#SLP2B Class of 2014: Commencement Advice from Dysphagia Cafe

Dear Class of 2014,

You have finally made it. Well, I know for a handful of you, it still means one last class that had to linger over the summer, but you finally did it. Many have the choice to work more within the medical confines of Speech-Language Pathology or to work in clinics and schools. I speak, now, to approximately 50% who will choose to work in the medical setting. Of those who want to work in the medical setting, there may be a handful that say, “Get me away from swallowing stuff.” I speak now to those who say “ I love working with those patients who have dysphagia.”

Here’s a short list, but by no means an exhaustive list, of expectations:

http://www.dysphagiacafe.com

1) Expect for the next several years for you to have lingering headaches after work, as your brain approaches overload, from learning at least five new things daily.

2) Expect to say some really stupid things to an RN or MD, there is no better way to learn.

3) Expect to be grossed out by a mammoth dried secretion during oral care.

4) Expect to be expectorated on by a trach patient until you learn to not stand in front of him.

5) Expect to whisper to yourself daily,  “I have no clue.”

6) Expect to take “forever” to generate your impressions and recommendations.

7) Expect to gasp when you witness gross aspiration.

There will come a time when things start to really click. Don’t make the mistake of letting that be an overconfident moment.

1) Humble yourself when you make a mistake and learn from it.

2) Discipline yourself to read at least one journal article a week. Not just any journal article; pick a topic and focus on that topic for a month or two.

3) If you do not understand a medical diagnosis, go home and look it up.

4) Be intentional and practice your confident communication with family members, caregivers, RNs and MDs. It is a skill to get MDs to trust you, a skill you will get with practice.

5) Take the time to nail down clinical skills in dysphagia. Spending 30 minutes to feed a dementia patient, early in the career, may do wonders for clinical growth.

6) Participate in as many VFSS and/or FEES as possible. Take the extra time to review the studies multiple times. Really grasp that aspiration is such a small piece to the diagnostic exam.

7) Contemplate that understanding the etiology of dysphagia is critical to treating the problem.

8) Target your therapy to make it patient specific. Avoid thinking that you only focus “neck up.” Understand there is often a bigger picture that includes the whole body, when referring to patients with dysphagia.

If you don’t take this unsolicited advice. Just Remember:

1) Expect that you will make a huge impact in a patient’s life.

2) Expect that returning a patient back to an oral diet is amazingly rewarding.

3) Expect that you will have great joy when your continuous education clicks with some staff members.

4) Expect to be a specialist in an area that few in the medical field understand, outside Speech-Language Pathology.

5) Expect to never stop learning, no matter how many years you have been in the field.

While my passion is dysphagia,it may not be your passion. Regardless, I wish you all the best as you embark on this most challenging, yet rewarding, career.

Sincerely,

Jonathan M Waller

MA CCC-SLP

Founder of Dysphagia Cafe

Dysphagia Therapy: More Rehabilitation and Less Compensation

I have been on a kick lately. You know those kicks that come after you reboot at a stimulating conference? Perhaps, they come when you have an encounter with a special patient. Well, this dysphagia kick has me singing a new song. It’s called: “Let’s rehabilitate and not compensate.” Perhaps this is not a new headline for many clinicians, but I have had this concept in my head for a long time. I may sing its praises to colleagues who may be interested in hearing, but rarely do I ever tell patients, RNs and MDs about it, until now.

This concept requires significant buy-in. It starts from the minute I enter the patient’s room and meet him for the first time. I have two minutes to win over her trust. No longer do I lead-in with “My name is John Doe and I am a Speech-Language Pathologist and we are going to see if you can swallow.” That usually gets me

1) I can swallow fine

2) My Speech is fine.

I have learned to adapt to my audience. Such adjustments may include, “I am your swallowing trainer for the next 3-4 weeks and if you train really hard, I am confident you will be able to achieve your goals.” I want her to know:

1) Therapy is mandatory if they want to get better.

2) Therapy is going to be hard work.

3) I want the patient to know that when I visit , I am not coming to “check” to see if they “pass”

4) I inform the patient that I am there go-to person if they have any questions, misunderstandings, concerns about how they are swallowing.

5) We will establish together and work hard towards attaining the desired goals

Sound too flowery?

Now, that I have patient buy-in, it is my job to remind the RN, that when SLPs come to see the patient, we are not checking to see if they “pass” or “fail”, but we have a treatment plan to improve their safety with PO. In many cases, I ask them not to use the terms “pass” or “fail” around the patient as this sends the wrong message after every session. This is achievable, right?

Now, whether I communicate daily results with the MD via conversation or documentation, I am more strategic in my writing. In my notes, I am focusing on what the patient can do, not necessarily on their deficits. I am focusing on their motivation. If my target audience is a Pulmonologist, I may discuss how their cough is improving and leave the base of tongue discussion for another time. The MD starts to think, “This SLP really knows what he is talking about.” Small victory???

