The Swallow Your Pride Podcast
The Swallow Your Pride Podcast was created with the purpose of diving deeper into the issues that speech-language pathologists face when working with patients with swallowing disorders. We’ll discuss many controversial topics in order to provide the LATEST evidence-based treatment strategies, and create a community of dysphagia clinicians who want to consume incredibly valuable insight and information. Our goal is to allow you to #swallowyourpride, and be open and willing to try the latest in evidence based treatment approaches by learning from experts and researchers in our field in order to create the best outcomes for our patients who need it most!
Have you been hearing scary campfire stories about PDPM? You are not alone! Friend of the podcast Edgar Vincent Clark is back to share some calming & inspiring words about this much-feared transition. As he tells us, “adversity breeds opportunity.” This is going to be a whole new world, but dysphagia will still exist there too.
Feel like you get pushed around in your facility because nobody knows what you do, why you want what you say you need, or why you can’t just do things like the last SLP? It’s tough out there for a young SLP. Respect can be a difficult thing to earn, but Erika McLean shares insights on how you can make it a realistic goal for you. Erika herself moved into a leadership role in her inpatient rehab facility DURING HER CFY! Miracles do happen!
If you’re working with patients with Parkinson’s disease, or anyone else with cough dysfunction, (and really, who doesn’t?) Dr. Karen Wheeler Hegland’s got info for you. Cough assessment isn’t scary or only for specialized research clinics. Dr. Hegland is here with research and normative values to help you make educated decisions about dysphagia management in patients with cough dysfunction.
The day has come for us to discuss the famous and beloved MDTP! Dr. Crary walks us through its research history, what MDTP can really do, and common misconceptions. He also shares some exciting new upcoming changes planned for this year (including hope for expanded course offerings)!
089 – Lori Burkhead Morgan, Ph.D., CCC-SLP – Feeling the Sparks: sEMG Biofeedback and How to Ask for It
Dr. Lori Burkhead Morgan is here to talk about her famous articles on exercise science as it applies to dysphagia (specificity is the name of the game, and it turns out strength may not be the belle of the ball). Dr. Morgan also spells out the what, how, and why of sEMG biofeedback. Worried you could never get such fancy equipment where you work? She’s got you covered with motivation and references.
Remember WAAYYYY back in episode 16 when Dr. Jamie Fisher talked all about how to transition to becoming a medical SLP the right (ethical) way? Kellie Green does! And she’s here to talk about what it looks like when you follow the yellow brick road (hint: it’s great!). Kellie shares about what to look for in a workplace and what work you’ll need to put in on your own time to make the dream a reality.
That fact that tube feeding is contraindicated in advanced dementia can sometimes feel like the biggest open secret in the medical world. Now that Emily Tricarico has introduced the SEGUE model of how to dialogue with our medical colleagues, we have to be sure to say something worthwhile. Educating physicians about the risks associated with tube feeding and dispelling the (numerous) misconceptions is an admirable goal, and Emily is here to arm us with the facts and position papers to do it!
084 – Craig Coleman, CCC-SLP – SLP Advocacy and ASHA Elections
082 – Jennifer Kizner M.Ed CCC/SLP, BCS-S – Let’s FEES It Up! How to Start an Endoscopy Program – Part 2
We continue our talk this week on the intricacies of FEES competence with Jennifer Kizner.
Jennifer also shares how to toe the line of describing without diagnosing when things look funky in the pharynx. Can you define exophytic? Pedunculated? Time to learn!
What’s that? We haven’t talked enough about FEES for you? Fear not. Here to grant all your wishes, Jennifer Kizner delves deep into what it takes to start scoping. In this two part episode, Jennifer talks about not only what’s needed for individual competency, but also how to get your facility’s FEES program up and running. Nothing we love better than a scope in a nose (aka instrumentation aka EBP)!
How many times per day do most dysphagia therapists hear, “I don’t have a swallowing problem, there’s just some phlegm in my throat” or, “Food just gets stuck in my throat”? These complaints might usually lead us to think about GERD, but what if there is more going on?
We have all heard of muscle tension dysphonia, and today Christina Kang leads us into the world of muscle tension dysphagia. Christina shares how we can impact quality of life in a population where swallow function might appear totally normal until you take a closer look.
Taylor Evans is back for part two of our discussion on inpatient rehab. We dig in further to what life looks like on the patient side of a rehab stay.
078 – Jessica Lasky, MS, CCC-SLP – Ethically Speaking: The Entanglement of Billing and Treatment Efficacy
We all know we have to do right by our patients, but we don’t usually think about how billing comes into it. We are clinical staff, not accountants, and there isn’t usually a business incentive for our employers to keep us informed on these points. BUT…can you really say that each minute you spent with (and billed the patient for) was worth their money? Or is it possible that this chunk of change could have been better used in another way? Jessica Lasky is back to talk about how to get ethical, and some great resources to support your best ethical practice.
077 – Jessica Lasky MS, CCC-SLP – You Had Me at Hello, or Why to Reach Out to Other SLPs to Advance Your Career
All you have to do is ask! You know how they ask you why you want to be an SLP on your grad school applications and we all write about how we just want to help people? But you really mean it? SLPs are nice, helpful people. You probably have more resources at your fingertips than you realize. And beyond that, you might be able to shift your focus to the areas that you really need work on when you have someone to tell you what the road ahead looks like. So get out there and mingle!
076 – Laurie Wennerholm MA, CCC-SLP, BCS-S – Dysphagia without Aspiration: A Closer Look at Total Laryngectomy
When pressure gets so built up in the pharynx that patient’s TEPs have leaks after 1 week, we have to get creative. There is limited research on this population, but what we are starting to hear is very interesting! Laurie Wennerholm shares the latest research and current best practices for assessment and treatment of dysphagia in a population we never used to treat for dysphagia.
075 – Kelsey Day M.S., CCC-SLP – Volunteer Yourself! (The Secret to Starting Treatment of ICU Vent Patients)
Kelsey Day picks up where we left off last time. Now you have your assessment done, where do we go in treatment with trach patients in the ICU? Biofeedback, pitch glides, ice chips, and expiratory training may all be a part of the answer.
When is it too soon to see trach patients? In the OR. After that, they’re fair game. Kelsey Day explains how the PT ICU model of early mobility is a path we can follow as SLPs to get in early to work with vent-dependent patients to stop (and hopefully reverse) disuse atrophy.
