Swallow the Gap
A pivotal podcast on a mission to improve medical intervention for patients with swallowing disorders (dysphagia). Primarily intended for medical speech-language pathologists (SLP) and also relevant for professionals and students involved in pulmonology, otolaryngology, gerontology, nutrition, rehabilitation sciences, and various other areas of healthcare. Join us as a force for change by inspiring critical thinking, facilitating discussion, and stimulating professional development for those involved in the evaluation and treatment of patients with aerodigestive disorders.
https://www.swallowthegap.com (Gap Education, LLC)
Swallow the Gap
Special Edition: 150 Years of Experience, Behind Closed Doors
What happens when you get 6 speech pathologists with 150 years of collective experience stuck together in a room?
You’ll have to listen to find out!
Join Julie Blair, Laurie Sterling, Dr. Deb Suiter, Dr. Barbara Messing, Jo Puntil, and Dr. Tim Stockdale (that’s 1, 2, 3, 4 ASHA fellows!) in a special edition episode, as we enjoy a laid-back evening conversation at the 2024 ASHA Convention in Seattle, Washington.
Reflections include Swallowing Cinema, patient choice, and growing through vulnerability.
Sponsor:
This episode is sponsored by the Milton J Dance Endowment – a sponsor dedicated to support of head and neck cancer patients and swallowing disorders in all populations.
Background photo credit: Daniel Schwen (https://commons.wikimedia.org/wiki/File:Seattle_4.jpg)
Gap Education:
https://swallowthegap.com
Facebook:
https://www.facebook.com/GapEducationLLC
Instagram:
https://www.instagram.com/swallowpatho
This episode of Swallow the Gap is sponsored by the Milton J Dance Endowment, a sponsor dedicated to the support of head and neck cancer patients and swallowing disorders in all populations.
Speaker 2:My name is Lori Sterling and this is a special edition of Swallow the Gap ASHA 2024. That was really good. I like it.
Speaker 1:So, in case you missed it, that was Lori Sterling, and this is a special edition of Swallow the Gap at ASHA in 2024. Lori Sterling, who are you?
Speaker 2:I am a speech pathologist at Houston Methodist Hospital in Houston, Texas. I'm like why am I saying that? Because it's pretty obvious I am in Houston. I have been an acute care speech pathologist for over 30 years now. I did a fellowship in Baltimore at the same place. One of our other guests here, Barbara Messing, did hers. It was like a residency and way back before CF residencies were popular, Before they were known. Yeah, it was a clinical fellowship, but it was only for a year.
Speaker 2:Yeah, but it was only for a year it was still called clinical fellowship yeah, but it was only for a year, so it was kind of like a residency. Then you moved on.
Speaker 2:That's right, but I have been very involved with ASHA for a number of years, beginning with SIG 13. And it's still a division. When it was a division, yeah, way back when became like the director of what I don't know what it was of education and became director of what I don't know what it was of education and became involved with convention and co-chaired convention in 2019 and I'm going to co-chair convention 2025, our centennial, our centennial and, yeah, with uh, four other wonderful, four other wonderful um clinicians, audiology and speech pathology, but they're having four this year. We're having a total of five. It's a co-chair council just something special for the centennial, yeah, and it's going to be held in washington dc so, yeah, get it on your calendar.
Speaker 3:Is it going to be the week before thanksgiving?
Speaker 2:it's going to be the usual time it is but no, I've been a clinician for a number of years. It's always been acute care, critical care and swallowing, except for a late midlife crisis when I did some pediatrics. I wanted to learn more about birth to adult. I mean, I knew about adult to geriatrics, but I wanted to learn about swallowing and babies.
Speaker 1:So a little kickstart there you go. And who else we have.
Speaker 2:This is I'm Deb Suter. I am currently at the University of Kentucky. We're the director of the Voice and Swallow Clinic. So right now I am doing clinic five days a week and teaching dysphagia. I've taught dysphagia to graduate students for over 20 years and then I do research as well, probably best known for developing Yale Swallow Protocol with Steve Leder, which is a protocol to assess for dysphagia risk and aspiration risk for people with dysphagia.
Speaker 2:And then I have been in various positions throughout the years with ASHA. That's actually how I met Laurie and most of the people that are here in the room. Laurie and I met through SIG 13 years ago where we were trying to break into working with ASHA and trying to figure out how we could get more involved, and then kind of worked my way up through becoming B6C chair, so chair over all the special interest groups, and then got involved with CFCC and then became chair of CFCC, and so that's kind of where I am right now. Deb and I served as she was editor and I was a CE administrator for 613 back when it was all paper, and that's how Julia met you. Yeah, through Bing, yeah.
Speaker 1:All right, who are you?
