Newsletter :: August 2006

Monthly Motivator
Principles
The soul is dyed the color of its thoughts. Think only on those things that are in line with your principles and can bear the full light of day!

MBSS Workshop Conference – The Truth Behind the Fluoro We have a full conference, only a few seats left, 5 to be exact! You can also put your name on a cancellation list if we have any one that has not paid or cancels their reservation, we will call you and offer you the seat. We look forward to seeing you on the 12th!
A questions I get asked a lot: “Are TSHA CEU’s good for ASHA CEU”S?”
TSHA IS AN ASHA APPROVED SPONSOR. TSHA and ASHA have a reciprocating agreement in that they recognize each other’s program of approved hours. ASHA uses CEU (which 1 CEU is equal to 10 TSHA hours) while TSHA uses hours. TSHA hours count towards ASHA requirements such as CCC and ASHA hours count towards Texas licensure requirements. If anyone has had a problem, have them contact Loretta Lee who is the TSHA representative for ASHA. Loretta can be contacted as follows: lorettalee356@earthlink.net 254-445-2387

Texas Summers
HOT! HOT! HOT! Shall I describe it any other way??? Unfortunately this time a year is one we in the mobile business all dread! Often due to hot temperatures, being parked on hot concrete, running A/C on high, and sitting on one location for long periods of time, can cause our generators to over heat. We take all precautions and maintain all required and preventative maintenance on them to 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 if these generator issues occur we may have to adjust your scheduled time. Thank you for your understanding. Stay cool and take your Starbucks cards to get a GRANDE FRAPPACINO!

QA – DiagnosTEX does QA on all the patients we service. The intent of this Modified Barium Swallow Study (MBSS) Quality Assurance (QA) is to review the results and outcome measures taken on a monthly basis on studies/consultation completed by DiagnosTEX. This QA is completed in order to assist DiagnosTEX in establishing, maintaining, and ultimately improving the provision of mobile MBSS. MBSS outcome measures are intended to document if method of nutrition, diet, and liquid recommendations as well as management/treatment recommendations are being followed and if the patient is benefiting from the recommendations. Also if the recommendations are not followed, why?
The following areas are addressed:
• MBSS tallies per month
• MBSS diet and treatment recommendations,
• Analysis of patients outcomes post MBSS
• Silent aspiration
• Removal of tube feeding/NPO status
• Esophageal disorders observed
• Use of strategies
• Satisfaction surveys
We get excited about the results sometimes. I am excited about some of them recently! We had a 49% diagnosis of Esophageal phase deficits relating to dysphagia! This can only be identified on an MBSS. The MBSS is the only diagnostic evaluation that can assess all 3 phases of the swallow at one time! We also eliminated 60% of the patients off of tube feeding! YEAH!

DiagnosTEX is just a phone call away.
We understand that a local competitor has closed their doors in the DFW area and are automatically faxing your paperwork to another local competitor of their choice. The choice of MBSS service providers should be you, they should not be choosing for you! I know some of you found this out the hard away and have already called us. For the rest, DiagnosTEX is just a phone call away. We will be competitive with any pricing you may have received. We have 3 vans servicing DFW, 5 days a week and we can be at your facility within 24-48 hours of your request and paperwork. Here are some more reasons why local SLP’s choosing DiagnosTEX:
1. I choose DiagnosTEX as my mobile MBSS mobile service provider because I can always count on quality swallow studies performed by top notch professionals who have been doing them for years. The SLP’s on board are always willing to help provide suggestions on how I can better help my patients or answer any questions regarding dysphagia. The entire staff (including the receptionists, doctors, and drivers have always been a pleasure to work with! Jean, N. Richland Hills, TX
2. I use DiagnosTEX because of the superior professional expertise of their staff, their willingness to work with the facility Speech Pathologist to determine the most appropriate plan of care for each patient, and the quality of their reports. (SLP handouts and the Starbucks gift certificates.) Judy, Fort Worth, TX
3. I choose DiagnosTEX as my MBSS mobile service provider because they provide exemplary and comprehensive diagnostic services for my patients with swallowing disorders. The DiagnosTEX team is superior in their knowledge, skills, and rapport with patients and staff. Leslie – Ft. Worth, TX
4. I choose DiagnosTEX because my previous MBSS providers do not seem to be in the business for the right reasons. DiagnosTEX really cares about each and every patient and is always helpful in ways to treat to the client, along with follow up calls to check on how my patient is doing. Tamra, Richardson, TX

Clinical Café Question: Does a reduced gag reflex indicate Dysphagia?
Not necessarily, but should be assessed and considered as a clinical indicator if you are observing other signs and symptoms. A weak gag may suggest decreased pressure to safely move the bolus into the esophagus. It could indicate Vagus nerve involvement. Keep in mind though, there are often very functional swallows with reduced gag reflex.

Dysphagia Tidbit – The 9 D’s of weight loss in the elderly
1) Dentition 2)Dysgeusia 3)Dysphagia 4)Diarrhea 5) Disease (Chronic) 6) Depression 7) Dementia 8) Dysfunction 9) Drugs ( Robbins, L.J. 1989)Swallowing muscles are mainly striated, suggesting their metabolic rate during malnutrition may more closely resemble that of skeletal muscles than internal organs (Sullivan, 2003). Elderly individuals face age and nutritionally induced physiologic changes that predispose them to increased risk of developing dysphagia and as a result, nutritional disorders including malnutrition( Hudson et al, 2000). They may be eating but caloric intake does not meet nutritional need and micronutritient may be reduced causing under nutrition.
(Greip et al, Toth et al, Raynaud et al.)