Our guest chat host tonight on October 2, 2000 is Dr. Cathy Lazarus, from Northwestern University. Dr. Lazarus' clinical work involves assessing speech and swallowing disorders, using bedside and clinic tests as well as videofluoroscopic examinations of swallowing, and providing therapy to improve both skills. Her work also involves neurologically based communication disorders and dysphagia in an acute care hospital setting. Outpatient clinic interests focus on assessment and treatment of functional voice disorders. Dr. Lazarus is the Swallowing Program Coordinator for the 2000 ASHA Convention. Tonight she will chat about assessment and treatment of swallowing disorders. <Maggie> how do you diagnose a swallowing disorder <Cathy> You perform a clinical examination, which includes an oral-motor exam and a swallow exam. Then, if you feel that there is pharyngeal phase swallowing problem, x-ray study. <Adrienne> do you recommend thickened liquids? <Cathy> not being able to swallow is very devastating. <Katie> One of the swallow studies I observed did all of those things..it was very interesting <Adrienne> and how do you decide how thick? <Cathy> I only recommend thickened liquids if I cannot eliminate aspiration with postures, maneuvers, or a combination. <Kelly> Gravity works? :-) <Cathy> Katie - good that you were able to see a decent study being performed! <Erin> did you know what you wanted to specialize in when you were our age....2nd year college kids? <Cathy> Actually, i was a pre-med major and the first quarter of my freshman year I didn't do too well in chemistry and calculus and I was going to drop out of college, but someone told me NU had a speech program <Adrienne> good question <Katie> the liquids don't they enter into the trachea if they are too thin? <Adrienne> that's what I was thinking <Adrienne> gravity could almost be a bad thing <Erin> wait, what do the liquids do in the first place? <Katie> that is what happened with the older women I was observing... <Cathy> Liquids are the easiest to aspirate, since they move the fastest. <Katie> they test the swallowing <Erin> to get nutrients through their bodies without an IV? <Katie> no <Erin> oh, just for testing? <Cathy> You typically give patients liquids, puddings, and a masticated consistency, like a cookie. <Adrienne> just to clarify: aspiration is when food or liquid enters the trachea instead of the esophagus, yes? <Erin> nevermind, i mean i am clueless....sorry <Cathy> Yes, down in the x-ray suite. Yes, aspiration is just that! <Kelly> That stuff tastes terrible-- had to eat some the other day for class! <Katie> they let you observe the swallow on the x-ray <Cathy> Yes, barium is not too pleasant tasting. <Adrienne> what do they swallow? <Adrienne> UGH <Adrienne> Do you ever have patients that don't cooperate during the test? <Kelly> Dr. L-- saw a study where they mentioned mixing barium with blueberry syrup-- do you mix stuff in? <Adrienne> or follow the recommendations afterward? <Cathy> If you ever get the opportunity to observe swallow studies in x-ray, you should - they're quite interesting. <Kelly> My professor laughed at the idea of "mixing" to improve taste <Cathy> No, we don't mix much other than our standard consistencies. We'd rather take the time to check out the effects of postures and maneuvers on swallowing and you don't want to expose the patient to too much radiation! <korissa> i just saw a video today with x rays of swallowing. it was interesting <Erin> we've been discussing cleft palates a lot in our class, what kind of swallowing problems can occur as a result of those? <Katie> you can also test regular foods so that the dietician at the hospital can have a good menu for the patient <Cathy> Actually, folks with cleft palate usually compensate and don't typically exhibit swallowing problems, other than newborns, who do have difficulty sucking. <Adrienne> mushed up food is still better than a feeding tube <Cathy> yes, pureed foods still taste better than no foods. <Adrienne> guess "mushed" isn't a technical term :~) <Cathy> Mushed is just how some patients feel the food looks! <Adrienne> do you have young patients or are they all elderly? <Erin> what about a swollen or incompetent eustachian tube? <Cathy> Don't think that should affect swallowing. Have never seen it do so! <Anonymous9184> Dr. L, what kind of specialized training does a grad student need in order to pursue a CFY with neonatal swallowing? <Cathy> Good question. You would want to request a practicum at a hospital facility that has a NICU. <Erin> oh, i looked at neonates today for FSW, there was one with swallowing problems, he'd been there for a week <Katie> Dr. L is it true that lowering the chin aids swallowing? <Cathy> Yes Katie, lowering your chin can prevent aspiration in those folks with poor tongue control or a delayed triggering of the pharyngeal swallow. <Kelly> Dr. Lazarus, do you work with other populations other than swallowing? Did you start out in swallowing or focus there after a few years out? <Adrienne> why do many premature babies have sucking problems? <Cathy> Kelly - I started out working in a preschool special ed program. But they went on strike after the first day of school, so I needed to find another job. <Kelly> lol <Adrienne> wow! <sw29> how did u like