073 – John Holahan, MBA Founder of SimplyThick – Through Thick and Thin: Xantham Gum and IDDS Implementation
If you’re into grainy sludge, feel free to skip this episode. For the rest of us, John Holahan, founder of Simply Thick, is here to talk about xanthan gum, rheology, and IDDSI.
072 – Meredith Oakey Ashford, MA, CCC-SLP – Palliative Care: Discussions in Dysphagia at a Crossroads
For patients with mod-severe to severe dysphagia who are unable to eat, tube feeding might not be the answer…but where does that leave you? Palliative care discussions are a delicate balance of learning about the patient’s goals, beliefs, and plans, while staying within our scope of practice. These can be challenging conversations, but Meredith Oakey Ashford has come to share suggestions for conversation starters, mindset, and to explain the SPIKES framework for delivering bad news. Listen to our discussion and learn how to get comfortable with uncomfortable conversations.
This was a really random, solo, vulnerable episode that I decided to record at noon today. Not your average interview nor what I had planned, but something that’s been bugging me. I’ve had so many conversations lately with MedSLPs that are just so burnt out and wanting to leave the field, and it really is easy to blame the system, but what if we viewed things from a different lens?
How do you solve a problem like edema? Even in ideal ACDF recovery, patients will have edema. Watching, waiting, and working on adjunctive dysphagia therapies are all a part of the answer. Despite often being an elective surgery, ACDF can result in terrible complications (including dysphagia and respiratory failure). Michelle Deghan discusses how to approach complex cases post-ACDF—from evaluation and treatment techniques to the current research.
069 – Sonja Molfenter, Ph.D., CCC-SLP – On Pharyngometry and Presbyphagia, Big Pharynx, Weak Pharynx
Dr. Sonja Molfenter took an ASHA convention break to discuss her new study titled Volumetric Changes to the Pharynx in Healthy Aging: Consequence for Pharyngeal Swallow Mechanics and Function. She used MBS in combination with a pharyngometry (special throat sonar) to learn about what’s normal when it comes to pharynx size and swallow function.
068 – Martin B. Brodsky, Ph.D., ScM, CCC-SLP and Paula Leslie, Ph.D., CCC-SLP, FRCSLT – Part 2 of At the Table: Blogging away the Researcher-Clinician Divide
Dr. Paula Leslie and Dr. Marty Brodsky are back for part 2 of our jam session “At the Table…” In this episode we tackle if *MORE* content really is the magic sauce to get all dysphagia clinicians up to speed or if we need to back the bus up and focus on critical thinking first.
067 – Martin B. Brodsky, Ph.D., ScM, CCC-SLP and Paula Leslie, Ph.D., CCC-SLP, FRCSLT – At the Table: Blogging away the Researcher-Clinician Divide
Dr. Paula Leslie and Dr. Marty Brodsky are back to discuss what we can do to bridge the researcher-clinician divide. For starters, let’s not dig it deeper. Blogs, social media, and podcasts are here to speak your language and point you lovingly in the right direction, just like Wikipedia. Yes, you need to be savvy about what sources and information you trust, but in the end we all want to help our patients, and it’s much easier when you don’t need a decoder ring.
Have you philosophized and fantasized about getting your Ph.D.? But *maybe* the idea of retaking the GRE makes you want to run and hide? This episode, Megan Nosol discusses the barriers to getting started on a PhD, how to work around them. You’ll need to having clear priorities, and a little savvy before you dive into the deep end of research. Megan shares tips and hard-won tricks so you won’t have to go the long way round to applying. Time to stop feeling like a philistine and get that PhD!
065 – Tiffani Wallace, M.A., CCC-SLP, BCS-S – Swallowing in their Natural Habitat: Home Health Dysphagia Therapy
Your patient may swear by the old gods and the new that they are thickening their liquids and doing their exercises, but are they really? Tiffani Wallace has found your beloved home programs covered in dust under the couch and is here to tell us where to go next. Home health is about meeting patients where they’re at (literally) and seeing what really happens when people leave the clinic and head into the wild.
064 – Dr. Michelle Troche – Down with Dystussia! How Treatment of Cough Dysfunction Can Improve Dysphagia
Do you have your doubts that coughing into that funny blue plastic tube could really fix a swallow? Well Dr. Troche is back to lay out the (rock solid) research on respiratory muscle strength training and put those doubts to bed. Spoiler alert: It’s crazy how many different kinds of patients can benefit. Dr. Troche also talks about the future of cough research ongoing in her own lab. She is using biofeedback to work on improving accuracy of urge to cough (remember how we said this was important last episode?), and even talks about how you might start to move in that direction out in your clinic. Last, we zoom out for a look at the big picture of cough, dysphagia, and the SLP’s role to let you know you can hack it.
Now before you tell me you already know that cough is associated dysphagia, listen Linda, listen. This is no mere time to sit back and wait for your patient to cough. We are here for quantifiable information with high sensitivity and specificity! We’re talking peak flow, Borg scales, and more. Dr. Michelle Troche is here to remind us why we all fell in love with our frenemy cough in the first place, and to tell us how we can amp up our clinical practice if we pay attention to cough the right way.
“I’ve been swallowing for 87 years, I think I’d know if I had a problem.” Well Gerald, you may have a point. An old swallow is not always a bad swallow, and Yvette McCoy is here to tell us more. If we know what is expected as a part of the normal elderly swallow, then it will help us see clearly when our patients have crossed over into the land of dysphagia. Yvette delves into functional reserve and sarcopenia, as well as specific characteristics of presbyphagia, so we don’t thicken poor Gerald into oblivion.
If you know there are patients at out there in your hospital who need you, but aren’t on your caseload, here’s what to do. Zach Smith describes actions you can take to get doctors and nurses to sit up, take notice of your speech department, and get those referrals flowing in.
060 – Rick McAdoo M.S., CCC-SLP – Pain Isn’t Gain (But Movement Is): Research and Rationale Behind the Effective Swallowing Protocol
E-Stim, NMES, ESP, oh my! Rick McAdoo of Ampcare guides us out of the electric alphabet soup, and towards clarity for this complex modality. Through trial, error, experimentation on Rick, and tons of research, Ampcare developed their ESP. Wondering if you have to crank up the electricity if you hope to make any change to your patient’s swallow? Rick explains how parameters are the most important thing about your NMES program. Targeting muscles in a sensitive part of the body buried layers under the skin is no smooth sailing, but Rick is here to guide us through the muddy waters of NMES, and to prove that pain isn’t the best thing for your patient, but movement is.