Now, granted these may be ideal and isolated scenarios, at best, that likely do not apply to most situations. The main point is that, I believe there is room for us to change the way we do business. Lets face it, globally, outside of Speech-Language Pathology and a hand full of ENTS, other professions and patients, just do not understand dysphagia.  As Swallowing Pathologists, (sounds catchy, huh?) it is our responsibility to rehabilitate patient, staff, MD misunderstandings, rather than compensate. The ways in which we do that may require a new way of establishing rapport with patients, new ways of branding ourselves and our services to staff, and new ways to reach our various target audiences. We all know this deep down inside, some may have it figured out, but now it’s time to start talking about it out loud.

 

To Dysphagia Therapists Everywhere: Happy New Year!

This is the part where I spread out a host of resolutions: Eat better, lose weight, buy a Porsche, never touch honey thick liquids with a ten foot pole…Wait, this is not about me.

Once upon a time, in March 2013, Dysphagia Cafe set out to facilitate a community for the Dysphagia Therapist. The hope was not to create an advice forum or individual expert page, but a community that is supported by experts from all corners of the earth. There has been some amazing guest blog posts that have made this site’s content rich and diverse.Personally, I have enjoyed the amazing networking and feel fortunate to have met a lot of brilliant and inspiring people along the way. We learned about Dr. Michael Crary’s favorite coffee and a little something about dysphagia rehabilitation. We talked about cities like Reykyavik, Iceland and we learned that Mash Mission is a really cool way the English say, “Let’s fundraise for a good cause by eating puree food.”  I finally feel somewhat confident about using #hashtags and am no longer afraid to use “SLPEEPS” when referring to colleagues in the plural.

Needless to say, I am having a blast in the geekiest way possible. I am hoping you are finding this community to be in good taste for the purpose of learning and growing for the benefit of our patients.

I am looking forward to help make Dysphagia Cafe a brighter, richer and tighter community in 2014.

Have any clinical resolutions? Please leave them in the comments box to share.

Happy New Year!!!

#Dysphagia Cafe : )

Not the Blog Post I Wanted to Write about MBSImP Training: By Rachel Wynn, M.S. CCC-SLP

Article Written by: Rachel Wynn, M.S. CCC-SLP

Take a look at the date on the picture above. Yes, I attended the MBSImP seminar over one year ago. And I signed up for the online course (to get certified) while I was at the seminar.

I wanted to write a blog post about how great MBSImP training is and how it has been incredibly useful to my practice. We all want to write positive reviews, right? But more than that, we want to show where we’ve been successful. I can’t write that post though. I haven’t finished the training…

The seminar was great. I totally respect Bonnie Martin-Harris. Her team’s effort to standardize the procedure and documentation of MBSS is very needed. As an SLP working in the skilled nursing setting, I rely on other therapists to complete MBSS assessments on patients I recommend. And I rely on their documentation to determine what we’ll do next in therapy. I often didn’t get the information I wanted, not because the therapist did anything wrong. They just seemed to be looking for different things than I wanted.

So even though I wasn’t actually doing MBSS myself, I felt that it was a valuable tool and signed up to the complete the online training to become certified.

When it came time to do my online training I became frustrated, not because the material was poor or the technology was poor. Everything was fine there. Dysphagia is just difficult for me to study online independently. I found myself being just slightly off when judging aspects of the swallow. Maybe it is my computer screen, but I frequently missed the “trace” residue on studies.

I’d get frustrated and I’d quit. Then I’d pick it up again a month or two later. Rinse and repeat. I’m still not finished.

The training is good. This student doesn’t learn dysphagia well online. The nuances are too difficult to discern. Ideally the MBSImP training would be a part of a dysphagia course in graduate school or would be completed by a group of colleagues who could study and implement practices together.

I want to finish the training. (I’m a perfectionist –  must have that success!) Anyone in the Boulder/Denver, Colorado area and want to get together to hammer this out?

Join the conversation. Tell us about your experiences with MBSImP.

About the Author:

Rachel Wynn, MS CCC-SLP is speech language pathologist specializing in geriatric care. She blogs at Gray Matter Therapy, which strives to provide information about geriatric care including functional treatment ideas, recent research, and ethical care. Find her on Facebook, Twitter, or hiking with her dog in Boulder, CO. 

Related articles

• Measuring Sensory Loss in the Throat as a Component of Swallowing Dysfunction
• Lets Get Organized: New App for SLP Interns and Clinical Fellows
• Dysphagia Rehabilitation and a Nonfat Latte: Interview with Dr. Michael Crary
• SLP Inspiration: Oh, to be able to “talk and eat”

Clinical Fellowship: ‘Tis the Season

 

ON THE TWELFTH DAY OF FELLOWSHIP MY CI GAVE TO ME…

12-Cranial Nerves

11-Patient Caseload

10-New Evals

9-Stacks of Competencies

8-Minute Chart Review

7-Pack of Tongue Blades

6-Research Articles

FIVE SIPS O’BARIUM!!!

4-Bites of Puree

3-Decks of Cards

2-Ibuprofen

And a Name Badge With My Own Key

MERRY CHRISTMAS AND HAPPY HOLIDAYS TO ALL, ESPECIALLY TO ALL THOSE AMAZING CLINICAL INSTRUCTORS AND ALL THOSE FEARLESS CLINICAL FELLOWS.

Sincerely,

Dysphagia Cafe