July 2020 Newsletter

Happy Independence Day! God Bless the USA!

Happy 4th of July to everyone celebrating our country’s independence but don’t forget to honor our veterans and current military who have served to ensure our FREEDOM! We know that freedom does not come free… there is a cost, as some gave all!  LET FREEDOM RING!

July 4th is Independence Day

We celebrate American Independence Day on the Fourth of July every year. We think of July 4, 1776, as a day that represents the Declaration of Independence and the birth of the United States of America as an independent nation. But July 4, 1776 wasn't the day that the Continental Congress decided to declare independence (they did that on July 2, 1776). It wasn’t the day we started the American Revolution either (that had happened back in April 1775). And it wasn't the day Thomas Jefferson wrote the first draft of the Declaration of Independence (that was in June 1776). Or the date on which the Declaration was delivered to Great Britain (that didn't happen until November 1776). Or the date it was signed (that was August 2, 1776). So what did happen on July 4, 1776? The Continental Congress approved the final wording of the Declaration of Independence on July 4, 1776. They'd been working on it for a couple of days after the draft was submitted on July 2nd and finally agreed on all of the edits and changes.

Other things in July worth acknowledging:

  • National Cleft & Craniofacial Awareness & Prevention Month (NCCAPM)
  • National Wheelchair Beautification Month – Woohooo! Let’s decorate those chairs!!!
  • July 7 – Chocolate Day – Just July 7th?  Am I the only one who thought this was every day?
  • July 11 - Slurpee Day
  • July 17 – National Hot Dog Day – celebrate the dog days of summer
  • July 21 - National Ice Cream Day
Summer CEU opportunities with Ampcare, register at www.ampcarellc.com
  • July 11th - Arlington, Texas
  • July 17th - Austin, Texas
  • August 22nd - Newark, New Jersey

Looking Ahead

Mark your calendars for the TSHA 65th Annual Convention & Exhibition, taking place Thursday, April 15 Saturday, April 17, 2021, in Austin!

COVID Recovery

DiagnosTEX will be seeing patients that have recovered from COVID-19 following hospitalization, whether due to pre-existing dysphagia, overall deconditioning from the Coronavirus infection, or impaired airway protection secondary to prolonged intubation.  DiagnosTEX will see patients that have met the CDC criteria for “Discontinuation of Transmission Based Precautions” as outlined on the CDC website. Please see our COVID recovery packet on our website at www.dysphagiadiagnostex.com

Dysphagia Tidbit - Dysphagia and COVID

As treating therapists we are facing an influx of patients who have likely been extubated. Oropharyngeal dysphagia (OD) is a very common complication in/post ICU patients that have required intubation/mechanical ventilation or had tracheotomies or NG tubes. These patients likely have had acute respiratory infection/pneumonia/respiratory insufficiency needing a high concentration of oxygen and mechanical ventilation. All these situations are common for COVID-19 patients that are currently filling our local hospitals due to the pandemic.

OD can be associated with prolonged hospitalization, dehydration, and severe nutritional and respiratory complications.  Postintubation dysphagia in critically ill patients is related to the duration of mechanical ventilation and the occurrence of dysphagia is due to multifactorial changes. The endotracheal tube passes through the oral cavity, oropharynx, larynx, and trachea. There is a high risk of laryngeal and tracheal injury, postintubation voice complications, and dysphagia. Predictive factors increasing the risk of dysphagia and aspiration after extubation include age, and whether the patient has already had dysphagia prior to the intubation or developed it as a result of the current disease.

One systematic review in literature concluded that risk factors for dysphagia after extubation included congestive heart failure, functional status, increased hospital length of stay, hypercholesterolemia, increased ICU length of stay, multiple intubations, increased operative time, perioperative transesophageal echocardiography, and sepsis. One study reported that the predictor of aspiration risk is intubation lasting more than 7 days, in another study the duration of intubation in patients after cardiac surgery, has been confirmed to be a strong predictor of dysphagia as well.

When interacting with a patient, it is recommended you stand at the side of the bed when performing a bedside swallow evaluation to minimize the risk of transmission. Reflex cough testing should be omitted in patients with confirmed COVID-19. Bedside examination may be partially unspecific in extubated patients, as patients recovering from a critical illness may have a cough and gargling voice for reasons other than the aspiration. This is why an MBSS is so important. Patients with prolonged intubation should have assessed swallowing before the first oral intake.

To determine appropriate therapeutic approaches, you must know what, when and why the dysphagia is occurring. Let DiagnosTEX help you do that.  Therapy needs to be customized as there is no one single approach that fits all patients.

Postintubation Dysphagia During COVID-19 Outbreak-Contemporary Review

Zofia Frajkova, Miroslav Tedla, Eva Tedlova, Magda Suchankova & Ahmed Geneid Dysphagia (2020)

FREE Online Clinics

From June 15 through August 14, 2020, the University of St. Augustine will be providing FREE teletherapy (both evaluations and treatment) for children and adults. All student clinicians will be supervised by a certified and licensed speech pathologist.  For more information please contact Amber Lemmon at alemmon@usa.edu  

There is good happening in the world, every day, everywhere — we just need to look for it and share it.

Be inspired!Here's something good in an inspiring story to help motivate and inspire us every day. We all need to hear something good during this crazy season we are in!  It made my day and brought me joy! This is one of many stories where I have heard of a life that was changed through the use of Ampcare ESP for the treatment of dysphagia.  Kelli, the treating SLP, sent me a text that said; “I’ve been meaning to tell you I had the best patient ever!”

This 50-year-old man with a heart condition began showing symptoms of stroke after heart surgery. One of these symptoms included his inability to swallow and he ultimately required a feeding tube as his main source of nutrition and hydration. He began therapy for his swallowing difficulty with a speech therapist at the hospital using Ampcare’s FDA-cleared medical device.   Although he made some progress, he was discharged home with the feeding tube and continued therapy at home with another speech therapist, also certified and trained to use Ampcare ESP (Effective Swallowing Protocol). She continued his ESP treatment, advancing him properly in the modality coupled with appropriate traditional dysphagia exercises, i.e. ice chips, effortful swallows, and tongue exercises.)  After three months of dysphagia treatment with Ampcare ESP, he was re-assessed by an MBSS at his home and determined safe to begin eating and drinking again. His feeding tube was removed and he is back to enjoying his cup of coffee each day. Kelli ended by telling me, “ESP gave this man back his life!”

This testimony and picture were sent to me (with written permission by the patient). Kelli said that her patient wanted to send a picture of himself to me, “drinking his cup of joe” and to say “thank you from the bottom of his heart”. This is exactly why I chose dysphagia as my area of specialty. Who doesn’t like a good cup of coffee? 😊 Ampcare’s goal as a company and ultimately as healthcare professionals is to serve.  Ampcare’s commitment to healthcare is to achieve positive patient outcomes with targeted products designed to meet the needs of both the patient and the healthcare professional. That is accomplished by working to eliminate aspiration pneumonia and the use of feeding tubes caused by dysphagia by improving the options and availability of dysphagia treatment techniques. Kelli had added that he “loved the E-stim treatment and the benefit of it giving him back his life”. 

We get up each day to live life and when you get to be someone who makes someone else look forward to tomorrow, that is confirmation you are walking out your purpose. Everyone wants to be the sun to brighten someone’s day but it sometimes makes you feel even better to be the moon to brighten their darkest hours. This is his testimony, but it ultimately becomes mine as well.

Permission was given by the patient and treating SLP to tell the story and use the picture.