Chronic Aspiration

Emily (0:15): Hi, everyone. I'm Emily. And this is Eva. And you're listening to Speech Talk. We're your research book club so you

Unknown Speaker (0:23): can do evidence based practice

Emily (0:24): in practice. So let's start talking. Eva, start me off. How was your week? What's fun?

Emily (0:31): What's interesting?

Eva (0:32): I can't really think of anything specifically fun. It was kinda funny from today. I had I was walking down a hallway, and a patient who was completely bed bound was on a bed in the hallway. And another patient I have who is known to have extremely short memory and inattention and poor safety starts pushing his bed. And I was like I just, like, stepped in.

Unknown Speaker (0:57): I was like, hey. Excuse me. Do you know whose bed this is? Are you supposed to be doing this? And the patient in the bed was like, get out of here.

Unknown Speaker (1:09): I do this every day, and they both got so mad at me. I was like, you try to intervene like lifeguard style. You're like, I see a potential safety issue. You're like inserting yourself. Then those people are like, get out of here.

Unknown Speaker (1:23): It's my cigarette break. Leave me alone.

Unknown Speaker (1:26): Was it really a cigarette break, or is it like an afternoon stroll via cot? Like, was just still this.

Eva (1:34): Scroll via cot. I I do know that, one of the patients takes a cigarette break. I don't know about the other one. So, I can't I can't confirm or deny whether it was a dual cigarette break or not. But then the maintenance guy was like, hey.

Unknown Speaker (1:48): I just want you to know, like, some of the patients are pretty on edge today. I was like, oh, man. Did something happen, or is it just that it is fully 90 degrees in the building in the middle of March? He was like, it's it's the heat.

Emily (2:04): That's super funny. I like that. I can I can just picture, like, one person in a wheelchair and the other person in a cot and just losing

Eva (2:11): control? Sometimes, like, the the safety awareness, you're like you're like on the you're like, I'm on the ground preventing safety situations. For people who can't see, I'm like blocking with my hands, I'm chopping apart safety concerns.

Emily (2:27): And then the patients are hitting you back with, get away from me. I enjoy this. It's my right to roll down the hallway in my cat. That is wild. God forbid they hit a hill.

Eva (2:40): Yeah. Other fun news, kiddo number one, age wise, is fully potty trained. So milestone. Yay.

Unknown Speaker (2:48): Good job, Josie.

Eva (2:51): That's right. Okay. How about you, Emily? What's been going on this week?

Emily (2:55): So this is kind of funny, but also embarrassing. So we have talked about my student before. I have very intentionally not told my student about this podcast because I didn't want it to be, like, interfering with, like, the setup or the dynamic,

Unknown Speaker (3:12): and I didn't want her

Emily (3:13): to feel, like, any kind of way or, like, you know, that I was trying to promote or anything weird. So I just I never said anything. I never brought it up. But the other day, we were in the middle of a treatment, and she was like, no. You're gonna be you'll be famous one day.

Emily (3:30): And I was like, like, that's a that's a strange choice a strange choice of words. And she was like, yeah. You'll probably hear from Asher or something. I was like, nah. Asher probably hates me, honestly.

Emily (3:42): And I was like, I act I was like, I actually do this podcast. She goes, I know.

Unknown Speaker (3:47): Oh, really? She knew?

Unknown Speaker (3:48): Yeah. The whole time. And I was like, you knew the whole time and you didn't say anything? She was like, well, I looked you up. And I was like,

Unknown Speaker (3:57): you done been googled.

Emily (3:59): And you know what's funny is that she knew about the podcast the whole time and never listened. And and my husband was like, you know, Emily, that is your target demographic as new students. If you can't even get your student to listen, you're really not doing a great job.

Eva (4:18): Oh, god. He you know what? He's making sense to me.

Unknown Speaker (4:24): Like, real self life lessons.

Unknown Speaker (4:27): Self promoting. I don't wanna say I feel like I'm gaining, and it's like gaining what? The what? Gaining what? We don't financially benefit.

Emily (4:36): We don't. Nope. We are not financially benefit. So she's probably the smarter one for not having a podcast, you know. Yeah.

Unknown Speaker (4:46): It's hard out here.

