At my extern this semester at Fort Hamilton Hospital I have had the
opportunity to observe and participate in many video fluoroscopic
evaluations and dysphagia therapy. I have also had the opportunity to be
part of successful dysphagia therapy which allowed an 81 year old man to
eat and drink normal foods again. I truly think this was one of the most
exciting and rewarding experiences!  To follow is the observation report of
the evaluation and dysphagia therapy.
 
Evaluation Observation Report
 
An 81 year old man was admitted to the hospital in November 1997 due to
heart disease and dehydration.  At this time he underwent open heart
surgery.  Excessive coughing and choking were noted by the nurses and
doctor after eating, therefore his doctor referred a video fluoroscopic
study to rule out aspiration. The video study was performed yielding the
following results:  severe pooling in valleculae and pyriform sinuses and
aspiration during the swallow with all textures (thin, thick, puree and
mechanical soft).  Aspiration was still present after utilizing strategies
such as a chin tuck and head tilt.  Recommendations were made for patient
including alternative feeding and participation in dysphagia therapy.  His
doctor then placed a G-tube in patient.  Dysphagia therapy was not pursued
by the patient at this time.  One month later, the doctor ordered a repeat
study which revealed the exact same results.  It was at this time that the
patient opted to participate in dysphagia therapy.
 
Therapy Evaluation Report
 
The patient attended dysphagia therapy for a total of 10 treatment
sessions.  Therapy consisted of the Mendelsohn maneuver, effortful swallow
and chin tucks. These exercises were instructed and practiced during each
therapy session using a biofeedback unit.  The biofeedback unit uses
electrodes attached to the larynx to display level of laryngeal movement to
both patient and therapist.  After 10 treatment sessions and home
programming (his family was very involved) the doctor ordered yet another
video in hopes of better results due to therapy treatments.  During the
course of therapy I got to know this man very well (he is the grandfather
of a girl I went to high school with).  Every time he came to therapy he
told me about the hamburgers he could smell cooking on the grill outside
and the exact number of days it had been since he had enjoyed a cup of
coffee.  It came to a point where I felt like he was becoming very
depressed and I was concerned about his mental health.  However, he was a
hard worker which paid off!  A repeat study was performed which yielded the
following results: no pharyngeal residue, no aspiration with any texture
(utilizing hard swallow) and trace penetration with thin liquids by cup (1
out 4 times).  Recommendations were made to follow a regular diet following
aspiration guide lines and continue with home programming.  He was given a
dysphagia packet and high risk foods to avoid.  My supervisor just recently
contacted him and he had an appointment with his doctor to discuss removal
of the food tube.