059 – Jessica Conn MS CCC-SLP – The Real World: Rural SLP Edition, or How to Survive as the Only SLP in Town
This episode, we look at challenges faced by rural SLPs. Maybe you’ve been thinking to yourself that all this talk of imaging is fine and dandy at a fancy urban university hospital, but that’s just not how it goes in your neck of the woods. Jess Conn is here to tell us about what being an SLP in a rural area is really like. Can it be hard to get the mobile MBS van to make the 4 hour trip out to your facility? ABSOLUTELY! Is that a reason to stop trying? Of course not!
058 – Martin B. Brodsky, Ph.D., ScM, CCC-SLP – A Systematic Review on Laryngeal Injury – Does it Have Any Impact on Voice and Swallowing Disorders?
How many times do you get patients with a voice or swallowing disorder and no obvious neuro diagnosis? What the heck might have possibly happened to them? Did you know that according to this paper, 49% of patients with laryngeal injury post extubation present with dysphagia? Are you aware of the significant association between laryngeal injury and penetration/aspiration scores? What about the costs associated with readmission due to a repair of tracheal injury? Apparently, Dr. Brodsky was on to something when he decided to write this systematic review… and he’s here to spill the beans on what this paper CAN and can NOT tell us!
057 – Ed Bice M.Ed., CCC-SLP – What Does Neuroplasticity Have to do with Swallowing Therapy? Spoiler Alert: EVERYTHING!
Do you cringe when people start talking all about neuro in our field like that wasnt quite what you signed up for? Or maybe it super interests you, but still seems way over your head? Do you know that EVERYTHING we do in swallowing therapy revolves around neuroplasticity principles? Yup, we’re like little exercise scientists for the swallow (Don’t stone me if you disagree, just play along with my analogy.) Ed Bice is back to talk about the importance of keeping the neuroplasticity principles front and center when developing and carry out our treatment plans.
056 – Jenny Reynolds M.S. CCC-SLP, CLC, CNT – Fiberoptic Endoscopic Evaluation of Swallowing: Clinical Applications in the NICU setting
SLPs have an ever growing presence in the NICU and for the longest time we were limited with using videofluoroscopy for these little babies. Now with the advancement of FEES and awesome SLPs leading the charge to improve access to instrumentation in their facilities, we have another option to provide these babies and their families. In this episode, Jenny Reynolds dives in to ALL the issues and roadblocks they had to overcome to get FEES going in their NICU. It took a lot of teamwork and patience, but sets an incredible model of perseverance for others in our field.
055 – Pam Smith Ph.D., CCC-SLP- Don’t let yourself become old school… what CAN we do without an instrumental and how do we document patient choice?
What do you do if you just can’t get an instrumental assessment on your patient? Is there anything that you CAN do? Dr. Pam Smith is back for part 2 to explain what may or may not not be done to help your patient, and how to have those risk/benefit conversations with your patient and the family. In this episode, Dr. Smith also discusses how not to become old school, and how its ok to learn from our past mistakes to continue to evolve into the best clinician we can be.
054 – Pam Smith Ph.D., CCC-SLP How Do We Meet Our Administrators, Colleagues, Supervisors, and Patients Half Way?
*WE* all understand the importance of instrumental assessments, but some of our colleagues, supervisors, administrators, and even patients don’t! So how can we change that? How can we change the narrative to a language that they understand, so that everyone can get on the same page and allow the patient to make the most informed decision. Dr. Pam Smith is here to give us some tips to meet them halfway.
053 – Joan Kelly Arsenault, MA, CCC-SLP, BCS-S – Costs Associated With NOT Getting Swallow Studies: Re-admissions, Aspiration Pneumonia, Mis-diagnoses, and Thickener
Are you still hesitant to order instrumental assessments? Do you watch your patient aspirate 1 sip of honey thick and shut down the study? Do you know all of the REAL reasons that we have to be sure we are ordering instrumentals assessments for our patients even the insanely expensive ones? News flash: The benefits still outweigh the cost! In this episode, Joan Kelly Arsenault dives in to everything the SLP should be aware of when we deny or don’t give our patients a full and complete study.
052 – Pam Holland M.A., CCC-SLP – Swallowing and Supervision: Students and Supervisors learning together!
Have you ever thought about taking a grad student but you weren’t sure how? Have you ever complained about the poor preparation that some grad students receive? How about being part of the solution instead of perpetuating the problem! Pam Holland from Marshall University is here to explain all of the ins and outs about supervising grad students and how it can be mutually beneficial for all involved! Pam also included some very thorough show notes for this episode to help you weed through the alphabet soup of supervision acronyms.
051 – Susan Butler, PhD, CCC-SLP, BCS-S – Why Healthy, Normal Adults Aspirate and Why Your Patient Might Aspirate More Frequently on Milk and Not Water
Did you know that some healthy normal adults… aspirate?!? As many as 30%?!? Yup they do! Dr. Susan Butler is here to explain the research, why it might happen, and why some of our patients do not experience any respiratory concerns and others develop pneumonia. Dr. Butler also discussed why patients may aspirate more on milk than water, how some healthy older adults who aspirate have lower pharyngeal pressures and lower tongue pressures, and why we need to let our patients chug!
Thank you thank you for supporting this podcast to 50 episodes! Many of you have been requesting more episodes about me, so I somehow let my friends twist my arm and ask ME anything! No you will not learn a darn thing about dysphagia in this episode, but you might learn about my love of wine and other random facts. Thank you from the bottom of my heart for supporting the Swallow Your Pride podcast!
049 – James Coyle PhD, CCC-SLP, BCS-S, ASHA Fellow – Aspiration Pneumonia Does Not Always Mean Dysphagia, Poor Clinical Indicators, and the Use of High Flow Nasal Cannulas
If you’ve ever worked with a patient with aspiration pneumonia then you should probably listen to this episode. Did you know that aspiration pneumonia does NOT always mean a diagnosis of dysphagia? Do you have any clue what you should know about a chest xray? Do you still believe that all aspiration pneumonia occurs in the right lower lobe? What about feeding your patients on a high flow nasal canula? In this episode, Dr. Jim Coyle discusses ALL of this!