Unknown Speaker (4:47): Oh, preach. Preach. Hard out here for

Unknown Speaker (4:49): a pimp.

Unknown Speaker (4:53): What are we talking about this week?

Emily (4:55): So this week, we are talking about chronic aspiration. And this is something I have really been thinking a lot about because of how frequent frequently we are talking about aspiration in general. But when we're talking about aspiration, we'll talk about it as maybe it's a chronic thing, maybe it's a singular thing, but very rarely are we thinking about those long term implications. At least for me, I'm not heavily thinking about, you know, two months, three months, or, you know, a few even a few weeks from, like, when the problem starts to what that might look like for our patients. So something I felt I personally did needed a little bit more education on, so I thought it might be helpful for others as well.

Eva (5:49): Well, I like that because as you said, we're talking about aspiration all the time, but who's aspirating all the time? Mhmm. That's something we really need to be thinking about. We usually go and we're like, oh, the patient was seen coughing. That's usually, like, we get the call in.

Eva (6:02): It's like, there was a there was a meal or something went wrong. And so we're usually looking at things in the sort of I don't know if urgent is the right adjective that I'm looking for, but the sort of like, oh, this thing just happened. Let's try and fix this. But in the hospital where there's tons of support or in skilled nursing where there's a lot of support and people can come in regularly and do meal modifications, they can provide feeding support, they can provide swallow strategies, etcetera, What happens when that patient goes home? You know?

Eva (6:37): Or they convert to a long term patient and they have fewer opportunities for evaluation and treatment. It's like, if they're chronically aspirating, it is not getting immediately addressed all the time. And so and they don't have the monitoring. So what yeah. What does happen to those people?

Eva (6:52): Wait up. Wait to think about it and and ask the question and inspire today's podcast episode, Emily.

Emily (6:59): Do what we can. Okay, guys. Before we get into the research, quick break. So this week's article was so beautifully titled chronic aspiration by Benjamin Fickinall. And I just wanna say that this article's title was so great.

Emily (7:19): I was able to remember it in its entirety and type it out without copying paste. I I read the whole thing on less than a breath. I was very pleased with this title.

Eva (7:34): Was this on? Well, did you read the title? It's titled chronic aspiration.

Emily (7:38): Yeah. The two words, chronic aspiration, Benjamin Fick. Anyways, so we're talking about chronic aspiration. So just a quick recap for any of those listeners who do not remember what aspiration is.

Eva (7:56): Or don't spend all day explaining it to other people.

Emily (7:59): Right. All day. And then you spend your free time at night explaining it on your podcast.

Eva (8:09): Or explaining it to your mother who chronically coughs on food because she won't stop talking while eating. Mom, you know it's a problem.

Emily (8:16): So what is aspiration? Food or liquid going down your windpipe into your lungs. And most people know this happens, and you your response is that great big cough.

Eva (8:30): We hope so. We hope you're having a big cough. It's a good safety indicator.

Emily (8:35): Sometimes people can aspirate food and liquid without knowing. That's that silent aspiration.

Eva (8:41): No big cough.

Emily (8:43): No big cough, but those signs that someone might have gotten food or liquid into their lungs past their vocal folds would be their breathing has increased, their breathing rate has increased, their eyes are watering. So, yeah, I mean,

Eva (8:59): this happens to everyone every once in a while. Most people cough, things cough. You know, you cough it up, you go, and you reswallow, everything and is all good. But think about that cough for a normal healthy person, and it still takes quite a long time to clear and is really uncomfortable.

Emily (9:15): So in all those situations, we're thinking about how we're aspirating liquids, but sometimes you can aspirate food. If you're aspirating food, that's when you think about, you know, the feeling of choking that food instead of being dislodged and coming out of your mouth, it's going down further into your airway. So that can happen with big pieces of food and need surgically removed or really tiny pieces of food. And, you can silently aspirate those really tiny pieces of food and just clog up your lungs with that bolus, boli, with the Question. The things.

Eva (10:00): Is it Greek or Latin etiology? Boluses versus boli. But yeah. And not to worry everybody that, like, oh, what if I don't know that I am constantly having food going into my airway? This is not typical.