Speaker 2:So I'm Julie Blair. I'm at the University in Charleston, South Carolina. It was my first job. My last job, you work with Janina. I do. I love her. She's great. She is amazing. She's got to be one of the nicest people on this planet.
Speaker 1:Oh, she's a jerk, don't lie, she's very nice.
Speaker 2:She's actually way nicer than me.
Speaker 1:Janina Wimskill.
Speaker 2:Janina, I still can't say her last name.
Speaker 1:She's awesome, she's super great.
Speaker 2:But yeah, I was at MUSC, lori was there with me for a while.
Speaker 1:That's how.
Speaker 3:I know, julie. Yes.
Speaker 2:My wedding and then she left us, but she was my introduction into ASHA. So when she stopped being the CEA, she asked do you want to do this role? I forgot about that and so I got pulled in right before they transitioned away from the paper, which was which is a pretty sweet to go go into that, that role. And then I applied for SIG 13 to be on the board and got to work with Deb, where it was the first time I joined Facebook, so that she would poke me. Oh, look at that. Oh, the pokes. I forgot about the pokes, oh my gosh. So that was my first Facebook experience. I've had just a lot of really awesome opportunities because of the people that I've worked with or been around. Bonnie Martin Harris was at MUSC for a number of years and so through her I got to be part of some research and got to do some things at the va to work, a party too I worked with marty broski.
Speaker 2:It was so funny he would answer the call smarty broski, I'm gonna call him when he does that you better look out kind of gets blurred together smarty broski smarty broski. I like it.
Speaker 1:That's very funny marty, if you're listening, you better watch out marty, yeah, um, but uh so.
Speaker 2:So I've been there. I've teach the head neck cancer course there. I work predominantly with head, neck cancer, voice and swallowing all grown-ups. Occasionally I'll do like a scope on a small person, but that is only to be a helper to a colleague otherwise yeah, yeah, all all big people, okay, big people all right, who are you?
Speaker 2:so I'm barbara messing and what a journey it's been. As a speech pathologist I never would have anticipated all the little changes in life events. Yeah, that I and recreation of my career. But I started at shock trauma as la, as Lori had mentioned, and that's when I really fell in love with dysphagia, because we would do dysphagia rounds with Dr Bosma and the team and look at the video studies you know video fluoroscopy studies and it was just so intriguing. And so that was many years ago.
Speaker 2:I worked with TBI patients. Then I found the world of head and neck cancer in my next position and also fell in love with stroboscopy and voice disorders, so laryngeal those with the larynx and those without the larynx and airway issues. So it's just been a really wonderful journey Along the way. I got my PhD through the University of Queensland with Liz Ward and Kathy Lazarus as my advisors, and what an experience that was. And so I learned about research, how to do research, and that's another love of mine, and so I really feel I've just had a great career and I've been very fortunate.
Speaker 1:I've met these wonderful women and we've journeyed through all of it, a lot of it.
Speaker 2:And here we go, joe Pantel, all right here's, joe, lay it down.
Speaker 3:I'm always the caboose. Sorry, no, julie's the caboose, no, I'm the caboose and I'm the caboose. So I have worked in critical care my whole life. Events and traits kind of are my love or high flow or delirium and all that kind of stuff. And I'm trying to think of when I met all these wonderful women Throughout the career. I did do a lot of stints in ASHA with SIG 13, when it was a SIG 13. And I think I was just Division 13 when it was looking, either writing something for Division 13 or reviewing something for Division 13.
Speaker 3:Way back when I absolutely hated swallowing, like I went to school in Illinois and Jerry Logerman trained me. And when I moved to California the last thing I wanted to do was swallowing. But I worked in the Thousand Bend Trauma Center. I was low man on the totem pole, I was 15 speech pathologist and they basically said to me if you want a job, you're going to have to start a swallowing program. And I was like I don't like swallowing, that's just not, that's not. I liked head neck cancer, I like cleft palate. I liked all these things and I thought, well, I have to have a job because it clearly I needed to pay bills and so my father always taught me to be hang around with people who were a lot smarter than you, and I did. You're pretty smart yourself. Well, thank you, thanks.
Speaker 3:So I developed a team of physicians and nurses and respiratory therapists and thought I know about swallowing, but I don't know about all of the things that happen with swallowing. I don't really know about the pulmonary system or the gut system. So I proctored classes at UCI and it was wonderful to go to med school and not have to take a test, like I could go to med school and go to any class, and all these positions that I worked with were teaching classes like come learn about the pulmonary system. So I sat and took their classes and I didn't have to take a test, which is wonderful. So I learned a lot about things that I never thought I'd learn about.