048 – Pam Holland, MA CCC-SLP – Part 2 – Interprofessional Education and Practice in Dysphagia: The Graduate Student’s Perspective
How much do you collaborate with colleagues in other professions? Do you work side by side or not at all?!? Pam Holland from Marshall University and her group of graduate students are here to tell us all about their advocacy projects that they did this past semester. This episode includes interviews that these students did with other professionals about OUR field and everything they want to know about US! Don’t miss it! This is part 2 of a two part episode.
047 – Pam Holland, MA CCC-SLP – Interprofessional Education and Practice in Dysphagia: The Graduate Student’s Perspective
How much do you collaborate with colleagues in other professions? Do you work side by side or not at all?!? Pam Holland from Marshall University and her group of graduate students are here to tell us all about their advocacy projects that they did this past semester. This episode includes interviews that these students did with other professionals about OUR field and everything they want to know about US! Don’t miss it!
046 – Martin B. Brodsky, Ph.D., ScM, CCC-SLP and Paula Leslie, Ph.D., CCC-SLP, FRCSLT … At The Table Of Instrumentals, Recommendations, and other Ethical Dilemmas
Welcome to the latest segment of the Swallow Your Pride podcast. I am delighted to have Dr. Paula Leslie and Dr. Martin Brodsky join me for what we hope to be a monthly roundtable discussion, weighing in on audience-directed topics related to swallowing and dysphagia. Are you of the belief that instrumentals should be considered for every patient? Perhaps they aren’t ideal in specific circumstances? Who do you believe should be primarily responsible for writing the recommendations, the clinician who completed the instrumental assessment or the clinician who knows the patient best? These discussions and other perceivably ethical dilemmas (that really aren’t dilemmas at all—they’re the law) are passionately discussed.
045 – Edgar Vincent Clark, M. Ed. CCC-SLP – Part 2: If a Picture’s Worth a Thousand Words, Then FEES Must Be Worth a Million
“If you’re not ordering FEES because you’re afraid of missing something, then you’re not ordering FEES for the wrong reasons.” In this episode, Vince Clark dives in to some other myths about FEES and the benefits it provides to his patients and colleagues. We discuss the increasing prevalence of laryngopharyngeal reflux disease and it’s impact on swallowing, how to subjectively rate it, and how to advocate for a further work up. We also discuss the interdisciplinary education that can take place when several professionals and the family gather around to watch the live study.
044 – Edgar Vincent Clark, M. Ed. CCC-SLP – When FEES Is Your Primary Tool: A Little History, Myth Busting, And How To Clean That Scope!
Do you use FEES? Do you have access to FEES? Do you think FEES is the new kid on the block? Do you think FEES is super painful, dangerous, and unsafe? Do you know how to clean that scope or will it eventually turn into a coat rack? In Part 1 of this 2-part series, Edgar Vincent Clark and I dive in to something we are both overly passionate about… FEES! We discuss the history and dispel some myths about safety and pain. We also get into the nitty gritty of how to clean your scope. (Pssst: It starts with knowing the kind of scope you have and getting your paws on the User Manual!)
043 – Leslie R. Roerk, M.S., CCC-SLP, CDP, BCS-S – Part 2: Treatment Strategies for Patients with Dementia: Now that we’ve diagnosed dysphagia, how the heck do we go about treating it with this population?
So now that we’ve diagnosed dysphagia in our patient with dementia, is there really, truly anything that we can do? Leslie Roerk is back for part 2 to help us with various treatment strategies for this population. If you’re interested in learning more about treating dysphagia in patients with dementia, check out the show notes. Leslie created a list of references and other great CEU offerings.
042 – Leslie R. Roerk, M.S., CCC-SLP, CDP, BCS-S – How Do We Assess Dysphagia In Patients With Dementia? A Review Of The SLPs Role
How do you assess dysphagia in our patients with dementia? Just the normal oral mech exam? A FEES? A VFSS? Do you have to get creative? Maybe? We really just need to know a few key points about our patient and their progression in order to know the best way to assess their swallowing. In this episode, Leslie Roerk dives in to everything the SLP should be aware of when assessing dysphagia in the dementia population, and the importance of utilizing the Global Deterioration Scale to guide us. She provides us with some great tips so that we are able to evaluate our patient’s feeding, swallowing, behavioral, and/or communication needs to provide patient centered care.
041- Raquel Garcia, M.S.,CCC-SLP, BSC-S – Feeding Tips and Tricks for Infants with Cleft Palate & Craniofacial Anomalies
Do you work with babies or kids with cleft lips, cleft palates, or other craniofacial anomalies? Do you desire to work in a NICU or outpatient at a Children’s Hospital, and wish you knew more about how to treat these kiddos? In this episode, Rokki Garcia dives in to everything the SLP should be aware of when treating babies/kids with craniofacial anomalies or clefts. From some hallmark signs and symptoms, to the various brands of bottles on the market that allow Mom and baby to have the best feeding outcomes. Raquel provides a wealth of research to help us to create a reputable craniofacial team in your area.
040 – Madison Macht, M.D – Why SLPs and MDs Should Be Like Peanut Butter and Jelly and the Fallacy That Feeding Tubes Prevent Aspiration
Are you and the MD in your critical care unit like peanut butter and jelly? Well you should be, right? Most often times when our patients come off of sedation, the first thing they ask the doc is when they can eat or drink again, so naturally they should know to call us! In this episode, Dr. Macht, a critical care pulmonologist encourages SLPs to work together with MDs or physician extenders to allow for patient centered care. He also discusses the fallacy that PEG tubes do NOT decrease aspiration pneumonia and the importance of family meetings to have these risk/benefit discussions.
039 – Taylor Evans M.Ed, CCC-SLP – Intergenerational Intradisciplinary Dysphagia Education and History
How much do you rely on your colleagues at work for dysphagia advice? Do you consider listening to their advice if they are less experienced than you? It’s time to break down the walls of “more experienced” vs. “less experienced” and start listening to each other. None of us are experts in any 1 area so we might as well put our brains together for the sake of our profession and our patients! In this episode, Taylor Evans dives in to all of the controversial topics that some SLPs do not believe to be within our scope of practice. He provides some great advice on how to come together to have these open discussions and learn from each other instead of just passive aggressively emailing a research paper.