Eva (10:15): This is most people have perfectly healthy swallows. When you cough, that reaction is your vocal folds dislodging things. It's the preventative aspect. But in terms of that discussion on chronic, what

Unknown Speaker (10:33): I

Eva (10:33): think Emily is getting at is that when people can have things going into their lungs consistently, lot of times, it's often associated with these micro aspiration events, like just slow cumulative instances where stuff might be pooling in the pharynx, you know, in the throat and just, like, getting a little bit in at a time. Just a teeny weeny bit.

Emily (10:54): Yeah. In this article, it specifically talked about micro versus macro aspiration, so small bits versus larger bits, but there's no indication for, like, what is a larger bit? Like, where is the crossover between tiny bits of food or liquid to that big pieces of food or liquid? But yeah. So if we have that chronic, we have those micro aspiration events.

Emily (11:22): We're talking about aspiration, and we're having patients who are making those informed decisions on whether or not their aspiration and their chronic aspiration that's happening all the time, if we're thinking about it as, like, are we as speech therapists? Do we do you feel as if we are underestimating that cumulative effect of that micro aspiration when it comes to our patients over time when we're making recommendations? Well, okay.

Eva (11:54): I think in order to answer that, we have to get a little bit into the research because beforehand, would have said no. I don't think so. I'm like, I don't know if it's just a little bit consistent over time. Like, it's just a chronic problem, and it's it's an issue, and it should be addressed. But I don't think I would have thought about perpetual small amounts of aspirated material as, like, accumulating.

Eva (12:23): So I don't think I would have had that kind of mental orientation around it. I think kind of like what you're saying at the beginning, I still think of aspiration as these kind of one off events, not continuous potentially building on one another. And so, I don't know. Do you wanna get into the research on, like, what he says about foreign materials and airway? I've got my excited face on.

Eva (12:47): So,

Emily (12:48): again, aspiration, something going into the lungs that's really not supposed to be there. So our article says, the president the the president.

Unknown Speaker (12:57): The president of foreign materials.

Emily (12:59): The president of foreign materials. The presence of foreign material in the lungs subsequently initiates an inflammatory response. There is conflicting evidence concerning the role of acidity in morbidity. Researchers don't fully agree on how much acidity actually contributes to lung problems. However, it can interfere with a surfactant, which is like the stuff that helps keep the airways open and damage the cells lining the bronchi or those tubes that go into your lungs, both by directly irritating and through the action of the digestive enzymes coming.

Eva (13:38): Yeah. So in summary, stuff doesn't belong in your lungs. And when it does and when it's acidic, it makes your lungs irritated and angry. And when they're irritated and angry, it can damage the process by which lungs stay open and damage the cell lining. Sounds uncomfortable and pretty bad.

Emily (13:59): Yeah. It is. It is uncomfortable.

Eva (14:02): I'm sure it is. I've not ex not experienced this personally, but I'm it sounds real bad. Yeah. But what I what I liked about this is specifically talking about the irritation and the pH levels. And while we didn't go into all of that, we tend to talk about, oh, aspiration, aspiration pneumonia, aspraunish pneumonia bad.

Eva (14:23): Right? Mhmm. And we're not really talking about the mechanism here. It sounds like part of what we're discussing is, like, acidic irritation of the lungs, which is decreasing pulmonary capacity or pulmonary function. Right?

Eva (14:36): It's like the lungs are having a harder time. They're irritated, and it's because we messed with them.

Emily (14:42): And it may not be acid causing the biggest issue. It's the fact that anything doesn't belong in the lungs. Once it's there, the body overreacts and creates that inflammation, the swelling, mucus, and airway tightening. But we do know that, you know, generally clean water can be reabsorbed into the body. How often is our our mouth completely clear of any bacteria?

Emily (15:08): How often are we only drinking, you know, pure crystal clear water? So we think about anything going into the lungs, we're talking about your teas, your your pops, your crumbly bits, and that's all causing the swelling, mucus, airway tightening.

Eva (15:27): To just kinda, like, untangle a little bit of what you said, it sounds like what you're saying is, look. When we're having liquids with stuff in them, be it tea or pop or milk or what have you, those are all things that can become irritants within the lungs. But, also, water. We tend to think, oh, water is safer, which comparatively, it definitely is. But if your mouth isn't clean and you're aspirating, you know, trace residue from your mouth or you don't brush your teeth that often, so maybe when you're drinking, you're getting some just general oral bacteria in with the wash, and you aspirate that, then, yeah, you're not just drinking straight water, are you?

