the Socks For Seniors Holiday Sock Drive –  PLEASE Help us this holiday season in providing warm, non-slip socks to seniors in nursing facilities!  We will be receiving donations through December 24th and distributing where they are needed the most!

Provale Cup – We are happy to tell you that if you or your patients order a Provale Cup and you mention DiagnosTEX, you will get a 10% discount off your purchase. Please spread the word!  You can order the Provale Cup directly from Provale at Reliant Medical Products.

Phone: 800-757-7579
Fax: 205-943-4748

Dysphagia Tidbit – Hard swallow …………………………. I am sounding off

I am truly disappointed in the camps of our profession. Social Media blogs have not helped our already divided profession, but the lack of respect and professionalism is so hard to swallow. No pun intended. Especially when it comes from those who are supposed to be mentoring.  There is a revived push for FEES in the last few years, which has been an option for instrumental evaluations for many years now. Susan Langmore, Ph.D., and colleagues coined the term FEES® in 1986 and published the first data demonstrating the effectiveness of the procedure in 1988.  This is not new.  What is new is mobile FEES. Those who perform FEES cringe at the term “gold standard” when referring to MBSS.  This is not a new description either, but I guess people have a problem with it being an “old” description.

Let’s stick with facts, once an endoscopic tube is placed down the nose into the pharynx, the oral phases are only indirectly evaluated and there is no evaluation of the esophageal phase (Gerber, M., Vaeronneau, M., 2002, ASHA, 2002.) With FEES, during the time of the swallow/airway closure, the swallow cannot be visualized, as the pharyngeal walls contract over the bolus, it collapses the lumen over the endoscope (“whiteout phase”).  MBSS is necessary to determine “WHEN” penetration or aspiration is occurring. An MBSS provides more information about the oral phase dynamics, coordination of oropharyngeal movements, posterior tongue movement and apposition with the posterior pharyngeal wall, hyolaryngeal elevation, aspiration DURING the swallow, UES opening, esophageal phase dynamics, and evaluation of the effortful swallow technique and the Mendelsohn maneuver (Langmore & McCulloch, 1997).  Langmore said this, I did not originate this information for this newsletter.  The MBSS remains the pre-eminent method to view  all 3 phases of the swallow……the oral, pharyngeal, and esophageal phase in real time and to diagnose the underlying cause(s) for the symptoms of aspiration and penetration, as it also allows visualization of the pharyngeal phase while compensatory strategies are tested for their ability to increase swallowing safety and efficiency.   Currently, no other technology has this versatility (Lewis, K., Liss, J., Sciortino, K., 2004).  Below in bold are recent claims about MBSS even in this DFW area today for marketing purposes:

MBSS is older – Absolutely! Proven over many years and yes, it has been referred to as a Gold Standard for diagnosing dysphagia, whether people like the term or not. It is the most widely accepted, research supported diagnostic tool for dysphagia to date.

Patient must be seated upright – True, it is the most optimal eating position for all humans, allowing full view of the pharynx and full laryngeal ROM.

Fees uses real food and liquids – MBSS uses real food and real liquids laced with barium. Barium is an inert substance which means it is neither absorbed nor metabolized by the body unlike dye.

Use of Radiation – Radiation time is limited to 2-4 minutes (approximately1.5 R/per min, State regs allow 10 R/per min). This is less radiation than a dental X-ray, upper GI, CXR, smoking a cigarette (anyone smoke?), or living in Denver, CO for a year.

MBSS requires a physician present – THAT is a good thing, not a bad thing!

MBSS Higher Cost – No it is not, the cost to the facility is less than $100.00. It is an exam of 3 phases of the swallow.

Mobile MBSS can only see limited patients – patients are seen in the parking lot of their facilities or driveway of their home in their own wheelchairs or bariatric chairs, with portable vents patients. Patients in isolation with proper universal precautions and 2 weeks of antibiotics are also seen for MBSS. 

It comes down to one thing, these 2 instrumental evaluations both have their place in the evaluation of dysphagia, they can be complimentary of each other  in the right situations, yet each treating therapist must decide which evaluation best fits their patient’s needs.  We are all in the business to get the patient the best dysphagia evaluation and treatment possible, keep this in perspective without throwing pot shots at each other, esp on the national stage, it does no good for those entering this rewarding career!  Professionalism has 4 areas: Positive Attitude, Respectful, Enthusiasm and Composure.