THE WHAT IFS...
What if my Speech Pathologist doesn't "believe" in instrumental assessments?
It is very difficult to deny the research. Oftentimes we are resistant to what we don’t know. The bedside swallow exam has been proven time and time again to be a screen. Some older, more experienced clinicians believe that they can utilize bedside clinical exams and/or cervical auscultation to assess dysphagia and make appropriate diet recommendations. Unless they have special x-ray vision powers, the research has shown the very high error rate with unfortunate consequences of potential harm to a patient and/or costing the SNF even more money while taking a lucky guess at what they think they are “seeing” without using actual imaging. They are stuck in the past and resistant to change. Once the Speech Pathologist or other facility staff see the value in an instrumental assessment, and how the majority of the time what they thought was going on is often not the case, and how it can actually help their patients and clinical practice exponentially, they understand.
What if my Speech Pathologist doesn't believe in FEES?
Believe us, we can teach an old dog new tricks. For the longest time, the MBSS was considered the gold standard in swallowing diagnostics. However, times are changeing. The research now shows that FEES is ALSO considered a GOLD STANDARD, and has actually been found to be equal to or even greater than the MBSS in detecting penetration, aspiration, spillage, and residue, The technology for mobile FEES and the research to support it has improved drastically. The procedure was developed back in 1984 by Susan Langmore Ph.D., but within the last 5 years, the medical imaging companies have been able to greatly reduce the size of the endoscope causing very minimal discomfort while improving the camera to provide a high definition image of the swallow. Win, Win for everyone!
What if I don't think my patient will participate?
Can your patient swallow? Then they can participate. We have to remember that with the older, geriatric population, the patients are much more desensitized than the general public. Many patients with dementia or even generalized anxiety have participated beautifully, in fact we have a 100% scoping success rate with this population. We can’t assume that they won’t participate if we don’t try. Remember, we do not charge if we are unable to pass the scope, so if you are questioning if someone can or will participate? Give us a call! We’ll give it a whirl, and we think you’ll be pleasantly surprised with the outcome.
What if I don't want to put my patient through that?
Through what? Through giving them the exact status of their swallow and evidence based recommendations instead of wasting your time and theirs making a lucky guess? We have to remember that we are constantly referring our patients to the ENT or GI doctors. What do they do there? They use this exact scope. Again, the technology has improved drastically in that the scope is much, much smaller causing very minimal discomfort. Trust us, we’ve done it several thousand times.
What if I can't see aspiration during the "white out" phase?
Did you know that only 5% of aspiration occurs DURING the swallow? Meaning the other 95% we can see beautifully during the FEES procedure. The reason that green or white food dye is used during the procedure is for this exact reason. If the patient falls in that 5%, we are able to see the dye below the level of the vocal folds.
What if I need to see the "oral phase?"
The mobile FEES exam is considered an assessment of the “oropharyngeal swallow”, meaning the oral phase can be deduced from the presentation of the bolus to premature spillage in the valleculae. Viewing the oral phase is not going to change whether the patient is aspirating or not, nor does it tell us the amount of spillage and pharyngeal residue, all factors that can be seen in a live, real time, high definition video of the swallow. What is your reasoning for needing to VIEW the oral phase? You can observe the oral phase by standing right in front of the patient and then as soon as the bolus falls passed the epiglottis or the pharyngeal phase of the swallow is initiated, we are able to view it in real time on the screen. Concerned about residue in the oral cavity? Have the patient open their mouth. Concerned about delayed mastication or oral transit time? Count the amount of time between the presentation of the bolus to the initiation of the pharyngeal swallow.
What if I need to view the esophageal phase?
Studies have shown that many signs and symptoms of esophageal dysphagia can actually be viewed better on a FEES than on an MBSS. If esophageal dysfunction is our main concern, the referral should be made to a GI doctor, which the recommendations of the MBSS will state as well.