October Newsletter 2009


Consultants in Dysphagia Evaluation and Management
817-514-MBS1 or 1-888-514-MBS1
Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
October 2009
Happy Fall!
Monthly Motivator: Attitude
You cannot tailor-make the situations in life, but you can tailor-make the attitudes to fit those situations before they arise.


Upcoming conference in DFW by Northern Speech Services
Dysphagia in the Elderly: Choosing Effective Interventions to Ensure Positive Patient
Outcomes – October 16-18, 2009. DiagnosTEX will be closed Friday, October 16, for an educational day. All DiagnosTEX SLPs will be attending this conference. Please keep this in mind when scheduling your MBSS.  Thank you for your understanding as we take a day to help us grow professionally, so we can advance our skills to service you better.

Ethics Course – ANOTHER OPPORTUNITY before the end of the year! Texas now requires 2 hours of Ethics CEUs, and the deadline for getting these 2 hours will be December 2009.  Our first course (Ethics.com:  Are you online?) in August was sold out in 1 week!  We had over 70 attend.  Our next 3 months of 2009 are very busy for us, but we were able to book a room and schedule another conference for Friday, November 6 from 9-4:30pm.  This will be the last time we give this course this year. We hope this is beneficial to many of you that were unable to get into the first one. Registration information is included. There is another course being given this month by Cantex.  It is scheduled for Saturday, October 3rd from 9:00-5:00.  7.0 contact hours/.7 CEUs. This event will be held at: South Shore Harbor Resort and Conference Center 2500 South Shore Blvd., League City TX 77573.  Phone number is 281-334-1000. Registration Fee:  $85.00 made payable to Cantex Senior Communities.
ESTIM course – I have had several inquiries about additional E-Stim courses.  Our next course is December 5, 2009 in Florida.  We plan on going back to Austin after the first of the year. We have about 5 others scheduled in 2010 in Louisiana, Boston, Georgia, and Kansas City, etc.  I will try to keep everyone updated in the monthly newsletters.

New DiagnosTEX SLP Handout/Reference Sheet – Our new October handout is on Tube Feeding. This educational handout is for helping your families understand various types of tube feeding.  Ask for yours next time we are at your facility.  We also have more clipboards if you need one.

October Dates to remember
24th – Make a Difference Day – Helping Others  www.usaweekend.com/diffday
7th-13th -Residents Rights Week – honor residents living in LTC facilities. www.nursinghomeaction.com
12-18th – Case Management Week – www.acmsa.org
18-24th – National Healthcare Quality Week – www.nahg.org
National Brain Injury Awareness Month – www.biausa.org
National Hospice Month – www.nahc.org
National Home Health Care Month – www.hospice-america.org

It’s Flu season – DiagnosTEX keeps stock of Airborne in the office and on our vans!!  J We service many elderly and medically fragile individuals in a day and we are very conscientious and our utmost concern is that we not unnecessarily expose them to anythingWe would like to ask all of the facility SLPs, staff, or family members that are ill, coughing, and/or may have a cold, to take precaution and PLEASE reconsider coming onto the van, as our small contained environment is easily contaminated.  Thank you for your consideration of this, our patients and the health of our staff.

October Dysphagia Tidbit – Dysphagia and Candy
Dysphagia aortica may occur exclusively in the elderly when chewing sialogogues (agent that stimulates salivary flow) such as sugarless hard candy or chewing gum.  These items get stuck in the esophagus near the aortic arch, especially when the patients are in bed a lot and have poor positioning in a cardiac chair or wheelchair. Usually on a modified dysphagia diet NDD level 3, the following sweets/candies are allowed/not allowed:
Allowed – Soft chocolates; honey; jam; jelly; sugar; chocolate syrup; molasses
Not allowed – Hard candies, chewing gum, or candies with caramel; dried fruits; nuts; coconut; marshmallows; taffy-type candy

Dysphagia after Heimlich Maneuver* Stephen A. Olenchock, Jr., DO; Deborah M. Rowlands, DO;
James F. Reed, III, PhD; Fernando M. Garzia, MD; and Joseph M. Zasik, DO, FCCP
Case study of dysphagia following Heimlich maneuver after choking on a piece of candy. – 56-year-old man presented with complaints of dysphagia and shortness of breath for the past 2 days. He denied chest pain, cough, fever, chills, or chest trauma. Ten days prior to hospital admission, the patient was self-treated with the Heimlich maneuver after choking on a piece of candy. The patient had a 120 –pack-year history of smoking and a medical history significant for emphysema. He had been using his inhalers regularly. Foreign body aspiration results in an acute increase in airway resistance and intrathoracic pressure. A person who aspirates a foreign body reflexively performs the Müller maneuver in an effort to cough. The Müller maneuver generates negative intrathoracic and transpulmonary pressures with attempted inspiration against the obstruction. Following the attempt to inspire, the choking individual attempts to cough. The cough reflex begins with closure of the glottis and contraction of the abdominal and thoracic expiratory muscles. Intrathoracic pressures may exceed 200 mm Hg with each cough, increasing the force of expiratory flow. When observers of a choking victim initiate the Heimlich maneuver, external forces are applied by performing subdiaphragmatic thrusts. This lifesaving technique facilitates the expulsion of the foreign body by increasing intra-abdominal pressures, exaggerating the role of the diaphragm during expiration, and increasing intrathoracic pressure.  All of these factors played a role in the herniation of the bulla as seen on the CT scan. The patient was referred to thoracic surgery for thoracotomy and repair. Examination of the pleural space revealed an adhesion between the apex of the right lung and the mediastinal pleura, with a large bulla herniated into the mediastinum. The patient underwent a right upper lobe bulla resection. He had an uncomplicated postoperative course and was discharged to home on the fourth postoperative day. This case demonstrates a rare complication of bullous emphysema from increased intrathoracicpressure. Spontaneous pneumothorax is a much more common occurrence in this situation.