Wednesday, July 25, 2007

Those Amazing Thickened Liquids

Warning... vent ahead!!!

So last week I had one of those situations that just makes you want to bang your head against the wall. Over and over. Or maybe throw things, but that can get you in trouble. But I digress...

Patient had an old stroke, but no significant residual dysphagia. After my initial eval, the patient was placed on a regular diet with thin liquids. I followed up for a meal monitor, just to make sure everything was okay... no problems.

A few days later, I was asked to see the patient again. Worsening medical status? New difficulty with meals? Pneumonia? Nope, the doctor heard "wheezing" during morning rounds and thought the patient "might have aspirated saliva," and so placed the patient on thickened liquids and asked for a reassessment. The reassessment is no problem, but how on earth does one expect thickened liquids to prevent the aspiration OF SALIVA? Never mind the completely erroneous assumption that thickened liquids are somehow inherently "safer".

So the patient is exactly the same as before, which is to say, not a significant prandial (mealtime) aspiration risk, so I recommend resuming the regular diet.

The next day I check the chart and discover that (1) the doctor is ticked that I didn't do a VFSS (hello, if you want that done, you have to WRITE AN ORDER FOR IT, or at least mention it in the progress notes so I know that's the "reassessment" you want!), and (2) the doctor knows I recommended the regular diet, but writes to continue thickened liquids to "make sure the patient doesn't aspirate gastric secretions."

So, not only do those amazing thickened liquids prevent the aspiration of saliva, they also prevent aspiration of reflux! Just wait til the surgeons find out! Never mind pre-op NPO status, just put patients on thickened liquids! (I'm sure the thickener companies wouldn't object...)

Gah. Anyways, I did correct the misinformation (there is NO EVIDENCE that thickened liquids prevent aspiration of gastric secretions, or aspiration of anything, really) and the patient was placed back on a regular diet at last (after a completely normal VFSS, no less). So all's well that ends well, but that reasoning was certainly a new one for me!