038 – Matt Ward, M.S., CCC-SLP – Part 3 of a “Frank” Discussion: Why It Is So Crucial To Have A Solid Foundation In Dysphagia Prior To Completing Instrumental Assessments And Making Recommendations For Our Patients
How important is the recommendation section of our VFSS or FEES reports? Sure we can train a monkey to identify penetration or aspiration, but it takes a solid foundation in understanding dysphagia, aspiration, pneumonia, and the impact of diet modifications before one should even consider thinking they are prepared to perform instrumental assessments. In this episode, Matt Ward is back for part 3 of his interview to discuss how our recommendations can help our patients or hold them back from reaching their full potential, and it’s vital that we are well educated on the impact that all of our recommendations can have.
037 – Matt Ward, M.S., CCC-SLP – The Importance Of A Protocol When Completing Instrumental Exams And How These Reports Can Follow Our Patients For Life!
Do you use a protocol when you perform your instrumental assessments? Should you? Are you aware of the benefits for other parties involved in our studies? How thorough are your reports? Do you write down everything? Or just a tiny bit? These reports follow our patients to their next level of care so it’s critical that we provide all of the information necessary for our colleagues to provide the best treatment possible. In the second of this 3 PART episode, Matt Ward dives in to the importance of a protocol and how our reports can follow these patients for forever.
036 – Matt Ward, M.S., CCC-SLP – Part 1 of a “Frank” Discussion: How Truly Prepared Are You To Perform Instrumental Assessments and Make Recommendations For Our Patients?
How prepared are you to really do instrumental assessments and write SUPER thorough reports? I bet there’s always more for you to learn! There is so much that SLPs don’t know about anatomy, physiology, neurology, aspiration, and pneumonia that are critical before we can begin to write thorough reports and make appropriate recommendations for our patients. In the first of this 3 PART episode, Matt Ward dives in to everything the SLP really, truly should understand before attempting to do instrumentals.
035 – Ramya Kumar M.S., CCC-SLP – How Do I Get To Work in the NICU? What Makes a Neonatal Therapist vs. a Peds Therapist? And the Importance of Making Long Term Changes at the Early Stage.
Are you just *DYING* to work in the NICU? With the teeniest tiniest cutest things ever? But feel like it’s trying to crack a secret code to work there? Have no fear, Ramya is here to help you get started. In this episode, Ramya Kumar discusses tips and resources to help you get your foot in the door. She describes the main differences between a neonatal therapist and a pediatric therapist (because it’s not just about feeding littler people! Eek!) She also explains Infant feeding strategies that are used in the NICU that outpatient/EI therapists should know as they see the NICU grads.
How much do you REALLY know about esophageal dysphagia? I’m sure it’s not enough. Can we really rule in primary oropharyngeal dysphagia without ruling OUT esophageal dysphagia? Yeah news flash to me too! Holy cow I felt dumber than a box of rocks after talking to Julie! In Part 2 of this episode, Julie Huffman dives in to everything the SLP should be aware of when treating dysphagia and how we MUST include the esophagus. She provides some awesome research papers to get us on the same page with our radiologists and GIs, and she tells us exactly what tests we should be ordering when we make referrals to other specialties.
How much do you REALLY know about esophageal dysphagia? I’m sure it’s not enough. Can we really rule in primary oropharyngeal dysphagia without ruling OUT esophageal dysphagia? Yeah news flash to me too! Holy cow I felt dumber than a box of rocks after talking to Julie! In this episode, Julie Huffman dives in to everything the SLP should be aware of when treating dysphagia and how we MUST include the esophagus. She provides some awesome research papers to get us on the same page with our radiologists and GIs, and she tells us exactly what tests we should be ordering when we make referrals to other specialties.
032 – Debra Suiter Ph.D., CCC-SLP, BCS-S, F-ASHA – The Yale Swallow Protocol: What Exactly Is It, How Do I Do It, The Impetus For Research Leading To Its Development, and Answers To Many Other FAQs!
Have you heard about the Yale Swallow Protocol? Do you use it? Are you reluctant to use it? Do you feel it’s just too good to be true, and not right for your patients or facilities? In this episode, Dr. Suiter is here to set the record straight. We dive into the research that was the impetus for this protocol, who is it for, who is it NOT for, and Dr. Suiter answers questions about the YSP submitted by our Patreon supporters.
031 – Karen Sheffler M.S., CCC-SLP, BCS-S – Setting the Record Straight On the WashPo Article on 2/25/18, Now How Do We Use This To Our Advantage? An SLP Action Plan to Encourage Education, Advocacy, and Transdisciplinary Care
A recent article in the Washington Post on February 25, 2018, titled “Swallowing problems are a big killer, but the treatment can be horrible,” had many, MANY inaccuracies about our profession, and in fact did not even name our profession! In this episode, we discuss Karen Sheffler’s excellent rebuttal blog post on swallowstudy.com and also discuss an SLP Action Plan, and how we can grow from this article to advocate and educate our colleagues.
030 – Carmin Bartow, M.S. CCC-SLP, BCS-S – Part 2 – How to Form a “Trach Team” in Your Hospital: Utilizing a Multi-Disciplinary Team Approach to Improve Outcomes in Both Speech AND Swallowing For Patients With Tracheostomies
In part 2 of this episode, we continue to discuss how and why to form a trach team in your facility. We discuss challenges that SLPs face when dealing with trach patients, the benefits of forming a trach team, and the SLPs role in improving speech and swallowing in these patients with tracheostomies. (listen to part 1 here) Today’s guest is Carmin Bartow, M.S., CCC-SLP, BCS-S, She is currently employed at Vanderbilt University Medical Center specializing in dysphagia management, trach vent intervention, and in head and neck cancer. She is a member of the VUMC Tracheostomy Consult Service. In addition to her clinical responsibilities, she facilitates a head and neck cancer support group, and recently taught Dysphagia as an adjunct instructor at Tennessee State University. Carmin put together a great outline of how to form a trach team, as well as several helpful references available below.