Speaker 3:And now I love swallowing and I've met these women through years of our case studies and we're also lifelong friends, which I know may not be important to some people. It's important to us. So, yeah, I've done ASHA stuff, I've done state stuff. I've seen so many different clinicians do such wonderful things in our field and I like the things that are happening coming up. These people coming up in their twenties and thirties are coming up with some fantastic research and I just, I just want to pass that baton to people about love, the love of the field and the love of mentorship versus, you know, and just exploring and expanding. It's pretty much where.
Speaker 2:I'm at.
Speaker 2:Okay, I think we've all mentored and gotten the value from that I mean I love long empowering younger clinicians and getting them more involved with swallowing, getting them involved with ASHA. You know what have you Well, and I think about all the opportunities I was given and if I had not had the people that were part of my career, part of my work family, I would not have been able to do any of the things that I've done. And I just had 30 years at MUSC Congratulations, thank you. And the younger clinicians had a little thing for me and they were asking you know what advice would you give new clinicians? And to me it's say yes, say yes to the opportunities. You know what advice would you give new clinicians?
Speaker 2:And it was to me it's say yes, Say yes to the opportunities, Say yes to be open to participate. You know you want to be part of this research yes. Do you want to present? Yes. Do you want to do a study? Yes.
Speaker 3:You know, it's just true. Do you want to see a patient at six o'clock that needs your help? Yeah, I'll do it.
Speaker 2:Do it Right, because it makes an impression and people remember and you'll get asked again.
Speaker 3:Right and doors open.
Speaker 1:Yeah Right, doors open yeah.
Speaker 2:So I would say we've learned. I don't know about you guys, but I feel like we've learned so much over the years. Our field is still continuing. Yeah, I think we have a lot more to learn about swallowing and you know, it's just ever evolving. But I think that growth is really important and I think we get that by connecting with each other, by reviewing studies and discussing. That's why we got together every year and did that Right. We took our unusual cases and presented them Things where your nuts patient.
Speaker 1:Oh, not case. Talk about that. It's about an hour on case, yeah.
Speaker 2:Or my patient who swallowed the denture.
Speaker 1:You know, I mean we can learn from each other, right yeah?
Speaker 3:Amazing. But we learn from each other, right, right? It's important, that's good.
Speaker 2:And learning from our maybe not so successful interactions. So, wow, this, oh wow. I really thought that this patient had this going on, but boy, was I wrong. And what did you learn from it? Because I think everybody needs to realize even the experts aren't necessarily always the expert. They're still learning, they're still figuring it out, right.
Speaker 2:I think admitting that we're not perfect shows our vulnerability. I can't say the word to people, but yeah, I think, admitting that we don't know, we don't have all the answers, I will text any of you all in this room.
Speaker 3:Yeah, we send pictures we send videos.
Speaker 1:We send videos like what is this yeah? I mean, it's 30 years into her career and I still don't think I'm perfect, and I know I'm not well, and on that note, aren't, or I know, at least four of you, are, every one of you, an asha fellow, everyone yes, yes, single one what no, you and you, you will be.
Speaker 1:We're gonna have a good time we're gonna hang out and let these losers do their own thing, you know yeah, laurie well, okay, four out of six of the people here ash Asher Fellows, and I don't count, so four out of five people here are Asher Fellows. There we go, and so there's one, but I lost my pin.
Speaker 2:I'm sorry you lost your pin. I lost mine too Does that mean that you lost your fellow. I'm still over here and I'm wearing my pin. I'm probably tonight.
Speaker 1:The point being is that you've been around, you've been practicing for a long time, you've been honored by your association and there's not perfection still there, but you're willing to admit and reach out for help and so I think a lot of us I can't say it anymore because I'm not the young whippersnappers right Come in and we're like we got to know it, we got to do it Versus coming into it, learning from our mistakes and being willing to make ourselves vulnerable and ask questions. We're not always trained that way. We're trained. We're kind of sometimes chastised for imperfection, which is a totally backwards way of living that promotes a facade and being pretentious and does not do what's best for patients. But anyway, I could go.
Speaker 2:I always said to my students that the minute you think you know everything is the minute you need to get out of the field. We need to always question everything that we do. I still do it, every single time I do a modified.
Speaker 3:Yeah.
Speaker 2:Miriam Swalens. Today I question everything I do and if you get to the point where you're comfortable, you hurt people, Right.
Speaker 1:You look at the progression of science and so we're at a pretty good point because 2024, like there's been some very logarithmic exponential growth and we know a lot. But like, if you go back 200 years, they probably thought they knew their stuff Okay, and we're probably pretty confident in it. And so, like, how do we know we're not there? Like, how do we know we're not there right now and in a hundred years you're going to discover so much more and we're going to be like, oh yeah, it's pretty dumb overall too. So I you've got to have an open mind to and be humble about it. But but about this thing that you all got together, it did for 17, 17, 15 years, 15 years, a long time. Yeah, swallowing cinema. What is the swallowing cinema?
