Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
There is no better time to express our appreciation for your business and friendship! The friendship of those we serve is the foundation of our success serving the DFW area!
This is the season to reflect on your blessings and those things for which you feel most thankful. I know at DiagnosTEX, we are incredibly thankful for each and every one of you who use us as your preferred mobile MBSS provider and have shared your friendship and support over the years. We wish you and your families and very Happy Thanksgiving with many, many blessings this holiday season!
IT IS ELECTION TIME! PLEASE DO NOT FORGET TO VOTE!!!!! YOUR VOTE COUNTS!
Emily Chase was our 200Th like on Facebook! Yay Emily!!! Thank you for Liking DiagnosTEX!
DiagnosTEX November Holiday Schedule Swallow and be thankful! DiagnosTEX will be closed on Thursday, Thanksgiving Day, November 26th and Friday the 27th, to count our blessings and spend time with our families. We want to meet all of your MBSS needs because we know PO feeding becomes important on many levels to many of your patients around the holidays, especially when Thanksgiving is traditionally planned and prepared with a great deal of attention to food. We also want to be fair and accommodating to each DiagnosTEX employee and their families. We are so thankful for them as well! Please keep our holiday schedules in mind when scheduling your MBSS at the end of November (and December)! ******Please take note and keep in mind that during this busy time of year, specific requests for specific times and/or days become exponentially difficult to accommodate. We may be unable to quickly schedule your patient with certain time and day requests. Please notify your staff, patients, and families of this. ****** DiagnosTEX bases our mobile clinic schedules by geographical areas for time, efficiency and operational cost. If your patient’s schedule is limited to certain days and times, we recommend an outpatient facility (such as a hospital). Our mobile service is an option for you that offers convenience in the equipment coming to you, but it is not for the flexibility of specific days and time schedules. Mobile offices also require flexibility in time; we are subject to many factors that can dramatically change our travel during the day and subsequently alter the exact time we may arrive. We all make a heartfelt effort to arrive during our scheduled time, but there are often things that are out of our control that may change our arrival time. We will always call to keep you updated on our ETA at the number you have provided us on the HX/consult form.
Please keep in mind that DiagnosTEX is not an X -ray service and we do not provide stat services. DiagnosTEX is a physician clinic/office and operates under normal physician office hours Monday through Thursday with an occasional Friday if a holiday or unusual circumstance with mechanical issues with the van interferes and/or effects the other scheduled days. Fridays are a day we use to service all of our mobile vehicles and this is company policy. As with any physician office, a patient’s paperwork must be processed and insurance must be verified before we schedule an appt. Also as a physician clinic/office we schedule appointments and it may take 1-7 days to get scheduled with us.
FEES VS MBSS – The use of fiberoptic endoscopy to evaluate the pharyngeal stage of the swallowing is a procedure developed by Susan Langmore, Ph.D., Kenneth Schatz, M.A., and Nels Olsen, M.D. Parameters that can be evaluated include pharyngeal pooling, premature spillage, penetration/aspiration,
and residue. The procedure is mildly invasive and is limited to the events immediately before the swallow and after the swallow event. With FEES, during the time of the swallow/airway closure, the swallow cannot be visualized, as the pharyngeal walls contract over the bolus and collapses the lumen over the endoscope (“whiteout phase”). Oral phases are only indirectly evaluated and no evaluation of the esophageal phase (Gerber, M., Vaeronneau, M., 2002, ASHA, 2002.
Indications for an MBSS over FEES (Langmore et. al., 1996): 1) Esophageal phase problem suspected or need to be screened 2) Globus complaints 3) Vague symptomology noted at bedside 4) Need to verify aspiration of liquids during the swallow 5) Need to get impression of the amount of aspiration. The MBSS allows viewing of the oral, pharyngeal, and esophageal phase in real time and in concert together and to diagnose the underlying cause(s) for the symptoms of aspiration and penetration. The MBSS 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).
ASHA Convention– November 12-14 in Denver, Colorado (Stop by and see the AMPCARE booth while you are there!)
Ampcare has launched its 8-hour ASHA Approved online/on demand continuing education training.
Online/On Demand Agenda includes:
Introduction Ampcare’s Effective Swallowing Protocol – ESP™
Module 1 Introduction to dysphagia
Module 2 Past and current research
Module 3 Anatomy and physiology of the swallow
Module 4 Cranial nerve assessment
Module 5 Muscle fiber types and recruitment philosophies
Module 6 Fundamental principles of NMES/ESP parameters
Module 7 Demonstration and video of ESP
Module 8 Electrode and Posture Device application, new exercises
Module 9 Programming Ampcare ES unit
Module 10 Oral motor management and facial placement
Module 11 Documentation, billing, and competencies
To register for the training click on the following link: www.swallowtherapy.com/online-ce-training-registration/
New Nutritional Product – Thrive Ice Cream – I do not know very many people who do not like ice cream, but I do not know any Alzheimer’s patient that does not like ice cream. Thrive is formulated to help with nutritional challenges of lean body mass, appetite and energy with more protein, calcium and fiber than eggs, milk and oatmeal. It comes in chocolate, vanilla, strawberry and no sugar added vanilla. I have tasted it and it is very good. They claim it is a nectar and honey consistency, but after watching sit at room temperature for a while it was melting to a thin liquids. Nevertheless I think the increased nutritional benefits to patients who can have thin liquids and have a sweet tooth as most Alzheimer’s patients do, this is a great option to improve nutritional status. You can find out more at www.thriveicecream.com.
Dysphagia Tidbit – Difference between pleasure feeds and therapeutics feeds
Pleasure feed– This diet is an order. This is a diet the patient has control over and requests at will, This is a diet consistency recommended that is safe and the patient and or family is in control of when and how much. This may be recommended to someone who has alternate means of feeding but is unable to manage 3 meals daily, may be on hospice and may require comfort measures only, or may have other limitations that only accommodates small PO intake at a time.
Therapeutic feeds is not a diet order, it is a part of direct therapy with the treating SLP. The treating SLP is in control of consistency, form of administration, amount and is usually given during a therapy session while being supervised with limited amounts. This consistency is recommended because it is at a higher risk of dysphagia, it may be more difficult for the patient to manage in large amounts due to fatigue, it may require 100% supervision with strategies, or may require further training/practice for safe swallowing facilitative technique or compensatory strategies. Usually another diet is recommended with therapeutic feedings even if it is NPO and alternate means of feeding is used as the main source of nutrition and hydration.