MB, a 60 year old male with a J-tube & diagnosis of stomach CA had just received his surgery for the latter with a gastric pull up pouch. He was to begin PO trials with the SLP at the SNF, but she was concerned about aspiration as well as digestion issues. The staff was unaware the patient was going to have secondary surgery to close the fistula at the site of the pull up surgery which had a catchment bag attached to it. (The site had not completely healed yet and was draining.) Unless you knew to examine the area of surgery this may have been missed. The LTC SLP intelligently requested a FEES for this patient, whose presentation you do not see every day. The patient was alert, oriented as well as in excellent physical condition despite his primary diagnosis. He was to be returning home shortly.
The patient easily participated in the exam. He was trialed with very small amounts of thin liquids, puree and dissolvable cracker. In terms of the oral pharyngeal component, nothing of clinical significance was noted. However to a trained therapist, a small hiss and splash under the patient’s clothes was heard. Yes……………….the food and drink – everything was coming through the wall of the gastric pouch into the bag! Had someone been performing the exam who had not seem complex cases like this over the years, this could have been missed.
The SDX FEES Specialist paged the surgeon, the situation was explained and the patient was allowed to have thin liquids as long as the bag was changed regularly and the site remained clean. The patient was given a post op surgery re-consult date before he went home. He hadn’t remembered that the surgery was 2 parts and that the fistula had to be closed. This decreased the patient’s anxiety ten-fold as he was terrified of what was washing through his bag. He plans to be discharged home, complete his second surgery to close the pouch wound, begin slowly transitioning back to small portions of regular foods and decrease or possibly eliminate his J tube feeds.
SDX prides itself on our hand-selection & thorough training of SLPs who have demonstrated excellence in long-term and medical therapy settings. It’s not always just about the exam, sometimes it’s the expertise AND ACCESSIBILITY of our FEES Specialists that lets you SEE the FEES difference!