Newsletter :: January 2006


Month Motivator

Believe and Succeed

Courage does not always roar. Sometimes is that quiet voice at the end of the day that says, “I will try again tomorrow!”


2006 upcoming Conferences

January 28, 2005, Austin, TX – Dysphagia Program Development and Management

Contact Professional Imaging at 1-866-675-MBSS for more information.

Professional Imaging LLC is a Mobile MBSS company in Houston and Austin, not a part of DiagnosTEX, LLC. They have invited me as a guest speaker.

February 11, 2005, Bedford, TX – NPO Ethical Decisions and Management.

DiagnosTEX registration information included in newsletter.


DiagnosTEX 2006 Dysphagia Calendars!

We have new DiagnosTEX dysphagia calendars just for you, to help you keep track of your busy weeks during 2006. We look forward to another successful year and working side by side with you to provide the best quality care for those suffering from dysphagia.


Severe Weather

Unfortunately here in Texas we do not get a beautiful snow fall, we get ice. This becomes a problem for anyone who travels, and we do a lot of that! 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. 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. Please drive carefully during these winter ice storms!


New website for Stroke Survivors – How to Conquer the World with One Hand..And an Attitude”. By: Paul Berger (Stroke Survivor and author) & Stephanie Mensh (wife, caregiver, and author) NEW website:

It’s dedicated to sharing more solutions and motivation to overcome challenges and lead a full life. On, you’ll find:

* Articles & tips for survivors & caregivers
* Resources for professionals
* 7-part e-course on overcoming stroke
* Books & dictionaries for aphasia & speech
* Readings for building self-esteem
* Survivors stories
* Paul-tested products:
* Grooming
* Kitchen
* Physical & mobility
* References & links we use often
* Our monthly newsletter – NEW for November
* Questions & Answers
* Details on our presentations & workshops
* Excerpts from our books & tapes
* News of our TV & newspaper appearances


Dysphagia Tidbit – Botox Injection for Torticollis, also known as Cervical Dystonia

I was called last month re: a case that I thought was very interesting and something I had not seen before. That is why I love this field! I went to the facility to review the MBSS tape with the SLP. The closest thing I could compare it to was the effects of radiation for CA. This was a patient receiving Botulinum toxin (Botox) injection for torticollis. Cervical Dystonia is believed to be due to abnormal functioning of the basal ganglia, and there is no known cure, only treatments to relieve symptoms. Botox is a therapeutic muscle relaxing agent, but is also a powerful poison made by bacterium, called clostridium botulinum. The effect of the toxin is to weaken or paralyze muscle. Botox used in clinical practice is purified so there are no other contaminants and doses recommended are well below doses that could cause human botulism. After looking at the tape and doing some further research, it was apparent that dysphagia is a common side effect of this procedure. Often temporary, but nevertheless an issue for those suffering from it. Too much weakness in the muscles injected, spread to other muscles. Dysphagia has been reported in 19% of the patients. It is likely due to the spread of small amounts of the toxin to the swallowing muscles. The side effect usually begins 3-10 days following treatment and can last for weeks or even months. Swallowing symptoms can be mild to severe. The particular patient I reviewed had so much muscle weakness pharyngeally that the PES was completely relaxed and remained open at all times and pharyngeal contraction was absent. There was elevation and epiglottic movement, but even the arytenoids were affected. Penetration was mild with nectar and honey thick liquids during the swallow, with no aspiration on any consistency. Due to muscle weakness there was no peristalsis to help clear the heavier more cohesive consistencies through the pharyngeal/laryngeal spaces, other than gravity and time. Thin liquids passed through quickly. The physician administering the injections must be very knowledgeable about the anatomy of the neck and surrounding area. If the physician wants to inject muscles at the front of the neck due to a certain type of torticollis such as anterocollis (neck and head pulled forward and down), they are near important muscles for swallowing and these risks should be discussed. The muscles that have to be injected are deep in the neck. I can also see where there would be concern about the Accessory nerve and effecting C3-C5. This is often the reasons that those with this type of torticollis are less satisfied with the injections.