Date:10-10-02
From: Julie Simpson
Subject: My mothers’s dysphagia
To: rikkilewis@slp.org

Rikki,
Recently we have been having some problems with Mom’s feeding. She is having a very difficult time with chewing foods that are hard or tough (like hard crackers or tough meats). She is doing excellent with liquids though and it seems as if aspiration is no longer the problem since we finally figured out the correct consistency we need to get to with the thick it, but now it is the chewing of foods that require more effort to chew that are causing her problems. I am wondering if maybe we need to come back and have her reevaluated or something so we can figure out why she is having a difficult time with the chewing of foods now.
Thanks,
Julie

Date: 10-10-02
From: Rikki Lewis
Subject: Re: My Mothers Dysphagia
To: julessim@yahoo.com

Julie,
It is great new to hear that your mother is doing so well with preventing aspiration of liquids and foods because that is the dangerous part of dysphagia. Now that we have that controlled I would like to incorporate some more oral-motor exercises to build strength in Mary’s labial seal (how well she is able to hold food in her mouth with her lips), tough strength (which is important in moving the food around so it can be chewed, and jaw/cheek strength (this is important in the actual chewing motion). Your mother’s stroke has left her with some mild muscle weakness, due to the fact that she has come so far with the exercises to prevent aspiration in the pharyngeal stage I am very positive about the oral-motor exercises, I feel she will quickly rebuild strength and will be able to chew these harder foods you discussed in your email. I would like to reevaluate your mother in the clinic to evaluate muscle strength and to decide what exercises will be right for her dysphagia and to determine which exercises will give her the most progress possible. You can just call the clinic and set up and appointment with me at your soonest convenience. I would also like for her to have another modified barium swallow (MBS) so I can see how things look now after the work we have done. For this MBS I want her to swallow just like she does at home with the postural changes that are in place.

Thanks,
Rikki Lewis, SLP

Date: 10-11-02
From: Julie Simpson
Subject: Reevaluation
To: rikkilewis@slp.org

Rikki,
Thank you so much for your input on my mother’s condition. I have called the clinic and we have an appointment for next Monday at 10:00. I am greatly looking forward to this, mother is very excited about her progress and hopes to finally start going out to eat again very soon. You know how important it is to her to be able to eat normally when she goes to restaurants with her friends. You have been so helpful through this entire ordeal and I just want you to know how appreciative we are of you.

Thanks,
Julie

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