For National Nutrition Month (March), we are all reminded to evaluate our diets and consider ways to improve our nutrition and habits, like cutting sodium or minding portion sizes.
However, some people require more complex solutions. For example, patients with swallowing and cognitive difficulties or comorbidities need special interventions to ensure adequate nutritional intake.
RehabCare Speech Pathologist Michelle Tristani shares common challenges and strategies for meeting nutritional needs for patients with dysphagia, a swallowing disorder, and other conditions that may present feeding issues.
For patients with dysphagia, which can be caused by stroke and is seen more frequently in the elderly, alternate methods of food delivery must be considered to provide nutrition and prevent patients from accidental aspiration. "There are many nutritionally dense dietary supplements available to us," says Michelle. One of the most helpful tools is a supplement called Magic Cup." Magic Cups are nutritionally dense and have a pleasing taste. Magic Cups are an excellent choice for patients who require thicker textures to protect their airways.
To prepare supplements and meals, SLPs coordinate with dining staff and work together through role delineation to suggest effective feeding techniques for specific patients. "Daily communication with dining services prior to and after mealtime is paramount," says Tristani. "Therapists, nursing staff and nutrition services staff build a rapport and get on the same page regarding the patients' modified diets."
The good news is that options for swallowing interventions and compensatory strategies are also many and growing. "From oral motor, pharyngeal and laryngeal exercises to chin tuck postures, the main goal is to select the appropriate individualized set of strategies that will benefit our patients." Some patients benefit from technology that provides biofeedback and gives the therapist a deeper view into body functions and each patient's muscles when they swallow.
There is not a one-size-fits-all swallowing intervention. Clinicians educate patients and their families on the methods, risks and benefits so that they may make informed decisions. "We support our patients' right to choose," adds Michelle.
Patients with cognitive conditions may require therapists to take more control. Alzheimer's patients sometimes wander and ambulate during most of the day. Instead of requiring these patients to sit for a period of time and eat a meal, therapists will trial finger foods to be consumed along a patient's walking route.
"In every case, being flexible, working as a team and being attuned to the patient's needs contributes to positive outcomes for our patients with nutritional challenges," says Michelle. "We keep the patients' best interests at the forefront."
Back in April 2011, I started hainvg lower backache and nausea on a daily basis. At this time I did not have a doctor due to my ObGyn retiring in December 2010. I had been going to this doctor for over nineteen (19) plus years and was forced to find a new doctor. Needless to say after going to multiple doctors for almost three months with no diagnosis, I was completely and utterly frustrated. While I was convinced it was a female related issue, I was referred to Dr. Zavaleta by a co-worker.In June 2011, I made my first appointment with Dr. Zavaleta. I immediately felt the genuine concern, relief, and knew that this was the doctor I had been hoping to find. Within days, Dr. Z, diagnosed me as hainvg a rectocele and enterocele which resulted in me needing a posterior repair. Dr. Z took the time to explain in complete detail what this meant and what the procedure would entail. He stated that my backache should subside immediately following surgery. We immediately scheduled my pre-op procedures and operation. Dr. Z explained that it was a simple procedure that I could have on a Friday and return to work on Monday.Right after surgery my backache was better until six days later. I was in extreme pain and was forced to call Dr. Z on his cell at 8:30 or so at night in which he immediately returned my call. The backache continued for several more weeks which was very discouraging to me to the point I was wishing I would had never had the surgery. I absolutely felt worse than I did before the surgery. At this time, I was calling, texting, and going to see Dr. Z every time I turned around. I ultimately ended up going in every morning at 7:00 a.m. for therapy work in which Dr. Z did not charge me for these services due to my financial situation. Actually he probably felt sorry for me when I think about it. Not only did Dr. Z go out of his way by doing this, his staff worked me into her (Holly) schedule by being at the office every morning at 7:00 a.m. to help me work through the pain.I cannot tell you how many times that Dr. Z, and Annie (Dr. Z’s PA) received text messages, calls and emails due to my complications and ALWAYS took the time out of their work day, night time, and offered on weekend to meet me at the office to examine or assist me. Honestly, I felt at one point they were going to tell me that they couldn’t see or treat me anymore due to the outrageous times I text or called for help or just counseling on my pain.As of today, with much guidance and patience by Dr. Z and his staff, I feel like a new woman! My back pain is gone, my stomach swelling is gone. While I didn’t have any symptoms of constipation, I am hainvg more bowel movements which I believe has caused me to lose weight, and sexual intercourse is unbelievably awesome for me and my partner! Dr. Z kept telling me I would feel like a new woman when all was said and done, but I didn’t believe him after all the complications, the incompetence of other doctors not diagnosing me and feeling so bad for five months before surgery. But he kept on until he saw to it that I was taken care of.At the end of the day, I could not have made it through this illness without his and his staff’s continuous care, calls and counseling. Dr. Z not only called me personally to check on me multiple times, but he gave me his cell phone number which made a world of difference throughout this process. I was so convinced that I would never find another doctor like the one I had for nineteen years, but he well exceeded those expectations.Today, he is stuck with me for life and I want to thank him and his staff from the bottom of my heart for doing their job above and beyond my expectations.Sincerely,Gayla L. Snow
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