February 2016 Newsletter
DiagnosTEX, LLC
Consultants in Dysphagia Evaluation and Management
817-514-MBS1 or 1-888-514-MBS1
Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
February 2016
Happy Valentine’s Day!
The heart has its reasons of which reason knows nothing.
Here are some interesting facts about Valentine’s Day.
- In AD 496, Pope Gelasius I declared February 14 Valentine’s Day. He was a romantic!
- In the 1800s, doctors commonly advised their heartbroken patients to eat chocolate, claiming it would sooth their pain. I don’t know about you, but Chocolate eases my pain! J
- Richard Cadbury produced the first box of chocolates for Valentine’s Day in the late 1800s. LOVE THIS MAN!
- Teachers will receive the most Valentine’s Day cards, followed by children, mothers, wives, sweethearts, and pets.
- About 3% of pet owners will give Valentine’s Day gifts to their pets.
- An estimated 198 million roses were produced last year just for Valentine’s Day.
2016 DiagnosTEX Dysphagia Calendars and anatomy clip boards – We have a few left. If you have not received yours, please let us know.
Notes from the 2015 ASHA SLP Health Care Survey – Although SLP’s treat a wide range of disorders, those who work with adults spend most of their clinical time on swallowing (41%), followed by aphasia (16%) and dementia ( 13%), TBI and motor speech at both 8%, voice at 5%, augmentative communication at 4% with accent modification being the lowest at 1%. Overall, SLP’s spend more time providing clinical services to adults (54%) than any other age group according to the survey.
Upcoming 2016 CEU’s
Dysphagia Research Society Annual Convention – February 24, 27th in Tucson, Arizona
TSHA Annual Convention is in Fort Worth this year!!! March 10-12.
Critical Thinking in Dysphagia Management, University of Florida, March 18-20,
Success Story? Ampcare wants to know! Please tell Ampcare a little bit about your success stories with ESP®. Email info@ampcarellc.com. The one with the most submissions will receive a prize.
Influenza/Flu Positive results. – Any patient in isolation with an influenza positive test or with flu/risk/symptoms of the flu should not be seen in the mobile unit. Our small contained mobile environment can be easily exposed and effect the fragile, elderly patients that we see during the day, despite our decontamination procedures we use. If the patient has the flu and requires this procedure immediately, please refer to local hospital where this type of illness can be more properly handled. Thank you for your understanding and help with this issue during this flu season.
PQRS – (Physician Quality Reporting System) – All SLP’s in private practice must have reported on 50% of their Medicare Part B eligible patient visits or will be penalized by 2% on ALL claims for Part B service in 2016. It is time to report 2015 PQRS this year!
Dysphagia Tidbit – Swallowing Co-morbidities
Xerostomia
Dryness, which often extends from the mouth to the pharynx and esophagus, can hinder bolus flow and result in the retention of material along the swallowing tract. Oral residue can increase the risk for bacterial growth if careful oral care is not provided post meal, while residue more inferiorly can be a critical risk factor for aspiration. That is, material retained in the pharyngeal recesses can be inhaled into the trachea post-swallow.
Esophageal Motility
Equally threatening is the risk of residue within the esophagus traveling retrograde, or refluxing from the esophagus into the pharynx and potentially the trachea, when a patient reclines after a meal. The retention of material within the esophagus, termed intraesophageal stasis, and its potential to flow retrograde toward the pharynx, known as intraesophageal reflux, (Jou et al, submitted, 2008; Robbins et al, submitted, 2008) are distinct entities from the more commonly recognized gastroesophageal reflux and once identified can be treated with inexpensive behavioral adjustments . Insufficient saliva may also increase the risk for esophagitis, since the bicarbonate in saliva serves as a neutralizing mechanism that protects the esophagus from inflammation in the presence of acidic gastroesophageal reflux.
Sensory Changes
Sensory input for taste, temperature and tactile sensation changes in many older adults). For instance, sensory discrimination thresholds in the oral cavity and laryngopharynx have been shown to increase with age. This disruption of sensory-cortical-motor feedback loops may interfere with proper bolus formation and the timely response of the swallowing motor sequence, as well as detract from the pleasure of eating.
Sarcopenia
Structurally, sarcopenia is associated with age-related reductions in muscle mass and cross sectional area, a reduction in the number or size of muscle fibers, and a transformation or selective loss of specific muscle fiber types. Sarcopenia is inherently associated with diminished strength. There are reports in the literature of sarcopenia-like changes in muscles of the upper aerodigestive tract and the observed age-related changes in strength and function suggest pervasive changes in lingual muscle composition
Medications
Older patients frequently report difficulty swallowing pills as the first sign of a swallowing problem. Polypharmacy, unfortunately, in old age is routine practice as the incidence of certain medical conditions increases with age. While difficulty swallowing pills can be an indicator of dysphagia, the drugs themselves can be part of the problem. More than 2000 drugs can cause xerostomia or influence lower esophageal sphincter relaxation (thereby exacerbating gastroesophageal reflux) via anticholinergic mechanisms. An equally large number affect cognition and mental status, or influence the tongue and bulbar musculature by delaying neuromuscular responses or inducing extrapyramidal effects, which can hinder safe and sufficient oral intake. Angiotensin-Converting Enzyme (ACE) inhibitors have been considered for elderly dysphagic patients even when they do not have hypertension, secondary to studies showing lower rates of pneumonia in patients treated with ACE inhibitors however, ACE inhibitors also are associated with symptoms such as chronic cough that may mimic, mask or exacerbate dysphagia symptoms and therefore should be prescribed judiciously in the older adult at risk for dysphagia.
Senescent Swallowing: Impact, Starategies and Interventions, Ney, D, Weiss, J, Kind., A, Robbins, J, Nutr Clin Pract 2009 Jun-Jul 24(3) 395-413