July 2011 Newsletter

Clinical Café Newsletter
By: Ronda Polansky M.S., CCC-SLP

Monthly Motivation
EXCELLENCE
Every job is a self-portrait of the person who did it! Autograph your work with excellence! Excellence is never an accident; it is a result of high intention, sincere effort, intelligent direction, skillful execution and the vision to see.
DiagnosTEX strives to achieve this with every patient we evaluate.

Happy 4th of July to everyone celebrating our country’s independence and honoring our veterans and current military! Thank you to everyone who has served and/or is currently serving our country! We appreciate you more than you will ever know! We know that freedom does not come free… there is a cost! DiagnosTEX will be closed Monday, July 4th in observation of this important holiday. Please keep this in mind when scheduling your MBSS.

Texas Summers – HOT! HOT! HOT! Shall I describe it any other way??? Unfortunately, this time of year is one we dread in the mobile business! Hot temperatures, being parked on hot concrete in the sun, running A/Cs on high, and/or sitting on one location for long periods of time can often cause our generators to overheat. We take all precautions and maintain all required and preventative maintenance on our equipment, and strive to ensure this does not happen… but the Texas summer can be unforgiving and generators can only get “so hot” in triple digit temperatures. Please be aware that IF these generator issues occur we may have to adjust your scheduled time. Any time we can park under a portico (covered entrance at the front of a building) would be helpful to us, your patients, and the completion of your studies. Please check with your administrators on this; we appreciate your understanding.

DVD copies – DiagnosTEX will provide each patient, SLP, facility, or home health with one copy of the DVD/MBSS when we complete the study. Any additional copies requested of the DVD will be $10.00 per copy to cover time, staff, and postage.

NEW staff at DiagnosTEX – We are growing and would like to introduce you to our new staff and welcome them to DiagnosTEX. Carlos Barsurto and Jordan O’Mary are our new techs. Patrick Barnes M.S., CCC-SLP (who has actually been with us almost a year) and Jennifer Jones M.S., CCC-SLP, are our newest additions to our SLP team and have suffered through our grueling DiagnosTEX training program! 

E-Stim conference – I have had several calls asking about E-Stim conferences. We had one in Arlington in April, and Houston in May. We will likely have one more before the end of the year. Currently scheduled E-Stim conferences are: August 13, 2011 – Tulsa, Oklahoma; and August 27, 2011 – Albuquerque, New Mexico. For more information please call AMPCARE at 682-561-2444.

New Home Health HX form – We have typically used our standard consult/history form for all home health patients. Providing MBSS services for a home health patient can be much more complicated in scheduling and paperwork. With the increase of home health referrals over the past years, we are recreating an alternate consult/history form for home health patients only. We will require the new form to be utilized on ALL home health patient MBSS requests beginning July 1st. Please call and ask Linda for the updated version so we can fax it to you, or you can locate it on the website at www.dysphagiadiagnostex.com. Use the new form when sending in your paperwork on all home health patients. Thank you.

Free Webinars – “Tracheostomy and the Use of Speaking Valves with the Adult Population” at 4pm on Tuesday August 2, 2010. Register at www.advanceweb.com/speech

Dysphagia Tidbit – Treatment of Dysphagia after ACDF – An anterior cervical disectomy with fusion (ACDF) is commonly performed to treat cervical disc herniations and other cervical pathologies. Two common ACDF surgical complications are dysphagia and dysphonia. Therefore, SLPs treating this population should have a good understanding of the surgical process in addition to the appropriate anatomical and physiological conditions before and after surgery. With this knowledge, you can make good clinical decisions as they relate to evaluation, treatment, and counseling. While sensory and motor function can be predicted based on level of injury and clinical presentation, it is important to know that herniations can impinge on nerves and the spinal cord itself, so this can vary among patients. The surgical procedure of ACDF involves making an incision in the anterior lateral area of the neck and moving the neck muscles aside. Retractors hold back the trachea, esophagus, and arteries. The spinal muscles are lifted and pulled aside in order to gain access to vertebra and discs. Spreaders are inserted to pull apart each vertebrae above and below the disc. Small grasping tool are used to remove the entire disc, and the disc space is replaced with bone graft to prevent collapse, restore nerve function, and/or prevent additional nerve damage. Cervical screws and plates may be placed for stability. The recurrent laryngeal branch of the vagus nerve passes through C5-C6, which is responsible for many of the muscles for swallowing, but keep in mind this does not exclude dysphagia if other levels are involved. One study found that post-op dysphagia occurred in 60 % of the patients and 32% had symptoms for more than 6 months. Post-op dysphagia following the anterior approach was reported in 50% at one month, 32% at 2 months, 17% at 6 months, and 12.5% at 12 months. Vocal cord paresis was identified in 1.3% of the patients at 12 months. Therefore, SLPs need to know how to treat both transient and long-standing dysphagia. Peri- and post-surgical causes for dysphagia include laryngeal and pharyngeal edema, endotracheal pressure, prolonged retraction of the esophagus, soft tissue dissection, infection, nerve injury, esophageal perforation (rare), and hardware complications. Typical recommendations include downgrade in diet with strategies. SLPs should reassess patients who continue to report or demonstrate s/s several weeks post-op, and ensure patients are tolerating and taking adequate nutrition and hydration for healing and participation in therapy, reduce or eliminate aspiration risk, and to educate patients through the process.