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Friday, June 3, 2011

Video Swallow Study

Actually, it's called a "videofluoroscopic dysphagia evaluation". Bob had his yesterday and, unfortunately, the results were not very good. This time, I got to watch the procedure, which was quiet interesting. Bob has had several of these studies, but I was never invited to watch before this one.

First, before they started the test, they had to send for two orderlies to physically pick Bob up from his wheelchair and set him into another chair. The chair they use is called a "Hausted Vic Chair" and is quite narrow, so narrow that Bob looked rather squashed in it. I wondered how they ever get anyone who is large into such a chair. They strapped him into the chair and positioned him between what looked like a blank wall and the x-ray device, which was lowered on the other side and so close that Bob had to pull his shoulders inward to let the device be put into position. It did not look very comfortable. I stood behind a glass partition with the doctor and a television monitor on which we watched the video. The doctor was dead silent through the whole procedure, so I was left to make my own interpretation of what I was seeing on the monitor. I tell you, it's a rather bizarre feeling to be looking inside your husband's skull and neck while he sits across the room!

The therapist began the evaluation with chocolate pudding mixed with barium. You could see the pudding on the monitor going through Bob's mouth, out the back and down his throat. It looked good to me, because the pudding went down his throat, although rather in splats of three separate swallows. You could see all his muscles moving. She did the pudding twice with the same results, about three separate swallows but it all went down. Next, she tried some thickened liquid (Bob later told me that this liquid "sucked", meaning it didn't taste very good.) The liquid went through his mouth, out the back and then, just sort of sat there. Stuck. Right at the top of his throat, toward the front, an area I was later told is his epiglottis. I could hear the therapist coaxing him at that point to "swallow", "swallow hard" and "clear your throat" and finally the liquid slipped down his throat, but a small amount dribbled into his airway. Not good. The therapist called the evaluation to an end at this point, because, she told me later, that she was not inclined to let her patients aspirate. The doctor then left but not before turning to me and saying in a very self-righteous tone, "so, he was smoker, huh?" At which point, I wanted to slap him.

Afterward, the therapist reviewed the video with me and pointed out a few things, like the "epiglottis" which she said was weak and barely moving. I pointed out that the epiglottis was pretty much situated in the same area where the electrodes are placed for e-stim therapy and asked her if continued e-stim wouldn't help him. And we had a long discussion which consisted of basically me trying to convince her to continue with the swallow therapy and her making excuses. At one point, she confessed she felt "caught in the middle" and that she really did want to continue therapy but felt pressured by the case manager to discharge Bob. At the end of the conversation, we agreed to a plan, which is that she is going to do some research on the epiglottis and e-stim, to see if there is any studies etc. out there indicating that e-stim can help this particular problem (so that she can present this info to the case manager in order to argue for continued therapy) and I am to retrieve the video footage from his last swallow study in February (done at a different hospital) so that she can compare the footage to this new study to see just how much progress has been made.

I wish I had better news, but at least there is some hope for continued therapy. Right now, Bob is scheduled for one more week of swallow/speech therapy and that's it. I already called the hospital where Bob had his eval done in February and can pick up a copy of it on Monday.

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