Myths in Dysphagia

Maybe you’ve heard of the Dysphagia Therapy Group Professional Edition on Facebook.  Maybe you’re even a member.  It’s definitely worth a look!

One of the  conversations started by a very active member and a friend, became a very hot topic.  Myths heard regarding dysphagia is a hot topic in the SLP world.  Below is a sample of some of the myths that were posted.

If a pt is having trouble swallowing, and SLP cannot eval until the afternoon or next day, put them on puree with nectar thickened liquids bc that’s the safest diet for everyone.”

“Thicker liquids are always safer than thins, so when in doubt, go thicker.”

“If a pt isn’t able to swallow, they should be referred for mbs or fees.”

“Straws are always a no-no.”

“Monitoring temperature for a spike a half hour eating will tell if pt has aspirated.”

“Monitoring O2 during PO intake will tell if pt has aspirated.”

“I had an slp say once that a trach pt can’t aspirate. .”

“A runny nose (absent of other s/sx [signs/symptoms]) indicates aspiration.”

“An NPO (nothing by mouth) recommendation is always a good choice for a pt who aspirates on everything.”

“ALL dementia and Alzheimer’s patients qualify for ST…”

“Chest xrays only show how a person breathes and nothing to do with aspiration”

1) The cuff should be inflated at all times to prevent aspiration. 2) The patient must tolerate cuff deflation for an accurate swallow eval. 3) a Gtube should be recommended if no consistencies are safely tolerated. 4) you should sign off the case if nobody is following your recommendations, 5) a waiver is a good idea when a patient is “noncompliant” so you CYA, 5) other professions should “automatically” understand SLP jargon and interpretations in eval and therapy notes.”

“People who aspirate are all doomed to death by aspiration pneumonia.”

“Patients with dysphagia should never be in reclined during PO”

“Any patient who has “aspiration pneumonia” in their diagnosis must have dysphagia.”

“AND.. Everyone who aspirates will develop pneumonia”

“I accidentally forgot to thicken the patient’s liquids…they didn’t aspirate though…they didn’t cough or anything. Ugh.”

“Any pt who requires pills crushed in purée really needs a swallow eval, even if they have no problem at meals.”

“6) an MBS is a pass/fail exam. 7) an slp can not/should not discuss end of life/hospice options with families, 8) when a patient demonstrates understanding it means they will carryover the strategies into dynamic mealtime behaviors.”

“A patient with no teeth or poor dentition is not capable of managing solid consistencies.”

“All patients could benefit from a chin tuck.”

9) patient advocacy ends with leaving a message for the doc (who never reciprocates communications). 10) irritable doctors should be avoided and communications abbreviated.”

“There is no need to refer a post op cervical surgery patient showing signs of dysphagia as he is definitely going to improve eventually”

“Piecemeal deglutition is abnormal.”

“Feeding tubes prevent aspiration pneumonia.”

“Penetration of barium on MBS is reason to downgrade liquids.”

All patient’s with dysphagia require a spouted beaker”

“When I worked in a SNF (skilled nursing facility), my favorite myth from CNAs was (when a pt was coughing during meals) “raise your arms!” Or “eat some bread” Really??”

“Well it’s not RLL (right lower lobe) pneumonia, so we know they didn’t aspirate.”

“If pt aspirated on all liquid textures, go with the thickest”.

Carbonated liquids are nectar-thickened liquids …”

“A cough always indicates aspiration”

“Alternating bites of food with sips of liquids to clear the oral cavity.”

“Absence of a gag reflex means someone can’t swallow anything safely …”

“Edentulous patients should be put on a puréed diet.”

“Penetration means downgrade. Stop the MBS if you see aspiration. If you have an NPO pt you should never use PO (oral) trials in therapy. MBS at every 30 days.”

“Don’t do a Modified if the family doesn’t want a PEG (feeding tube).”

“the patient is belching frequently, so the SLP should train the patient to not ‘gulp air while swallowing”

“They would swallow if you gave them food they liked better.”

“Straws can not be used with thickened liquids.”

“Thickened liquids at meals only”….

“Aspiration = pneumonia.”

“Objective studies are to see if patient is aspirating” (vs looking for dysfunctions and WHY)”

1) If a pt is on purée, they need their meds crushed.
2) A trache will ‘tether’ the larynx.
3) If a pt aspirates on pudding, don’t try anything else because pudding is the easiest.”

“I had a ‘dietary staff member’ tell my patients wife that whole milk is nectar thick so don’t add thickener.”

“Resident is NPO but it is “OK” to give medication by mouth (with water or food)”

“Lack of gag reflex alone indicates swallow eval when pt is otherwise okay with po intake.”

“Frazier water protocol won’t cause pneumonia. You can just hook them up to vitalstim without doing exercises and it’ll fix the swallow.”

There is a lot of education to provide!  Thanks everyone for your input and thanks Vince for letting me steal part of your idea!

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