Unknown Speaker (16:05): Is that right? Is that what you're saying?

Emily (16:06): That is perfect, Eva. I love that you can detangle my tired brain.

Eva (16:12): Oh, girl. You had a long week.

Emily (16:14): Okay. So this airway damage can lead to pneumonitis, fibrosis, bronchiolitis, and an increased risk of further subsequent infections. So let's get into some of these long definitions.

Eva (16:28): Let's do the fun word first. Pneumonitis. That's inflammation of the lung tissue. That's what a lot of the it is, like, suffix tends to mean, usually caused by irritation rather than infection. For our dysphasia population, it can often refer to, like, aspiration pneumonitis where inhaled material is the thing irritating the lungs.

Eva (16:47): And one of our key, you know, takeaways here is that this is like a chemical injury, not primarily bacterial.

Emily (16:53): Chemical, meaning gastric contents. So all of that heavy corrosive acidic things that are meant to be in your stomach and are protected in your stomach by a thick mucus lining are not safe inside your lungs.

Eva (17:12): Your stomach should be like Vegas. Like, what happens in your stomach should stay in your stomach.

Emily (17:18): That next one we talked about was fibrosis. So now we're getting into permanent scarring of the lung tissue that makes it thicker and less flexible. Over time, the repeated inflammation, like chronic aspiration, can lead to fibrosis. It reduces the lung's ability to expand and exchange oxygen effectively. If your lungs don't move, you can't breathe.

Eva (17:40): And we've talked about this as being an issue in other episodes and with other conditions like esophagitis. Right? It's like that constant passing of acid is really corrosive to pretty much every part of your body that isn't your lungs. Next one, bronchiolitis. Sounds like a dinosaur.

Unknown Speaker (18:00): I like that one.

Unknown Speaker (18:00): It does. It does. I like that one too.

Eva (18:03): Alright. So here we have inflammation of the small airways, the bronchioles. This is, again, causing swelling. This time, mucus buildup and narrowing of these tiny air passages. It can significantly impact your airflow and especially for those vulnerable patients.

Eva (18:19): Think people who already have pulmonary complications. And lastly, if these things continue, it can lead to an abscess in the lungs or even emphysema. And

Emily (18:33): so a lung abscess. Think a localized pocket of pus that forms within the lung tissue due to infection. Yummy. That yeah. The bacteria, it's often coming from aspirated oral contents, infect the lung tissues, and the body walls of the infection creates this tiny cavity filled with pus.

Emily (18:58): This area can actually start to break down and become necrotic.

Unknown Speaker (19:02): So I just feel like this episode has really turned into, like, reading gross stuff.

Emily (19:08): Like, you know, I'm It's it's bad. But, like, if our patient has portal hygiene and they have dysphasia with this chronic aspiration, like, this, you know, this could be a possibility for them.

Eva (19:22): Right. Next airway condition, emphysema. The pus continues. A collection of pus in the pleural space. And if you're not familiar, it's the space between the lung and the chest wall, not inside the lung itself.

Eva (19:37): Now this can compress the lung and impair breathing because as fluid is building around the lung, it is pushing on it. So that pus is putting pressure on the lungs. And this often requires more aggressive treatment. You need, like, drainage, not just antibiotics.

Emily (19:54): So then the article just broadly says that there's an increase of subsequent infection. So because of all of this happening, you have a higher likelihood of developing infections like pneumonia after lungs have already been irritated or damaged.

Eva (20:13): Yeah. And I I mean, I think about that for our patients in other capacities who have some sort of chronic issue, like pressure wounds or I'm in my mind, I'm actually coming a lot back to wounds, whether it's a pressure wound or not. It's like

Unknown Speaker (20:29): It's because

Unknown Speaker (20:29): your mind's on pus now. I was like, I'm thinking about the pus.

Eva (20:33): Yeah. But, I mean, like, once somebody has there's once there is so, like, all of your organs, including your skin, are meant to be these protective barriers. Once a protective barrier has ruptured, you're now, like, letting the floodgates in for other issues. Right? So chronic inflammation, potential abscess, like these other openings in our bodies are not supposed to be there, and people can have trouble fighting off what comes in.