Speaker 3:well, it started out with Nancy Swigert who thought that we should have say at least one lecture every single ASHA with board certified specialists in swallowing and swallowing disorders to give case studies, to just show that you have an elevation of credentials and that you show your vulnerability, that you're going to show this case study. That's kind of unusual and how you reached out to a team to figure out what to do with that. And and that's where it started and it evolved into something that we just do every single year now and more people have gotten involved in it. We've been involved in it for I don't know how many years yeah, I was the newest addition, I'm the two.
Speaker 2:Yeah, look the one that's.
Speaker 3:I mean nancy had me started with um donna edwards, and I can't remember the other person. I feel bad. I don't remember who the other person was, but she was a board certified specialist and then it went on from there and it was always something about bedside swallows or clinical swallows of ales and then instrumentals and what you do with patients.
Speaker 2:Right.
Speaker 3:From birth to.
Speaker 2:It was almost like before fees was really so much in practice and then we brought fees into it, right, right.
Speaker 3:And then you brought in high-resolution manometry. Yeah.
Speaker 1:So, but it's basically these are case scenarios, right, case studies that you build.
Speaker 2:We thought of the most Of cases that were challenging to us from the year. We were really thoughtful of the cases that I selected because we wanted them to be a learning experience for the attendees and we had I've done things where, like, I've been wrong you know which is like and the patient thought he was aspirin all the time. He wouldn't eat because he was coughing, coughing, coughing constantly and it was actually just his tumor pressing and when it went through the, we finally finally did a modify. They didn't do a modify right away. I mean it's kind of sad he could have kept eating, but they like pegged, never mind, it's just.
Speaker 2:But I don't know if they pegged him or not, it's been so long, but it was just like, as it as, as the bolus went through like kind of the aortic arch area, he had a mediastinal tumor and it was kind of pressing on the nerves and stuff and so he coughed. When it went through there, everyone was fine, but he was like I can't eat. I can't eat. I you know, I haven't eaten in a week and they found that great justification for an apv.
Speaker 1:Yes, that, that's the other which we.
Speaker 2:You know which we did, but we could see that. You know that's the other part of it that we'd like to bring forward is how do you examine? You know which we did, but we could see that. You know that's the other part of it that we'd like to bring forward is how do you examine? You know what do you do for your instrumental. It's it's not just a lateral view and it's lips to, I'm gonna say it, lips to les. Yeah, you have to look at the whole system because it's there's an interrelationship between what's happening, between the oral, pharyngeal and esophageal let me say the word phase, because they are phases.
Speaker 3:But they're not really phases.
Speaker 2:It's just lip-steal-a-s and you have to look at the whole system Because if the drain's not working, you're going to have residue in the ferret, you're going to have pressure differential. You're going to back up, your system's going to back up. It's all one tube is what I say almost daily.
Speaker 3:It's all one tube almost daily, one, two, one, two, yeah, part of that. With some chambers and valves, exactly, there's pressure differentials and those pressures are going to affect the pressures in the esophagus, are going to affect the pharynx. I'd like to pick, sometimes, cases where we allow people to aspirate and then is the like.
Speaker 3:What jim coyle and I talked about with one of your part podcasts was you can't always eliminate aspiration, so can we just do what's best for the patient and then work on pulmonary clearance tasks, work on oral stuff, keeping your mouth clean, keeping people mobile and letting them? Letting them aspirate and living a life that they want to live, instead of what our, what we think a patient should do?
Speaker 2:We do that, with so many of our patients that are post-radiation patients, we do?
Speaker 3:We should do it with HUTNAP.
Speaker 2:ALS. Als, I mean absolutely. Thank you.
Speaker 3:But for some reason in the acute neuro world, if they penetrate on a modified person.
Speaker 2:People freak out, right Like whoa whoa, whoa whoa. But we keep coming back and I repeatedly come back to that Langemore paper in 1998.
Speaker 3:That's a several years, I mean it's 25.
Speaker 2:More than 25. It's just old. I count the years. You need to keep coming back to that paper. And why has that not caught on with so many people? But that's the paper I go back to repeatedly. People, but that's the paper I go back to repeatedly with with the people, are the physicians, because you know, we, we are facing an aging population of chronic aspirators and they keep coming into the hospitals and there's no pathway for them and you know that. You know the doctor's like oh, if you're aspirating well, you should be dnr and on hospice.
Speaker 1:I'm like what well, no, that too, yeah, yeah, so that's, that's how things are, and but how do we? How do we fix it? What are the barriers to get there?
