Newsletter :: September 2006
Yesterday is ashes, tomorrow wood.
Only today does the fire burn brightly.
What a fantastic turnout for the MBSS Workshop conference, due to the amount of information we discussed we had to limit seating to give everyone the personal attention needed and we sold out all of the seats and added a few and had 60 in attendance! We enjoyed spending the day with you and look forward to seeing you next time! Thanks for all the great comments and scores. We do apologize for the unexpected media problems.
I have had many people calling and asking about any upcoming E-Stim conferences, we have some in the works but dates not confirmed, but I will keep everyone updated!
New SLP Handout
If you have not gotten your new SLP handout out on “Trachs” be sure to ask for yours next time we see you!
September DiagnosTEX Holiday
DiagnosTEX will observe Labor Day on Monday September 4th. Please keep this in mind when scheduling your MBSS. Have a safe and relaxing Labor day!
History Form and Medical Record
Reminder: If you are having the MBSS order signed on our history form, make sure this becomes a part of your medical record at the facility.
Web Site Resources
Dysphagia@b9.com – chat room
www.Sageproducts.com – product list for toothbrushes/toothettes that attach to suction machines
www.Gastroatlas.com – photos and graphs of anatomy, description of swallowing function. May be downloaded free of charge.
Reliant Medical provided with a couple of Provale cups to give away at the conference last month.
If you order the Provale Cup on line at firstname.lastname@example.org and mention DiagnosTEX in your email, they will provide you a discount on the cups.
RSI – Reflux Symptom Index ( Murray, T, Carrau, R, 2006)
A Score greater than 10 strongly suggests laryngopharyngeal reflux
(0= no problem, 5= severe problems)
1. Hoarseness or voice problem 1 2 3 4 5
2. Clearing of throat 1 2 3 4 5
3. Excess Throat Mucous or postnasal drip 1 2 3 4 5
4. Difficulty swallowing food, liquid, pills 1 2 3 4 5
5. Coughing after you eat or lay down 1 2 3 4 5
6. Breathing difficulties or choking episodes 1 2 3 4 5
7. Troublesome or annoying cough 1 2 3 4 5
8. Globus sensation 1 2 3 4 5
9. Heartburn, chest, indigestion 1 2 3 4 5
Dysphagia Tidbit – Dysgeusia and Burning Mouth Sensation
Dysgeusia is a chronic taste sensation of unknown cause while Burning Mouth Sensation (BMS) is a chronic oral pain sensation in the absence of pathology. Some causes of dysgeusia reflect actual tastants that have gained access to the mouth such as: reflux, postnasal drip, halitosis, infection, medications in saliva or gingival fluid. Taste phantoms refer specifically to dysgeusias that originate within the nervous system (Bartoshul, Kveton, Yanagisawa, & Catalanotto, 1994)
Patients with taste phantoms or BMS usually show localized taste damage particularly on the anterior tongue. When taste is damaged, the inhibitions it produces is abolished, leading to abnormal activity in brain areas previously inhibited. Women are more likely to experience these phantoms. The loss of bitter perception at menopause appears to disinhibit oral pain and place a greater risk for BMS. The first step to assessing oral sensory dysfunction is to determine the origin of the sensory complaint.
GUSTATORY STIMULATION – Various liquids are placed on the individuals tongue with an eye dropper. This procedure is utilized to determine which gustatory stimuli result in an increase in sensory feedback. This information will determine whether certain tastes will inhibit or facilitate neuromuscular tone (Payne, Joyce). Suggested substances to be used are:
Salty Bitter Sweet
Salt water lemon juice syrup
Saltine crackers vinegar vanilla
Bullion pickle juice honey
Tomato juice grapefruit juice jelly
WEST NILE VIRUS – Symptoms include Dysphagia (Moshiem, J., 2006)
This disease is spread by female mosquitoes and peak months for the disease are July, August, and September. Elderly people and those with poor immune system are more susceptible to symptoms of West Nile. Curiously, the virus can mimic neurological diseases such as Parkinson’s Disease, Bell’s Palsy, and Guillian-Barre Syndrome. Madonna Rehab Hospital in Lincoln, Nebraska had 27 patients; ages 24-91 admitted with a diagnosis of West Nile and 20 had dysphagia. Symptoms included severe oral and pharyngeal weakness and difficulty moving the tongue and lips. Some demonstrated absent pharyngeal swallow and laryngeal elevation resulting in difficulty managing secretions and saliva. Seventeen patients were admitted NPO and eight remained NPO after D/C. Twelve of the 27 required a tracheotomy tube and 8 needed vent support. FYI – There has been an increase in cases in Northeast Tarrant County over last year.
Past Conference Booklet Sale
We have several copies made and we will sell at this price until gone
Call DiagnosTEX to order
DYSPHAGIA 101 – $5.00
Bedside Swallow Evaluation – $7.00
NPO – Ethics and Challenging case Management – $10.00