Emily (21:02): So why does this happen? They have impaired airway clearance, so they're they're when aspiration happens, they're not re getting that aspiration out. They damage the protective lining of their lungs. So like Eva, you were just saying, once those floodgates are open, now we're susceptible to more things. There's an increased production of mucus which ends up acting as a trap for that bacteria.

Emily (21:32): So someone who's not able to effectively clear mucus is now having more mucus trapped with bacteria in there, and it's just sitting. Yeah. And clinically, what

Eva (21:45): does this mean? Like, this is where aspiration pneumonitis can progress into aspiration pneumonia. So, Eva through all of the things cited.

Emily (21:54): So, Eva, after going through all of those different clinical events, do you feel like inflammation is the problem maybe we should be more focused on than the aspiration event itself?

Eva (22:11): Interesting question, Emily. I think that no. I'm gonna say no. And here's why. What is getting into the airway in some ways doesn't matter.

Eva (22:31): It could be stomach acid. It can be food. The important thing is that we're recognizing is things are getting into the airways. Based on this research, it seems like regardless of the foreign material that is in the airway, it's gonna cause irritation. So I think as clinicians, our most important thing is to just be like, we gotta shut down, like, the airway access.

Eva (22:53): Mhmm. So I think it can inform the recommendations we're giving patients, but, ultimately, I still think that the most important thing is just closing down the airway. Again, not to air. Airway open for air. Closed for everything else.

Unknown Speaker (23:08): Air good.

Eva (23:09): Yeah. Exactly. Food bad. And, yeah, I think that's it. That's That's my my quick take.

Emily (23:18): Yeah. And I I agree. And I just I feel like listing all of these off and understanding how many factors go into that development of aspiration pneumonia or co occurring problems from this aspiration. It really helps me feel more holistic about the aspiration process and maybe take a little bit of personal responsibility off of us as speech therapists and more onto the medical team in general. Because as I can make recommendations on whether or not someone's aspirating and I know maybe these that patient is refluxing more because of these triggers, or I can see how they're eating and make make recommendations on posture and texture and yada yada yada, I still am not responsible for checking their lungs.

Eva (24:16): Yeah. But, you know, going back to that patient education piece overall, like, another thing we can always do education on is proper oral care. Right? Like, yeah. Hey.

Unknown Speaker (24:27): You gotta brush your teeth. Man, I just feel like being a mom has carried into over into everything. I'm like, look. You gotta eat well. You gotta sleep well.

Unknown Speaker (24:35): You gotta brush your teeth. Like, just telling it to everyone all the time at home and at work.

Emily (24:41): I know. And I do feel bad for, I guess, our listeners and our kids that we are just a broken record. It it's always the same recommendations. You brush your teeth, you sit up when you eat, you eat you eat well, exercise, get good rest, and everything is peaches and roses.

Eva (25:02): We we honor your decision.

Emily (25:04): So when all of these inflammation events are happening, how do we know? So CT scans. CT scans and radiology. So, again, smarter people than us are telling us how the lungs are doing.

Eva (25:19): Well, also, we're definitely part of that because when I say we're a part of that, like, we're not taking lung X rays. But Mhmm. You know, if we're finding aspirated material in the lungs and, you know, we haven't done an instrumental study, say they're a swallow a silent aspiration patient. Like, oh, hey. We now need to be doing a modified barium swallow.

Eva (25:41): We need to have them swallow in the radiography department or get a fees, you know, a video swallow study done so that we can look. Oh, where are we seeing the aspiration happen? Are any of these strategies effective? Because we wanna we wanna prevent it from going further down.

Emily (26:00): Yeah. And I think that that goes right into, like, how, like, how are we going to apply this? It's like we are now treating. We're we're just treating that aspiration events through doing our exercises and our education on avoidance.

Eva (26:16): I'm gonna go back to what you were saying about, kind of taking pressure off the speech therapy team. I think that this is something they highlight a lot that, like, patient care, particularly around, eating and aspiration events, is an interdisciplinary thing. They do I think they actually highlight the kind of chain of events really well that, like, hey. Nursing is usually the people most on the ground. They are crucial in observation of patient function.

