January 2008 Newsletter
Consultants in Dysphagia Evaluation and Management
817-514-MBS1 or 1-888-514-MBS1
JANUARY 2008
HAPPY NEW YEAR!!!
Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
Monthly Motivator:
The best way to predict the future is to create it! The sky is the limit when your heart is in it!
Upcoming E-Stim Conferences in 2008
East Texas – Hosted by Professional Imaging – Saturday January 26, 2007 in Tyler Texas Professional Imaging LLC is a Mobile MBSS company in East Texas, Houston, Austin, and San Antonio, not a part of DiagnosTEX, LLC. They have invited us as guest speakers; please call their Corp office 1-866-675-MBSS to register or any questions
Publications
Look for our E-Stim research article being published in ADVANCE SLP, DOR, and LTC this new year in February – March of 2008.
PREGNANCY
Please inform us if you are pregnant when you enter the mobile clinic to observe a study so we can provide you with a vest, for your protection. It is not recommended that you attend/observe the study unvested if you are pregnant. That is why we have many signs on the van indicating that you are entering an area of radiation. Please pass along this information to any family member that maybe attending the study as well.
DiagnosTEX 2008 Dysphagia Calendar
Be sure to get your new DiagnosTEX 2008 Dysphagia Calendar !
Scheduling your MBSS
If your facility cancels an MBSS schedule for a particular day , this pending MBSS will go back on the list as if the request just came it, therefore it will be another 24-48 hours, approximately, before we will be able to reschedule. Also be please aware that 24 -48 hours is a standard we STRIVE very hard to maintain. It is neither a guarantee, nor is it written any where in our service contract. In the nature of the mobile business there are forces of nature and Murphy’s law that create circumstances completely out of our control, which may result in situations in which we are unable to meet the 24-48 hour period. Also our 24-48 hour period includes work days only (M-F), not weekends. We do our very best to provide you with efficient, timely, and the highest quality of studies! Also if there are specific time requests or specific day of the week requested, we can not ensure scheduling in 24-48 hours due to the complex scheduling of our 3 vans with so many facilities in so many locations. Please notify your families that time restrictions may delay scheduling the patient’s study. We appreciate your understanding of this and we will continue to strive for the high standard…… of 24-48 hours!
Severe Weather
Unfortunately here in Texas we do not get a beautiful flaky snow fall, we get black ice. This becomes a problem for anyone who travels, and we do a lot of that in all directions! As winter approaches and the threat of severe weather conditions arise, DiagnosTEX owners and drivers will evaluate the conditions of the roads and DiagnosTEX will contact all scheduled facilities scheduled immediately if we are unable to meet our schedule for that day. If the weather conditions are so severe, as not to put our staff at risk driving in to work, we will cancel the day and reschedule the facilities as promptly as possible. If bad weather begins to occur during the work day, the owner and the driver present on the mobile unit will decide together if any changes in the schedule should be made. Although the patients are extremely important we do not want to risk the safety of our employees or vehicles to prevent further delay of our service to you due to injury or damaged vehicles. Our decisions to drive that day may be based upon whether or not public schools are closed because of road conditions. We will get cancelled studies rescheduled as soon as we possibly can! Please drive carefully during any winter ice storms!
Flu season – DiagnosTEX keeps stock of Airborne in the office and on our vans!! J We service many elderly and medically fragile individuals in a day and we are very concerned and conscientious that we not pass along anything to them. We would like to ask all of the facility SLP’s, staff, or family members that are ill, coughing, and/or may have a cold, to take precaution and reconsider coming onto the van, as our small environment is easily contaminated. Thank you for your consideration of this and our patients as well as our own staff.
History Intake form – Please fill these out as completely as possible and make sure you include a diagnosis related to the dysphagia. We need to have a diagnosis related to dysphagia. This will eliminate the amount of time we have to spend in the chart looking for the information required for our reports. Thank you for your help with this!
DYSPHAGIA TIDBIT – Ingested Barium and Bowel Impaction
If you google “barium impaction with Modified Barium Swallow Study” you will not find any information. You will find a lot more information on bowel impaction with a GI study. This is because of the amount of barium is significantly more. In a lower GI they fill the colon with barium through a tube entered through the rectum. In the Upper GI, the patients drink multiple cups of barium in a 20-minute procedure to coat the upper GI tract and gas producing crystals with pressure put on the abdomen. The exam table will be positioned at different angles and the patient’s abdomen may be compressed to help spread the barium. These actions assure that the barium is coating all parts of the upper GI tract. As the procedure continues, the technologist or the radiologist may ask the patient to drink more liquid barium for still X-rays. During a modified barium swallow study less than 4oz-6oz of liquid are given between thin and thick liquids, and barium is less than a 1 tbsp (10cc) when mixed with food. ALL of our physician reports recommend on the last page, that if the patient fails to have a bowel movement in 24-hours, to contact the physician to recommend an appropriate laxative. This requires the facility to monitor the bowel movement for 24 hours after the MBSS was completed. Barium used during an MBSS has often highlighted an impaction already in existence, but complication of an impaction is rare and actually uncited in the literature with an MBSS. The recommendations are precautions because many of our patients have a diagnosis/history that usually indicates them to be at high risk of poor bowel movements any way, such as 1) immobility (wheelchair bound) 2) poor nutrition and hydration 3) neurological complications. On a barium bottle label, rare instances of overdoses include amounts of barium at 30 ounces. Also as mentioned before, barium is inert which means it is not metabolized or absorbed by the body and enters and exits in the same form, therefore allergic reactions are rare and only documented in literature with barium enemas.