Speaker 2:it's education well what are the patient's goals? Right, okay, you have to be an advocate for the patient and certainly we have to give them the the most you know whatever's going to be an advocate for the patient and certainly we have to give them the most you know whatever's going to be the safest recommendation. But what do they want? As you were saying, it's really important and bring that into this discussion with the physician.
Speaker 3:Yeah Well, I've had lots of patients lately, where the families are like we're not going to do thick and liquid, we're not going to do a feeding tube, and I said, okay, then we're going to do what we can do. And so water brush your teeth, let's water aspirate. Let's do some ems, ems t, let's do pulmonary clearance tests. Let's get them motivated, our, our ots and pts. When they know someone's an aspirator, they get them up and moving faster. The ots get them to brush their teeth and feed them. That's their goal is up in a chair for meals. Brush your own teeth, feed yourself looking at it comprehensively.
Speaker 1:You're looking at why we care about aspiration, okay, pneumonia, asphyxiation, whatever pulmonary sequelae but then you're also considering all the other variables that can relate to those things and trying to control those. It makes sense. It's multidisciplinary work. It's like you're making sense I also.
Speaker 2:I also. I also want to do a plug for therapy, because in the acute care setting right, we can't just diagnose, we can't just assess Diagnose not use, yeah, diagnose, not use. I say it all the time. I think it's so important for us to use the skills that we've learned for therapeutic interventions and also use our instrumental examinations, the fees, to see do those strategies that we're implementing really going to help the patient? And I think that will guide how we can optimally help the patient.
Speaker 2:But, the frustration that I have, though, with therapy is, if I bring somebody back first, we still don't have guidelines for how many repetitions does somebody need to do these exercises for how long? So you bring them back and there's no real there's no improvement. And so then it's like did I not tell you to do the right exercise? Are you not doing it correctly? Did you not do it long enough? Did you not do as many repetitions? That's the frustration for me.
Speaker 1:There's a magic number, though I mean there's a lot of visualize. Yeah, there's no guiding principles but then there's a lot of digital life. There's not a lot of principles, but then there's variability. Right yeah, we have to modify.
Speaker 2:When somebody comes back and doesn't improve. You've got to that's the thing that I as I've gotten further into my career. It's not like it's not the exercise didn't work, it's like did I do something? Is there something that I didn't suggest for you that would benefit? Yeah, you well, sometimes we get to that point where there is nothing. You know we've done everything right and but I think we should do our best to use the skills that we have and the interventions, whatever they might be, and then guide it, you know, based on that patient.
Speaker 1:Yeah, exactly, do something, try so, you, you, there are a lot of different things here. There have been plenty of things that we could tangent and talk about for a very long time. So, like a moment ago, the idea was mentioned doing what's safe is what is as safe as possible, right? However, I bet if I went back and said what do you mean by that, that it would be more to it.
Speaker 2:What is safe?
Speaker 1:Well, what is safe it? Is life must be lived as safely as possible. I drive a car every day. That's not very safe.
Speaker 2:Do you wear your seatbelt?
Speaker 1:I do.
Speaker 2:Yes, yeah, absolutely. We rely on the tools that we have right To make our best clinical judgment, to be able to render a clinical decision to the patient, and then we work with the patient based on their goals. We implement our strategies, our our therapeutic interventions. We do the best that we can. There's no magic wand. I many times wish I had a magic wand for our head and a cancer patients, and they're not. You know that doesn't exist.
Speaker 1:So sometimes we have to understand that we live with aspiration anyway right, yeah, right, and that's what I that's what I'm going with is is it's? It's more than safety, it's just multi-faceted.
Speaker 2:It's faster than like your article.
Speaker 1:Yes, exactly Well, cause if we're just safety, safety, they aspirate, we stop. Okay, that's not safe, they aspirate, we stop. Then we, you know, or we do onyxiclic acid, we transfer it hospitalizations for pneumonia.
Speaker 2:This? Who talks to them about? This could happen. I don't know, because we don't know how much somebody could aspirate to get pneumonia regularly and so keep going, and here here are the best things I know to help you mitigate that. I think most of the time the patients are going to make, they're going to make their own decisions based on information that they know that give for their own goals, their slp.
Speaker 2:They're going to listen to it too. I mean, they need to draw on that. But you have to be careful because a lot of times people are going to put their own biases in their recommendations.
Speaker 3:That's just what I'm saying.
Speaker 2:And you know you've got especially older populations. I think they are less likely to question whatever somebody tells them they need to do from a healthcare standpoint.