029 – Carmin Bartow, M.S. CCC-SLP, BCS-S – Part 1 – How to Form a “Trach Team” in Your Hospital: Utilizing a Multi-Disciplinary Team Approach to Improve Outcomes in Both Speech AND Swallowing For Patients With Tracheostomies
In part 1 of this episode, we discuss how and why to form a trach team in your facility. We discuss challenges that SLPs face when dealing with trach patients, the benefits of forming a trach team, and the SLPs role in improving speech and swallowing in these patients with tracheostomies. Today’s guest is Carmin Bartow, M.S., CCC-SLP, BCS-S, She is currently employed at Vanderbilt University Medical Center specializing in dysphagia management, trach vent intervention, and in head and neck cancer. She is a member of the VUMC Tracheostomy Consult Service. In addition to her clinical responsibilities, she facilitates a head and neck cancer support group, and recently taught Dysphagia as an adjunct instructor at Tennessee State University. Carmin put together a great outline of how to form a trach team, as well as several helpful references available below.
028 – Tiffany Turner, M.S., CCC-SLP, BCS-S – The Importance of Multi-Disciplinary Care with Other Professionals, Treating the Entire Person, and Why Are SLPs So Resistant to FEES?
This is Episode 028 with Tiffany Turner, Tiffany is a board certified specialist in swallowing and swallowing disorders. She owns a regional swallowing and voice clinic in Tulsa serving patients throughout Oklahoma for FEES, videostrosboscopy, and swallowing and voice treatment. She is also on Oklahoma’s Muscular Dystrophy Association team and serves at a monthly ALS clinic. Tiffany has published several clinical resource ebooks for adult medical SLPs which are available on her clinic’s website at www.tulsasnr.com . In this episode, we discuss the Importance of multi-disciplinary care with other professionals, treating the entire person, and why SLPs are so resistant to FEES?
027 – Caroline M. Brindo, MA/CCC-SLP, BCS-S – Are We Using the MBSS To It’s Fullest Potential? A Day In The Life Of A Mobile MBSSer
In this episode, Caroline and I discuss the underuse of the MBSS. We read reports from SLPs all the time that only mention if a person aspirated or not and with what consistency, or even more maddeningly, a progress note that the patient “failed” their MMBS. We have this wonderful tool, and so many SLPs are not using it to it’s fullest potential. We also discuss one of the more detrimental acts that SLPs commit in establishing themselves as medical professionals. Physicians order all sorts of instrumental assessments before they make decisions about patient care. PTs, RTs, dieticians, etc., all request instrumental assessments before they make recommendations. Then SLPs come in and suggest major changes to a patient’s care based on what they see at bedside? Not every patient may need an instrumental, but way more patients are appropriate than are actually getting them. We also put to bed the great MBSS/FEES debate. They are both so useful and we can get such great, and in some aspects, completely different but still complimentary information, from both.
026 – Diane Bahr, M.S., CCC-SLP, CIMI – PEDS! Lip Ties and Tongue Ties and Buccal Ties, Oh My! Typical Mouth and Airway Development in Utero to 7 Years
Diane Bahr is a visionary with a mission. For more than 30 years, she has treated children and adults with feeding, motor speech, and mouth function problems. Diane is extremely concerned about the amount of time young babies are spending on their backs and in containers. She has hypothesized this as being one reason we are seeing late developing fine motor skills (e.g., feeding, speech, hand use, and visual function) and significant jaw and tongue retraction (which may be contributing to posterior tongue tie). She has attributed this to the apparent epidemic of mouth development problem we seem to be having and has done a significant literature review to support her work. Diane also just presented a very well received talk at the ASHA Convention with Kristie Gatto regarding normal mouth and airway development from birth – 7 years of age that she graciously shares in this episode.
024 – Brenda Arend, MA, CCC-SLP – The Dueling Banjos of Dysphagia: Why Didn’t My Patient Get a Swallow Study at the Hospital and What Can Be Done About It?
Tune in as we discuss the roadblocks that both acute care *AND* SNF SLPs face, and how we can build that bridge to boost continuity of care with special guest Brenda Arend, M.A., CCC-SLP. “Why doesn’t my patient EVERRRRR get a swallow study at the hospital before they come to me?” “Yikes that’s a pretty gnarly infection, I really hope their diet is upgraded once that infection clears and they get to their next level of care.” Have you asked yourself ANY of these questions? Do you find yourself extremely frustrated with the lack of continuity in care? Well sometimes (most times) there are many other moving parts. Brenda Arend, MA, CCC- SLP is the owner of Puget Sound Swallow Diagnostics, providing mobile FEES services to the greater Puget Sound region of Washington state. Brenda has particular interests in dysphagia, ethics, and end of life care.
023 – Eric Blicker CCC-SLP.D BCS-S – When A Cough Can Mean 1,000 Things: Discovering The Link Between COPD, Laryngopharyngeal Reflux Disease, And Dysphagia.
Do you know the impact that COPD can have on swallowing? Do you know the impact that laryngopharyngeal reflux disease (LPRD) can have on swallowing? Do you know the impact that COPD can have on LPRD? Do you even know what LPRD is? In episode 023 of the Swallow Your Pride podcast, Dr. Eric Blicker discusses some really interesting research on the SLPs role in assessing and treating LPRD and its link to the COPD population. Eric Blicker CCC-SLP.D BCS-S has been a Board Certified Specialist in Swallowing and Swallowing Disorders since 2008. That same year, Dr. Blicker received his Clinical Doctoral degree from Nova Southeastern University. Dr. Blicker is the FEES Committee Chairperson and Project Coordinator in the Mercy Health East Market in Cincinnati Ohio.
022 – Walt Fritz, PT – The Inter- and Intra-rater Reliability of Palpation, Myofascial Release, and Manual Therapy using a Patient Directed Approach.
Are you palpating your patients? Do you know what you’re feeling for? What is the inter- and intra-rater reliability of palpation? What if it has alternate uses? Manual therapy has been a longstanding practice in the PT world, and benefits are just now being discovered as it relates to globus sensation and dysphagia. Today’s guest is Walt Fritz, a physical therapist who breaks down the history of manual therapy, the use of myofascial release, and using a patient directed approach in treating dysphagia. Walt Fritz has been a physical therapist since 1985 and has been using manual therapy as his chosen intervention since 1992.
021 – Martin B. Brodsky Ph.D., Sc.M., CCC-SLP, F-ASHA – Crash ‘n’ Burn: Ending The 24 Hour Wait Time For Post-Extubation Assessment
In this episode, Dr. Brodsky discusses when to assess or screen for swallowing function post extubation – what has been done in the past, what is going on today, and what should you do tomorrow? Dr. Brodsky describes a life altering incident that has shaped his career, and we also discuss the importance of clinical research, evidence-based medicine, and why it’s called clinical “practice.” Dr. Brodsky is an Associate Professor of Physical Medicine and Rehabilitation at Johns Hopkins University. His peer-reviewed research publications, book chapters, and invited presentations focus on swallowing and swallowing disorders.