working in the preschool? <Cathy> When I started working at Northwestern, I never had a swallowing course. It took 6 months to figure out what I was looking at when Jeri Logemann, the guru, did the swallow studies. <Kelly> She wrote the book for our course!!! Logemann! <Cathy> Yes, she is my boss and has been for a very long time. She's a great teacher. <Adrienne> what course Kelly? <Kelly> I'm in a dysphagia (swallowing disorders) course this semester. Taught by Martin-Harris <Cathy> Oh, Bonnie is great! Really good teacher and a good person. You'll learn alot. <Kelly> Wow-- so far she's our favorite professor-- you can tell she "knows her stuff" <Anonymous9184> if you haven't had any clinical practicum experience is it possible to still look into a job in neonatal disorders or should you wait until you have some experience first <Cathy> I'd definitely wait til you have the experience. Actually, no one would hire you in a NICU if you didn't already have any! <Anonymous9184> Cathy, do you work with all ages with regard to swallowing <Cathy> yes, we see folks in the neonatal intensive care unit (NICU) up to the geriatric patient. <Erin> are all of you at NU but like 3 of us here at Miami <Cathy> I'd hook up with Donna Lundy at the U. of Miami - she knows alot about head and neck cancer treatment for voice, speech and swallowing She's a really sharp clinician. <Erin> thanks, though....i'm not sure about our swallowing specialists <Anonymous9184> do you work with other disorders as well? <Cathy> Yes, the majority of my caseload is voice disordered patients. <Robin> Cathy, Adrienne had asked a question earlier, why do preemies have sucking problems? <Cathy> preemies are delayed in their motoric and central nervous system development, which is why the suck/breath/swallow pattern can get screwed up, in simplistic terms! <Adrienne> what can you do for preemies? <Anonymous9184> I just recently got assigned a voice client, college-age singer with nodules. Is there any therapy website or resource you can refer me to? <Cathy> You know, there is a voice listserve, but I don't happen to know the address. I think it's out of U. of Iowa, Iowa City. <Cathy> I'd also refer to your class notes, texts, etc. You have a supervisor, right? <Maggie> Cathy, do you know of anyone at Miami Ohio who I can ask questions to <Cathy> I honestly don't, but I'd contact the speech and hearing program and see if someone would be willing to talk to you. I'm sure they would. They're always looking for good students. <Maggie> ok, thanks <Cathy> Jamie, are you enjoying your program and have you begun to see clients? <jaime b> Yes, I love it. It is a new grad program. I also attended ACU as an undergrad and saw a few clients then. Right now I have one new voice client but am doing most of my clinical work in an elementary <Kelly> Dr. L-- is tongue thrust considered a swallowing prob? I've got a client with tongue thrust at the elementary school where I'm getting clinical hours-- so far we're using oral-motor exercises <Kelly> My supervisor is worried about the resulting artic problems, but I was wondering if there might be a swallow concern? <Cathy> No, it's not considered to be a swaIlowing problem. It's a tough one to work on! <Kelly> She's 11 and doesn't want to be in therapy-- we are using lots 'o bribes. <Cathy> Artic problems are all you'll have with a tongue thrust, unless it's severe and if so, just will get alot coming out of the mouth at meals. <Cathy> Bribes work well! <Robin> Does any one have any questions about voice disorders? <Cathy> Jamie - glad you like the program. Voice clients are fun, aren't they.? You can hear the results immediately. <Adrienne> do you use computer programs with voice clients? <jaime b> I was wondering about some resources to check out for a client with nodules. She's a singer <Adrienne> I was able to use a Visi-Pitch once... <Cathy> Actually, we don't use computers, mostly because we can't send the patient home with the software and computer to practice. We'd rather get the patient to modify his voice without it. <Cathy> Visi-pitch is good, offers visual feedback, but still can't send it home with the patient! <Adrienne> right <jaime b> I actually haven't met with her yet. I am not sure where to start. I will see her this week for the first time <Robin> what are some of your most useful therapy techniques for nodules? <Cathy> Well, modifying their everyday behavior to start - quitting yelling, throat clearing, loud talking. Then move to modifying the pitch, loudness, breath support or airflow when they speak. <Cathy> Just raising their speaking pitch and getting a bit more out out when they speak works wonders. <Robin> What is your success rate with pts with nodules ? <Cathy> Pretty high, as long as they stay motivated! Only takes 6 to 8 sessions, typically. <jaime b> do you follow any particular program? <Kelly> What do you do if you have someone who yells for her/his job? i.e. teaching? <Robin> Dr. L is the expert for this! <Cathy> I see traders at the Chicago Board of Trade who yell in the pit. I teach them the "correct" way to yell that won't hurt their voice. <Cathy> It's also fairly easy to teach folks like teachers, trial lawyers, etc. how to project their voice. <Kelly> Is it too complex to explain "correct yelling" on