Evaluation
A 73 y.o. male presents to ST evaluation on 2/17/2024 with report of impaired swallow function d/t SSC T3 N1 cM0 of R BOT diagnosed on 10/30/2023 s/p 6 rounds of cisplatin and 35 rounds of radiation.
What is HISTORY OF PRESENT ILLNESS
This was recommended to be completed by patient multiple times throughout the day, before and after meals, literally all the time :)
What is ORAL CARE?
This treatment was considered however was not chosen as patient had not undergone repeat PET scan to ensure all evidence of cancer was no longer evident.
What is NEUROMUSCULAR ELECTRICAL STIMULATION
Posture changes, throat clears, coughing, watery eyes, change in vocal quality are all...
What are OVERT CLINICAL S/SX OF ASPIRATION/PENETRATION
October 2023: The patient tolerating IDDSI 7/0 until he began to notice significant weight loss and difficulty swallowing; this prompted an evaluation with ENT.
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January 2024: The patient presents with moderate-severe pharyngeal dysphagia c/b delayed swallow initiation, reduced BOT retraction, absent epiglottic inversion, reduced pharyngeal restriction, moderate residue across pharyngeal wall and pyriform sinuses resulting in deep penetration with likely aspiration. He is tolerating 3 tube feeds per day and ice chips/small sips of water for comfort.
What are PLOF and CLOF?
The patient was recommended to complete 3 sets of x10 per day of this pharyngeal strengthening exercise in order to keep the pharyngeal muscles active and halt potential atrophy.
What is EFFORTFUL SWALLOW
An evidenced-based, systematic exercise therapy program was recommended to patient and spouse at initial evaluation following completion of assessment measures. This protocol uses exercise-physiology and motor learning principles to safely and effectively advance oral intake of foods and liquids via pre-established hierarchy.
What is MCNEILL DYSPHAGIA THERAPY PROGRAM
The patient was 3 months into skilled ST treatment. The patient was awaiting f/u appointments with his oncologist and ENT. He was tolerating IDDSI 7/0 with use of safe swallow strategies and was weaning off tube feeds. This prompted a ~1 month break from ST services with plans for f/u following repeat scans and visits with physicians. During this time, patient was not as compliant with strategies. Instead of single sips of liquids he began to...
What is CHUG/DRINK TOO FAST/DISREGARD SAFE SWALLOW STRATEGIES
The patient scored a 140/200 on this objective measure that utilizes 24 items to assess the severity of dysphagia and the risk of aspiration.
What is MASA-C?
Pt scored within the "moderate dysphagia and moderate aspiration" range
The patient was recommended water/ice chips only after excellent oral care has been completed. What is this protocol called?
What is FREE WATER PROTOCOL?
Across puree trials, pt would intermittently report globus sensation. This prompted what recommendation?
What is DOUBLE SWALLOW, COUGH/RE-SWALLOW, OR THROAT CLEAR/RE-SWALLOW.
PET scan revealed no remaining cancer (YAY!). However, it did reveal "FDG consolidation" in the right lower lobe and right middle lobe of the lung. What could this indicate?
What is POTENTIAL ASPIRATION PNEUMONIA
Name that FOIS level:
3 Kate Farms tube feedings per day with variable intake of ice chips and sips of water.
What is FOIS level 2
FREEBIE! What is Kristen's favorite Taylor Swift album?
What is SPEAK NOW
10-day re-assessment; Name that FOIS level:
Tube feedings as primary form of nutrition and inconsistent pureed snacks
FOIS 2
PT also rated himself 26/40 on the EAT-10
A common complication of HNC is weight loss. The patient arrived to ST evaluation with report of initial weight loss of 70 lbs, which brought him down to 145. He has since gained 15 lbs back. What was his original weight?
215 lbs
This is a subjective measure that allows the speech language pathologist to determine patient's current eating habits. The higher the score, the more probable swallowing efficiency and safety is affected. Pt rated himself 32/40.
What is the EAT -10?
This is a lovely outlet for patients and their families to speak with other individuals that are going through a similar journey. This was presented to my patient and his spouse at initial evaluation.
What is HNC SUPPORT GROUP (Thanks Shay, Chris, and Tam!)
20-day re-assessment; Name that FOIS level:
Continued tube use. Consistent PO snacks/small meals.
FOIS 3
PT also rated himself 19/40 on the EAT-10
The patient participated in 35 rounds of radiation which led to him losing his taste buds d/t damage of what?
What are SALIVARY GLANDS?