020 – Dan Weinstein, M.S. CCC-SLP, BCS-S – Case Presentation on Social Media, Decision Making, Documentation, and Making Appropriate Referrals
Dan and I team up for a quick off the cuff “holiday edition” episode to present to *YOU* how to present a case on social media in order to get the best and most appropriate responses from your peers. Dan also tackles decision making, documentation, and the importance of making solid referrals.
019 – Russ Campbell, PT, CEO of Ampcare – IIb or not IIb – The Role of Neuromuscular Electrical Stimulation (NMES) Applied to Patients with Dysphagia
Questions about e-stim? NMES? What the heck is it? What does it even do? In this episode we learn all about parameters, placement, and plasticity! Russ Campbell received his degree in Physical Therapy from Northwestern University, Chicago, Illinois in 1989. He is a co-developer of the Effective Swallowing Protocol (ESP™) and CEO of Ampcare, a FDA registered medical device and services company that develops innovative technologies designed to improve the quality of life in people with swallowing disorders.
018 – Selena Reece, M.S., CCC-SLP, BCS-S – Does Starting a FEES Program Sound Like Too Daunting Of a Task? Here Are All Things To Consider.
Selena Reece received her Master’s degree from University of North Carolina at Chapel Hill in 2003 and obtained Board Certification in Swallowing in 2015. She has worked in acute care, outpatient, and inpatient rehabilitation settings. She currently serves as the Director of Educational Resources for Carolina Speech Pathology, while carrying an active caseload providing mobile FEES services. She has been deemed competent for supervision and training in FEES by Dr. Gregory Postma, a board certified Otolaryngologist. In this episode we discuss why we need instrumentals, how FEES can be a wonderful addition to your facility, and where to even begin with creating a FEES program.
017 – Jamie D. Fisher PhD, CCC-SLP Part 2! Trach/Vent FAQs: Do Trachs Cause Dysphagia? Is The Blue Dye Test Accurate? Why FEES In This Population?
Dr. Fisher is back for part 2 to discuss her main passion — trach and vent! In this episode, we discuss some tracheostomy and mechanical ventilation FAQs as they relate to dysphagia. Do trachs themselves directly cause dysphagia? Is the blue dye test accurate? Why is FEES beneficial for this population? Dr. Fisher received her PhD in Speech Language Pathology from Vanderbilt University. She is a speech-language pathologist (SLP) and clinical instructor with SA Swallowing Services and works at various hospitals, sub-acute care facilities, and rehab facilities.
016 – Jamie D. Fisher, PhD, CCC-SLP Keeping it Real: Transitioning to being a Medical SLP the Right (Ethical) Way
Dr. Fisher received her PhD in Speech Language Pathology from Vanderbilt University. She is a speech-language pathologist (SLP) and clinical instructor with SA Swallowing Services and works at various hospitals, sub-acute care facilities, and rehab facilities. Dr. Fisher holds ASHA Certificate of Clinical Competence, endorsement for endoscopy practice, and is a certified FEES trainer. In this episode, we discuss how to transition to being a medical SLP the right and ethical way because there is a right and a WRONG way! We also discuss the ethics at both the state licensure level and with ASHA if caught practicing incompetently.
On episode 015 of the Swallow Your Pride Podcast we have Rebecca Levy back for a Part 2! Rebecca is an SLP currently in the role of Clinical Program Consultant for ACP’s Synchrony dysphagia program. Rebecca has worked in healthcare for over 11 years. Rebecca’s current role of clinical consultant is probably her most fulfilling, helping to educate other SLPs and helping them to get superior outcomes with their patients! In this episode, we discuss ALL things thickened liquids – the good, the bad, and the ugly! We discuss why we should be treating our patients and getting them away from just “tolerating” diets, and what thickened liquids can actually do our patient’s physiology and psychology!
In this episode, we sit down with Jonathan Waller of Dysphagia Cafe to discuss all of the happenings in LA at the 2017 ASHA Convention! We also discuss some of the “Best Of” Dysphagia Cafe!
013 – Rebecca Levy M.S. CCC-SLP – Exercises, Exercises & More Exercises! Evidence-Based Treatment for Every Swallowing Impairment
In this episode, we discuss ALL things exercise! Exercises, exercises, and more exercises! Rebecca goes through all 17 components of the MBSimp and provides evidence-based exercises for each swallowing impairment. The show notes for this episode can be found at www.swallowyourpridepodcast.com and there is a cheat sheet chart of all of the impairments, muscles and cranial nerves involved, as well as exercises for each component!
012 – Dr. Jonathan Aviv: What SLPs Should Know about the Relationship Between Reflux and Dysphagia, the Safety of FEES, and the Acid Watcher Diet.
Dr. Jonathan Aviv, ENT joins us for Episode 012 of The Swallow Your Pride Podcast. In this episode, we discuss the editorial – “When endoscopy is an option, what would you choose?” the safety of FEES, what SLPs should know about LPR/GERD, and a food- not medicine -solution. Dr. Aviv also provided us with some food myths relating to LPR/GERD and dysphagia.
011 – Hillary Cooper, MA – CCC-SLP – Dysphagia Island Can Be a Lonely Place – Why It’s So Important to Build Bridges With Your Interdisciplinary Team to Overcome Barriers
In this episode, we discuss how we can advocate for our patients AND our field. She tells us how she has been successful with educating other professions and getting them on board and collaborating with us on our dysphagia treatment plans. Hillary also discusses having Dr. Stephanie Daniels as her graduate school professor, and how that has shaped the way she views continuing education. Hillary is also establishing a mobile FEES company called North Louisiana Swallow Solutions. Hillary is extremely passionate about pushing for the use of evidence-based practice in dysphagia treatment in these rural areas.
010 – Catriona Steele Ph.D., CCC-SLP, F-ASHA – The International Dysphagia Diet Standardization Initiative Framework, IDDSI Flow Test, & Skill-Based Training For Rehabilitating the Swallow.
