Yesterday, I took Bob in for another video swallow test. This is the third such test he has had since he's been out of the hospital. The last one was done in June. The first was in February.
The test in June showed no change from the one in February. Even though, at the time, I thought it sounded like some improvement had been made in the June report, when I took both the February and June test results to Bob's Ear, Nose, Throat doc (a.k.a. Dr. Doom) he confirmed that the results were the same and the only difference was in the interpretation by the Speech Pathologist. This time, I requested that the same Speech Pathologist who did the test in February do this test, so we wouldn't have the "interpretation" problem again.
Back in June, the Speech Pathologist stopped the test when Bob aspirated all of the "honey thickened" liquid. Pretty much, the pathologist freaked out at that point. She called this "silent and deadly aspiration" as Bob seemed to have no feeling or sensation that the liquid was going down the wrong way. He didn't choke or cough like a 'normal' person would and this was dangerous. At that time, she told me Bob's prognosis was poor for ever recovering his swallow reflex again and that he should be NPO (nothing by mouth) not even for swallow practice. She also discharged him from therapy, telling me that it was pretty much a waste of time. When I consulted with Dr. Doom, he agreed that Bob's prognosis was poor, i.e. "He should have gotten better by now." But Dr. Doom encouraged us "off the record" to keep trying and just "be careful," though medically, he said, he could not advise it. So we have--with our DIY swallow therapy including a daily indulgence in some "illegal" pudding. We've been doing this at-home, unsupervised therapy since June.
So, to say I was a bit nervous yesterday is a bit of an understatement. My fear was that the results of this test would be once again the same as the last two. I had asked the radiologist if I could watch the test, but she wouldn't let me, so I had to sit out in the hallway and worry while the test was being done. But imagine my relief and amazement when the Speech Pathologist opened the door and greeted me with a big smile.
Because there has, after all this time, finally been an improvement. Bob was able to swallow all of the "nectar consistency thickened" liquid without any aspiration (this is thinner than 'honey thickened') and he was able to swallow all of the pudding in one big "bolus" swallow! His swallow reflexes are faster than before and his cough is stronger. And though he still aspirates all of the "thin liquid" and some of the applesauce, Bob has been approved to now "eat for pleasure" twice daily!
Of course, only small amounts of "pudding consistency" foods and "thickened liquids", but hey---not damn bad for a guy with a "poor prognosis"!
Bob was actually quite sad after the test, feeling he had failed it once again. I'm sure he'd love to lose the peg tube and that's not happening any time soon. I had to spend some time encouraging him and explaining that really this was a good test and it meant we mustn't give up and we must keep up the tongue/mouth exercises and the swallow practice, because all our hard work is now starting to pay off.