November 2009 Newsletter

Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
November 2009
Happy Thanksgiving!
There is no better time to express our appreciation for your business and friendship! The friendship of those we serve is the foundation of our progress!

This is the season and the holiday to reflect on all your blessings and those things for which you feel most thankful. I know here at DiagnosTEX, we are incredibly thankful for all of you who use DiagnosTEX as your preferred mobile MBSS provider. You make our days so enjoyable! We appreciate your support and friendships. How can you thank someone for allowing you to do and be successful at what you love? I am not sure there are sufficient words to express our gratitude. I hope our appreciation shows in the effort we make to meet your MBSS needs and give you the best that we have to offer. We wish you and your families and very Happy Thanksgiving with many, many blessings!

DiagnosTEX November holiday schedule
Swallow and be thankful!
DiagnosTEX will be closed on Thanksgiving Day, November 26th, to count our blessings! Friday, November 28th operation will be dictated by the number of pending MBSS studies that we have. We want to meet all of your MBSS needs because we know PO feeding becomes important on many levels to many of your patients around the holidays. We also want to be fair and accommodating to each DiagnosTEX employee and their families. We are so thankful for all of them as well! Please keep our holiday schedules in mind when scheduling your MBSS at the end of November and December!
Upcoming ASHA Conference in New Orleans
November 19-21, 2009. DiagnosTEX will run only 2 vans on Thursday and Friday, November 19th and 20th. Most of the DiagnosTEX SLPs will be attending the ASHA conference. Please keep this in mind when scheduling your MBSS. We consider education a priority to help us grow professionally, so we can advance our skills to service you better. Maybe we will see you there!

The 2010 DiagnosTEX Dysphagia Calendar will be available next month!

New November educational handout – Pharmacology and Dysphagia – It is so important to know what medications our patients are on and how it affects them. So many different medications can impact a person’s behavior and function. Ask for yours next time we see you!

Finally!! – TSHA Ethics Online available this month Two hours of online continuing education (CE) credit to meet the Ethics Continuing Education Requirement. Accepted by ASHA and TSHA for CE credit
“Ethical Practice for Speech-Language Pathologists and Audiologists in Texas”
To register or get additional information go to: http://www.txshatrainingonline.com This course is offered at cost to TSHA members. TSHA Members cost: $40, Non-members cost: $75
Effective for renewals in May 2009 and after, a licensee must have had a minimum of two clock hours in ethics per renewal period. Extension of the two hour ethics requirement – at the February 27th board meeting the board members voted to extend the grace period for the ethics CEU requirement through December 31, 2009. Licensees who renew between May 2009 and December 2009 will have until December 31, 2009 to acquire the two clock hours in ethics for the previous renewal period, if they have not done so by the month of their renewal. These clock hours in ethics earned during the grace period will not count toward the ethics requirement for their next renewal in 2011.

Pill Esophagitis – This Esophageal dysphagia is often seen with pills such as Potassiu, antobiotics, Asprin, Osteoporosis meds, vitamin C and Dilantin. This usually occurs at the transition zone between the smooth and striated muscle at the level of the aortic arch. Symptoms include restrosternal pain in 72%, odynophagia in 74%, dysphagia in 30% and other symptoms such as nausea, fever and weight loss. Ulceration of a pill esophagitis should heal within 7 days. Unfortunately, many of our patients are given handful of pills, which is neither normal or safe! It takes about 6-8 oz of liquid, in an upright position, to clear a pill through the esophagus and we know our patients are not often given that chance. Often recommendations of crushed meds are made, but extended/sustained release meds should not be crushed as part of a blanket recommendation. When you notify your medical staff, they should have knowledge of this, but other options for those types of medications need to be discussed for the best interest of the patient.

Dysphagia Tidbit – Hot drinks and Dysphagia – Reversible thermal injury to the esophagus as the result of drinking hot liquids has been reported to generate alternating white and red linear mucosal bands, somewhat reminiscent of a candy cane. This phenomenon is associated with chest pain, dysphagia, odynophagia, and epigastric pain. Below is a report of a case of thermal injury to the esophageal and oral cavity due to the drinking of hot tea, including odynophagia and dysphagia.
Case Study – A 69-year-old man was referred due to a difficulty in swallowing which had begun a week prior to referral. The patient, at the time of admission, was unable to swallow even liquids. He had recently suffered from hiccups, and had consumed five cups of hot adlay tea one week prior to admission, as a folk remedy for the hiccups. Upon physical examination, the patient’s oral cavity evidenced mucosal erosion, hyperemia, and mucosa covered by a whitish pseudomembrane. Nonspecific findings were detected on the laboratory and radiological exams. Upper endoscopy revealed diffuse hyperemia, and erosions with thick and whitish pseudomembraneous mucosa on the entire esophagus. The stomach and duodenum appeared normal. The patient was diagnosed with thermal esophageal injury inflicted by the hot tea. He was treated with pantoprazole, 40 mg/day, for 14 days, and evidenced significant clinical and endoscopic improvement. Esophageal Thermal Injury by Hot Adlay Tea – Hoon Go, M.D., Hyeon Woong Yang, M.D., Sung Hee Jung, M.D., Young A Park, M.D., Jung Yun Lee, M.D., Sae Hee Kim, M.D., and Sin Hyung Lim, M.D.Department of Internal Medicine, Eulji University School of Medicine, Eulji University Hospital, Daejeon, Korea.