Dr. Catriona Steele is one of the main key players in the International Dysphagia Diet Standardized Initiative also known as IDDSI. She also has received international recognition for her work on tongue functioning in the swallow. In this episode, we discuss the importance of IDDSI and standardizations amongst thickened liquids and texture modifications, we discuss skill based training, and the importance of rehabbing the swallow, as well as we get to hear about some of Dr. Steele’s mentors and who’s work has really inspired her.
009 – Edgar Vincent Clark, M. Ed. CCC-SLP – The Financials Involved in Managing Dysphagia, and How instrumental Assessments Can Not Only Be a Cost Savings, But Revenue Generating For Your Facility
Today’s guest is one of my most favorite people in this world, Vince Clark (AKA Edgar Vincent Clark.) In this episode, we discuss the cost of instrumental assessments, and how they are not only a cost savings, but can be revenue generating, and also the financials associated with therapy materials, as well as where to locate all of the regulations.
008 – Megan Nosol, M.S., CCC-SLP – The ABCs of HNC – Important Considerations for your Patient with Head & Neck Cancer
Today’s guest is Megan Nosol. Megan is extremely knowledgeable in the world of head and neck cancer. She is super intelligent, and has not only skimmed the literature, but she really dives in and thinks critically, and relays it so well in to her clinical practice. Currently, Megan is a SLP at STEPS for Recovery, an outpatient clinic, where she treats adults who have trismus, an array of communication disorders, and dysphagia. In this episode, we discuss the ABCs of HNC, and Megan gives you a great general knowledge base about treating HNC. Don’t forget to download the show notes for this episode, and thank Megan for giving you tons of great info and references to check out.
007 – Yvette McCoy, M.S. CCC-SLP, BCS-S – Advocating for the Tools You Need to Do Your Job, The Predictors of Aspiration, and the Evidence-Based Triad
This is episode 007 of the Swallow Your Pride podcast, and on today’s episode we have Yvette McCoy. She is Board Certified Specialist in Swallowing and Swallowing Disorders, and owns a private practice clinic in Maryland called Speak Well Solutions. Yvette is also an adjunct instructor at the University of Maryland in College Park. In this episode we discuss how to advocate to your boss for the tools you need to do your job, we discuss Dr. Langmore Predictors of Aspiration paper, and we discuss the importance of the evidence-based triad.
006 – Dan Weinstein, M.S., CCC-SLP, BCS-S – Palliative Care in the Acute and SNF Settings, Feeding Tubes, Thickened Liquids, and Esophageal Dysphagia
Today’s Swallow Your Pride guest is Dan Weinstein! Dan is a board certified specialist in swallowing and is an incredibly intelligent and very well spoken SLP from the Philadelphia area. In this episode, we discuss palliative care in both the acute care and SNF settings. We dispel some myths about feedings tubes, thickened liquids, and how best to treat our end of life patients with dysphagia. Dan also touches on esophageal dysphagia and some things we should and shouldn’t do with treating that.
005 – Matt Ward, M.S., CCC-SLP – How the Yale Swallow Protocol Can Simplify and Improve the Accuracy of your CSEs and Re-thinking Rehab
Matt is an SLP in the Nashville, TN area where he completes mobile FEES for SA Swallowing Services, and works PRN in a hospital completing MBSS and treating acute care patients. In this episode, we discuss why your “comfort level” doesn’t matter, and we can’t be emotional with our recommendations, and instead use evidence based practice in these decisions. We also discuss how being conservative in our recommendations can have negative implications for our patients. Matt also discusses a “game-changing” paper for him written by Dr. Maggie Lee Huckabee about “Rethinking Rehab,” and how our treatment need to be specific, challenging, and monitored with feedback.
004 – Nannette Crawford M.A., CCC-SLP – Is this waiver worth the paper it’s written on? Ethical decision making, the importance of having a mentor, and to never stop learning.
Nannette is an SLP with over 45 years of experience who wears many, many hats, and wears all of them very, very well. Her specialty is cognition, brain injury, and post concussive symptoms, but she works in an outpatient clinic where she also treats patients with dysphagia. In this episode, we’ll cover the ever popular topic of waivers and why they should or should not be used, how to present treatment options to our patients, and how to advocate for our patients as part of interdisciplinary team. Nannette also discusses the importance of having mentors and support from others in the field, and you’re never too old to learn new tricks.
003 – John Ashford, Ph.D. CCC-SLP – The 3 Pillars of Pneumonia and Why Oral Care Should Be Considered an Oral Infection Control Program Instead
Today’s Swallow Your Pride guest is Dr. John Ashford! Dr. A is an incredibly knowledgeable educator and clinician. Dr. A co-owns S.A. Swallowing Services with his better half, and together they have a team of excellent clinicians that provide mobile FEES around Tennessee. Dr. A is very passionate about instrumental assessments and oral care, and has presented on his well researched topic of “The 3 Pillars of Pneumonia.” In this episode we discuss how a poor immune system, poor oral, and the events of aspirating all must create the perfect storm in order to cause pneumonia. We also get into the importance of instrumental assessments, and exactly how to perform oral care (Newsflash: It involves a toothbrush, and a toothbrush, and a toothbrush). Dr. A also discusses his favorite researcher that has helped to shape his thinking of swallowing disorders.
002 – Tiffani Wallace, M.A. CCC-SLP, BCS-S, Dysphagia Ramblings, Cranial Nerves, and Making Your Patient Aspirate
Today’s Swallow Your Pride guest is Tiffani Wallace! Tiffani is one of my most favorite people in this world, she’s board certified in swallowing, a blogger, author, presenter, and speaker. In this episode we discuss how cranial nerve exams should actually drive your therapy plans, and how watching your patient aspirate can be a good thing! Tiffani also discussed some of her most favorite treatment strategies and research papers that have helped to shape her dysphagia practice.
001 – Ed Bice, M.Ed., CCC-SLP – Dispelling the Fatigue Myth and How We Should NOT Sit and Watch Our Patients Eat
Today’s Swallow Your Pride guest is Ed Bice! Ed is one of the most intelligent and knowledgeable swallowologists out there. Somehow he is not a researcher, but he is so well-versed in the literature and is incredibly passionate about sharing the research with his colleagues. In this episode, we dispel the myth that the swallow is subject to fatigue. Ed presents us with an incredible review of the muscle physiology, what exactly we can tell at the bedside, and why there is no value in sitting and watching your patient eat. Ed also discusses several of his favorite research articles that have helped to shape his practice today.