Newsletter :: August 2005

1=Excellent       2=Good                        3=Average        4=Dissatisfied     5=Not interested in using service again.

Feedback: 1=90%         2=.09                3 =.04               4=NA                5=NA

Some of the written feedback we so appreciate:

                You do a great job consistently

                Everyone is pleasant and professional

                You have been wonderful, very efficient teams, very knowledgeable and always quick to consult

                Good quality of reports, very professional

                Love U guys!

                Everyone does a great job! The skill level of the SLP’s is excellent

                Always a pleasure knowing I will get a complete professional study completed

                Wouldn’t use anyone else!

Thank you for filling the surveys out!

Effects and Interactions

Here are a few well known drug-drug and drug-food interactions

Aspirin and blood-thinners – lead to excessive bleeding

Antacids – Can prevent antibiotics, blood thinners, and heart medications from being properly absorbed

Decongestants – interact with anti-hypertension drugs or MAO inhibiting antidepressants

Some Herbal Supplements – Ginko inhibits blood clotting, kava kava adds to the effects of muscle relaxants, sedatives, and antidepressants

Vitamins and minerals – Ferrous sulfate (type of iron) can cancel out effects of tetracycline

Certain food and beverages – grapefruit can cause problems with some blood pressure medications, the antihistamine terfenadine, and  transplant rejection-countering drug cyclosporine.

Sources http://nihseniorhealth.gov/takingmedicines/toc.html

http://familydoctor.org/otc.xml

http://www.fda.gov/cder/consumerinfo/WhatsRightForYou.htm

Stroke Connection Subscription

We have included a FREE subscription form for the Stroke Connection.  This is a great source for SLP’s and also for the SLP’s to pass on to their patients and Patients families!  I encourage you to send this in and take advantage of the free information and education!

Dysphagia Tidbit – Aspiration Pneumonia and Oral Bacteria

Recent research is confirming the original premise that aspiration pneumonia is not necessarily a result of food or liquid entering the lungs, but bacteria laden saliva.  In recognizing oral bacteria as a primary risk factor, we must adjust our approach.  A clean mouth has approximately 100 million bacteria that cling to teeth, tongue, gums, and buccal surfaces (YYUGH!)  When teeth are not brushed, the bacteria can quickly multiply and migrate to pharynx, sinuses, larynx, and ultimately the lungs!  This is the controversy with Free Water. In a resident with abnormal aspiration, the trip to the lungs is much quicker and more frequent.  The stress response of the body can begin a chain of events that alters the chemical balance of the mouth and allows gram-negative bacteria to dominate. The immune system, which is preserving energy to deal with the original insult, is unable to cope with the additional burden of aspirated oral pathogens.  Smoking and diseases such as COPD diminish these mechanical clearance systems, allowing for greater chance of infection to spread.  The risk factors are now adding up: accumulated oral bacteria, stress of trauma and inferior immune response, inefficient pulmonary clearance and aspiration.  Malnutrition, even for a short period, significantly burdens the immune system.  Respiratory clearance works best in people who are ambulatory.  Dehydration limits the flow of saliva, which allows bacteria to flourish in the mouth instead of being washed down to the sterile stomach.  If the patient is NPO, the situation is magnified by dry mouth and fewer automatic swallows. Additionally, people who do not eat frequently are perceived to need less oral care, when the reverse is actually true.  For optimal oral health the teeth should be brushed after meals, brush dentures after meals and remove them at night to soak in appropriate cleanser and clean inside of mouth by swishing or brushing with antiseptic mouthwash, not the typical institutional mouth freshener. Other steps to support recovery are to reduced risk factors through positioning, behavior and mobility; position the resident upright for all food fluid and medication presentations; and keep the head of the bed up at least six inches all day and night when tube feeding or reflux us present.

References include: ADVANCE June 27, 2005 Aspiration Pneumonia by: Brenda Logsdon