Speaker 2:One of the best things that happened in our facility is we got palliative care more involved in the care of patients to have goals of care, discussions with our patients because our surgeons are wonderful but they want to fix the patient Sometimes it's not fixable or the fix could actually come to sometimes be worse than what they've got and and having some discussions with patients to where they really really understand what are your choices and what are the choices that's right, that's right, that's it.
Speaker 2:That's part of our ethics, that's part of the basis of what we were supposed to do as speech and language pathologists is first, do no harm, yeah. Second, educate the patient. Well, maybe not in that order, but educate the patient, educate them on and balance between function and whatever quality.
Speaker 1:Yeah, you have to balance that I mean, ultimately, they're in control and so we're helping them. We're providing the information based upon our knowledge and skill set to be able to make the best decision.
Speaker 3:I think that's exactly it.
Speaker 2:We are there to provide education but, at the end of the day, what they decide to do right is up to them.
Speaker 1:100 and what happens when we get into the mindset that's like, okay, I'm gonna protect myself because I don't want to get sued and so I'm gonna document. I told this patient you need to be on my lethally. They said I'm not going to do it. And I said but if you don't do it, you might get pneumonia, you might die. And they said oh, I'm still not going to do it. Versus they said they're not going to do it, our recommendation and if they don't like that, maybe finding another way that they're okay with right, I think it's understanding.
Speaker 2:Are you protecting you? Are you protecting your patients? There you go, they're in control, right? Yeah, there was actually a really there was a good presentation today and they it was, I'm sorry, I hate to like only remember one of the presenters, which was nicole rogas pulia, but it was on with dementia and it was providing the families with choices of like okay, do you want to drink mildly thickened liquids?
Speaker 2:Do you want to do thin liquids and start doing better oral care? You know, and it was like providing the patients with choices and they're like do you want to do, you want to do emst, or you want to do like an effortful swallow and like some exercises and stuff like that. And they chose like emst. And I'm like that. I was like, wow, you know, yeah, it was, but it was out of her lab in um university of wisconsin and it was just like you know, boom, boom. I've been practicing forever.
Speaker 2:I'm like this is excellent, because you know I'm dealing with now that I've moved out of the texas medical center, I'm in a community hospital much more of an advocate for my patients, because we don't have the resources, and just like for being able to provide them. Let's let. That's an awesome like give them an op, give them an option, give them like two choices. They're more likely to actually right for quality of life and that's what they had like high adherence and you know, and I don't like they're not adhering to my recommendations. It's their choice. I don't, you know, I'm not big on that word, but it's better than oh no maybe adherence is okay, it's the non-compliant that drives me.
Speaker 2:They're a prisoner. Yeah like yeah, you're not, he's non-compliant. I'm like no, he doesn't want to do it can we just a step further?
Speaker 3:yeah, what you're saying is exactly take it a step further for those that work in acute care that have to pass a patient on. So I had a patient parkinson patient I just presented this on a tim's university and and he was Parkinson's known aspirator was in our hospital. For COVID aspirator within liquids pooled with pureed esophageal issues went to a care center. The therapist at the care center insisted he do thick and liquids. Of course he comes in the hospital. He's an indwelling catheter because he's got a, an issue that doesn't have anything to do with speech pathology. So he comes in the hospital with altered mental status and the very first thing he very delayed response altered all that and he said I don't want any thickened liquids.
Speaker 3:So what we did was we did exactly what they wanted, like you were just saying his preferences. Why I said no thickened liquids. We knew he's a known aspirator and then we passed it on to the patient that was going to the care center again different care center to the speech pathologist. I called the speech therapist and I said hey, you're going to get a patient of mine, this is what's going on. And they did the same thing that we did so. We followed up with with respiratory staff keeping his mouth clean yeah physical therapy involved.
Speaker 3:We're going to let him aspirate. And the wife was ecstatic because I said let me call the speech therapist instead of you saying the same thing over again. Right, we work with great therapists. And then he came back to the hospital a month later because he was quote better. Right Now he's going to do his modified again, we're going to repeat it and this modified is going to be better. Guess what? It wasn't that much better. So he's still an aspirator. I still showed everything to the wife and the patient and he hasn't come back with a pneumonia. So here's a guy who's Parkinson's.
Speaker 2:Everybody would freak out about him. The question is who cares Right? Who cares Right?
Speaker 3:He came back to the hospital like two weeks later altered mental status, sepsis, because he had an indwelling catheter. I was going to do. I said we're going to get him up in a chair, we're going to do, we're not changing anything. And they were good with that because we kept the patient preferences and we protected the patient as much as we could. Yeah, and follow through with what they wanted, what the skilled nursing speech pathologist wanted, all of that. We all put the patient first Instead of oh my gosh, he's aspirating. You've got to have thickened liquids. No, I was sneaking him coffee every morning. I'm like, is she sneaking him coffee every morning? There's quality of life 100% agree with that.