the chat? <jaime b> where do you find your techniques that you use in therapy <Cathy> It's a bit difficult, but I'll try. You teach them to breathe diaphragmatically, then work on how to exhale rapidly while they yell so they won't hurt the vocal folds. then you work up from single word <Cathy> to phrases and to then be able to yell repeatedly, which they do in the pit. <Kelly> Thanks! <Adrienne> do people generally come to you for tips on "correct yelling" or do you recruit from where they work? <Cathy> I learned a lot of my techniques from an old professor of mine, Hilda Fisher, PHD (of the Fisher-Logemann test of articulation competence fame! <Cathy> I get most of my voice clients from referrals from our ENT docs. <jaime b> do you know of any books/websites for us to look into? <Cathy> Jaime - you mean for therapy techniques? In voice, Joseph Stemple has a good book out. <jaime b> yes, thank you <Cathy> Most folks are willing to have a student tag along for a half-day or so to observe treatment, if you're thinking of getting your masters. <jaime b> do you have any advice for those of us that are about to head out into the "working world" of SLP <Cathy> Jaime - yes, I'd say don't do anything you are uncomfortable doing or that you are unsure of - ask another SLP or your supervisor. Question things and if you don't know something - look it up! <jaime b> thanks for the advice <Kelly> Do you work with Alzheimer's patients at all? <Cathy> Kelly - yes, we see them for swallow evals, but not typically for speech therapy. <jaime b> what is your favorite disorder to work with? <Cathy> I love to work with the voice clients and also with the head and neck cancer patients - they are all cognitively intact and can do everything you ask them to do and are typically very motivated. <Kelly> What's a common swallowing problem for that type of patients? My grandpa has Alzheimer's, and he's changing his "tastes" radically-- we don't know if it's mental or physical <Adrienne> that's interesting <Cathy> Yes, Alzheimers disease is tough - your sense of taste, food management in general changes over time. Kind of a combination of mental and physical. <Adrienne> is that common in people with Alzheimer's? Cathy> Yes, Alzheimers's causes one at a certain point to not recognize food within the mouth. We can do an x-ray study and the patient will start talking while the food is in his mouth. <Adrienne> Does Northwestern see any neurogenic disorders? <Cathy> Adrienne - yes NU does see LOTS of folks with neuro disorders. <Kelly> Wow. I think I need to look into that area. <Cathy> No, really, the coursework is good and there are lots of options for hospital and school placements. <jaime b> how long do you need to work in a practicum site for it to be considered "experience" <Cathy> One quarter counts as "experience". <jaime b> as in 3 months? can you count it as experience even as a student <Cathy> AT NU it's a school vs. hospital track. You can see both kids and adults and do a school placement and still see adults. <Cathy> Actually, our quarters are only 10 weeks, but you'd be surprised what you can learn in 10 weeks in a half day or full day weekly practicum. <Adrienne> would you say NU is more clinically or research oriented? <Cathy> Yes, we need more researchers in our field - too many of the faculty are retiring! <jaime b> if you are wanting to pursue a particular area that you do not have clinical experience in would you suggest spending 10 weeks in that area and then applying for a CFY or begin your CFY in something else? <Cathy> Yes, you can always take a clinical job and use your patients for research studies. <Cathy> Jamie - I'd try and get a broad base of experience in the master's program, to get at least a little experience in the area of interest. Hospitals want you to have some hospital experience, FYI! <Adrienne> will I have any input into where my CFY is? <Cathy> yes, your CFY is wherever you can get a decent job that sounds interesting to you! <Robin> tell us about the research you're doing with tongue strength. <Cathy> Robin - I've been having normal healthy subjects do tongue strengthening exercises and then assessing whether tongue strength improves. Also have a control group that get no exercises <Robin> how do you measure tongue strength...with what kind of instrumentation? <Cathy> Robin - I use the IOPI - Iowa Oral Performance Instrument - comes out of U of Iowa, costs $1200. <jaime b> I am wanting to work in NICU, however, the hospital in my area doesn't have an NICU <Cathy> Jaime - there aren't alot ot those around - see if you can do some sort of internship at another hospital. <Cathy> Adrienne - you probably will if you get some good experience in grad school. <jaime b> Adrienne, your clinical practicum experiences will help you get a feel for what area you want to go in to. You will most likely surprise yourself <Adrienne> neat :~) <Cathy> Glad to have chatted with all of you. I need to go too - my dog is bugging me to go out! <Kelly> Thanks <Robin> Cathy, thank you so very much for joining us! <jaime b> thanks for all of the helpful info, Dr. L <Adrienne> Thank you so much for coming to talk with us!! <Cathy> Robin - Thanks for the opportunity to have been in this chat! <Cathy> Good luck to all of you in school/ work, etc.! |