Speaker 1:I had a thought. It left me.
Speaker 3:Welcome to my life. I just think you need to pass on information to people not just live in our silos but like if I'm going to pass a patient to you.
Speaker 3:I'm going to call you and say hey, I mean, I did that the other day. I said you're going to get this 92 year old train wreck. She's a doll, Her son doesn't get it, but she's a doll. And this is what we were doing. And those guys call us and say hey, you're going to get a patient from us who's you know had another stroke. Something's going on. Make sure you follow them. That communication to the person passing back and forth, I think is vital it's really continuity, continuity of care is really that's a huge issue I forget.
Speaker 2:When we're discharging the patient that they're going to in the midst, we have to think about where they're they're going, how those recommendations are going to help them carry on. I think the hard thing in acute care is like they're gone the next morning. I didn't know they were going. I mean like I can monitor case management, but I don't know that they've gone.
Speaker 1:Well, but what if you have a good relationship with the people in the community and they know they can call you? So you might not get to call them preemptively, but they know they can reach out to you.
Speaker 2:I have people call me and I know there's probably HIPAA issues, but you know. No, it's not as long as you're involved in the care, okay, I was going to say HIPAA, shmipa, but you know we're not going to identify who that was.
Speaker 3:I asked the patient and I asked the worker yeah, Like this 92-year year old I saw last week. I said is it okay if I contact the people? Yeah, I talked to them and talk to them and I documented it. Patient and son, you are allowed.
Speaker 2:You're allowed. Yes, I will tell anybody who calls me. Whatever I'd like to ask, is it okay? You want me to?
Speaker 3:call them and I documented that. The patient and the son said it's okay. And I just document it just so that like nobody get Freaky Friday on you.
Speaker 2:But it is called continuity of care. It's something that we should be doing. It's not, you know, we don't have. You know it's something that's really important to help that patient and the people in the community.
Speaker 3:They appreciate it. They call me all the time and say, hey, you're getting someone back, and then, once you get that ball rolling, it doesn't stop. Stop, it just keeps. It's a wonderful relationship with the people in the community.
Speaker 2:Yeah, yeah I I want to go back to the mentorship thing because for young clinicians, if there are like young clinicians listening to this, find a mentor, reach out. I did that early. I reached out to barbara sunnies and would call her, like all the time.
Speaker 2:So find someone to, to help you to, you know bounce things off of yeah, whoever that might be whoever you feel that you respecting clinically yeah, that's important, make those connections, because there's a lot of questions unanswered that you, you know, you may find that having a mentor is going to really help you through your career and I think all of us here sitting here did that right. I mean, yeah, I did that as a leader. I mean we've all had people that we had mentors with.
Speaker 3:Besides, each other.
Speaker 2:Right Besides each other. I think right now we have each other, but also we are very I know we're all very passionate about mentoring the next generation of clinicians.
Speaker 1:It's a good continuity of care.
Speaker 2:And don't forget about PCSS, passing it on to John. Yeah passing it on and empowering people.
Speaker 1:Well, we've probably wrapped this up. I don't think there's really necessarily a core theme to this episode other than the fact I had something there. I had something there, it was going to come out, and I planned to edit this episode. It's going to be so perfect.
Speaker 2:Wait till you're 63.
Speaker 1:Wait till you're 63.
Speaker 2:Wait till you're 63. It just like disappears. Tell everyone you saved it. I look good for 63. I never tell so. Anyway, you're older than me.
Speaker 1:Stop it. Just to summarize A couple of things that we've gone through. The importance of communication yes, I think key. You know the importance of vulnerability, key. You know the importance of vulnerability. Not faking it till you make it which man I don't know how many episodes I've said that on people are gonna say, if you said that one more time, I'm gonna shut this thing off. But you know being vulnerable about what you know. And that goes with the mentorship too finding a mentor who will accept you for that and not expect perfection, because certainly they're not. And so you know you have a pretentious, dishonest individual if you have someone who's doing that but being open, willing to communicate with each other. A speech pathologist when you need help, but also when you're handing off care to, so people feel like they can reach out to you and you can reach out to them, man there's a lot more.
Speaker 3:Listen to your patient yeah, listen to your patient read a room read a room.
Speaker 3:Read the room that read the room. If you're in acute care or outpatient and someone comes in with that patient, read the room, look at the person that's with that patient, read, read the room with that patient. I think we don't get those soft skills in school and we, because we've worked for many years, can read a room really fast, but those are skills that are difficult to learn. How to? How much information do you really give? Like we're giving information about a modified and I said this is easy peasy, this isn't rocket science. I'm not a rocket scientist.
Speaker 3:Let me show you your modified barium swallow and I don't give terms, unless they're in medicine. Do I give terms? Right? But I'll say you know I have a system that you know, the TIM system, so you can say on there like here's your flapper, here's yeah, you don't want this going here. It's like a laundry shoot. The more you understand why you're doing what you're doing, the more you're going to be able to to help, not do the things that you're going to be able to follow these compensatory strategies easier. But read a room like there's times I'll be talking, you can tell the patient and the spouse are just yeah I would think I'm processing anything else at this point, important not to take those things for granted too, because they come so easy to you after years and years of experience.
Speaker 1:But it took you a while to get there and so not forgetting to break those things down and to explicitly provide instruction to students on those things too. So not just the physiology, not just what you see and why it matters, but the importance communication, because if you're handing off somebody from acute care to a long-term care facility or whatever you could have the best note.
Speaker 1:They might not have the time to read it, but they have the time to pick up the phone and you can explain something to them in two minutes and they can ask questions and whatnot. It goes a long way, and so just not forgetting about those things. So I guess I don't know what I one thing that I'm pulling out of this is is to look beyond the concrete and the physiology, the, what you see, but really to emphasize, like reading the room and and the, the communication, why it matters. It's just a lot of, a lot of different things.
Speaker 2:One little point I would like to make is don't forget about the caregiver in the room, right, because they are so critical to the rehabilitation of that patient. They're living with it and oftentimes they are the ones that's forgotten in the room, but they have to go and cook the meals and help the patient so once. It's important to the patient, what's important to the caregiver, absolutely. But but what? Why does? What do they ultimately care about? I think is the thing that, as I get closer and closer in age, to many of my patients.
Speaker 2:That's the thing. It's like what? What am I? What am I doing to my patient when I'm making these recommendations?
Speaker 1:yeah, it's real. You can relate to them more and so you empathize with them more and you're like what would I want if I were in their position? Yeah, no, it makes a lot of sense. And just a reminder, this is a very laid back episode. This is, this is talking. There's not something directly that we're looking at other than a bunch of people were very comfortable speaking with each other, who are bound by a relationship of doing not just swallowing sin, but working together in a number of different ways in the past, and I think one of the reasons you gel is because you've got a lot of pretty like laid back, similar mindset on a lot of these things, and that's very refreshing to hear from a lot of your perspectives. With that, is there anything at all that you want to leave with a lot of really good things to to draw out of that? And looks like you got to take off. Don't be ceremony huh, yeah, no that's right.
Speaker 2:I'm ready to go breathe the room I mean the relationships that we've formed over the years. I mean we've all been friends for, at this point, over 20 years at least I mean, but we love each other because we all, at the end of the day, care deeply about the people that we serve and care deeply about the impact that we have on other people. And just Well said Dr Souter.
Speaker 1:Yes.
Speaker 2:Professional relationships are important. They're really important to my life.
Speaker 3:Yeah.
Speaker 2:But these are the most important relationships that outside of my obviously intermediate family that I know. Yeah, yeah, yeah, my husband just thinks I shove applesauce in people's faces all day. So I didn't. I would say the other thing. The last thing is that when I started my career, I thought I needed to read everything, learn everything, and I felt overwhelmed. And somebody told me that's what you do every day is you practice, practice, practice, and that's what. That's what. That's what it's all about. It's just your practice and it gets better, but you learn as you go.
Speaker 1:Yeah, Very cool. Well, thank you all Really appreciate it. Great to meet and hang out and look forward to chatting again.
Speaker 2:Thank you, thank you, thank you.
Speaker 1:That's another episode of Swallow the Gap. Special thank you to our guests Julie Blair, lori Sterling, dr Deb Suter, dr Barbara Messing and Joe Ponteel, and I'm excited to announce a special two-hour webinar coming in late February involving most of these ladies diving into some fascinating modified barium swallow studies, and this course continues the 15 or so year legacy of swallowing cinema. For more information, keep tuning in or sign up for the mailing list at swallowthegapcom, or follow me on instagram at swallowallow Patho, that is, at Swallow P-A-T-H-O.
Speaker 1:Gap Education's last two webinars for ASHA CEUs received stellar ratings, at an average of about 4.8 out of 5. And they were a lot of fun, so we hope to see you there. Additionally, visit SwallowTheGapcom for more information about upcoming live and recorded courses in 2025. Many of them actually most of them on there toward the beginning of the year. And last but not least, a special shout out to this episode's sponsor, the Milton J Dance Endowment, a sponsor dedicated to supporting head and neck cancer patients and individuals with swallowing disorders across all populations. Thank you for listening and we'll see you next time.