Eva (26:43): If they're seeing issues, they tag in speech therapy. Speech therapy goes, they do their assessment, and they go, we're we have some concerns. Let's tag in radiology. Mhmm. And so we keep moving it further and further down, and that really should be a health care network moment.

Eva (26:59): Mhmm. Dietitian. Right? We're talking about they need to be educated. Obviously, we can provide something, but the dietitian might be more equipped, say, in a hospital setting to say, here's what's on the menu.

Eva (27:10): Here's what would best be suited for your needs here, you know, given this concern. And then, of course, there's cognitive concerns. Oh. They do talk about pediatrics in this article, which, again, save it for the kids podcast. But for our cognitively impaired patients, they may not understand.

Eva (27:33): Like, hey. The reason that we're not bringing you your morning hot coffee is because you have this, like, elevated risk for, you know, acid irritation in your lungs because you have chronic aspiration. And if they're really not getting in, they say, I want my coffee, you know, bring in family. This is where care goes back into the community. Right?

Eva (27:54): You talk to their kids. You say, hey. Your mom really wants her morning cup of Joe. She's not getting why we're saying this. Her quality of life and her desire is that she can sit there and just enjoy having a cup of coffee.

Eva (28:10): If she has alternatives that you might suggest, we can try and provide that. Or if you're her POA, if you're helping make her medical decisions, then what do you think? Should we just let her have her joe and be happy? It's, you know, again, that quality of life, particularly, I feel very strongly about this for end of life care. I'm like, give them whatever they want.

Eva (28:32): I I I don't care anymore. I may feel a little extremely on that one, but that's just me.

Emily (28:39): I know. And we always say, like, we don't care, but I feel like it's always the opposite. We we just care so much because that I I don't wanna take anything away from you that brings you any kind of joy. So, like, because I care so much, I want to make sure that you have all access to joy. Not because I don't, because I I love you.

Unknown Speaker (29:04): I

Eva (29:05): will more likely see you back in the hospital, but by golly, it is on your own terms. Mhmm. And I think another big thing that they bring up is feeding techniques. I think this is oftentimes in the dysphasia conversation, something that gets overlooked. We do staff and family training because if somebody has aspiration risk, it's exacerbated if they are reliant on other people to feed them.

Unknown Speaker (29:32): Mhmm.

Eva (29:33): Particularly if they can't say, oh, I'm not ready for the next bite. You know? That if the person putting food in their mouth is really not waiting for them to do a full swallow, isn't properly alternating, solids and liquids help them wash things down, then, you know, they're just the risk level keeps increasing. Yep. And yep.

Eva (29:56): And I think they they do mention, right, that surgery can be implemented, but that that is certainly not in, like Yeah. I regular therapy regular recommendations, and it's certainly not a conservative management approach.

Emily (30:13): No. And I think so this article talked about, like, laryngeal elevation or, like so, like, they would take your voice box and surgically move it further under your tongue to, like, move it out of the way or providing a surgery to open like, make a larger opening to your esophagus to more easily allow food down. And I I in general, I feel like that that has to be hitting on a more peds thing, a more and they even went as far as saying, like, completely closing off that airway to food, like, you know, providing that laryngectomy so that they are creating two completely separate tubes. Mouth tube for food only, tube from your neck for air only to completely eliminate any kind of aspiration event by completely separating the avenues in which you can breathe in food because they're separate.

Eva (31:21): Yeah. And I I think there were some things in this article that were a little unclear. Like, when you're looking at the prognosis section, it's like

Unknown Speaker (31:30): I hope everyone has the article open while we're talking about this.

Eva (31:35): I always hope that for this book club. So for example, they say better lung function prior to the insult or the damage is associated with a better outcome, while poor cognitive function is associated with worse outcomes. It's like, one, those aren't necessarily related statements. And two, like, yeah, if you're healthier going in, you're gonna have better outcomes. And cognitive function is usually really highly correlated with geriatric population.

Eva (32:04): So they overall have, like, increased rates of frailty, all these things. I was like, this could be teased out a little more. These seem like some pretty big blanket statements. I know maybe they didn't have the details. They were like, that's as much as we could say on this.

Eva (32:19): Right. I think, like, one last thing in the kind of, like, outcomes is the differential diagnosis section. I think a lot of people are like, oh, they were coughing a lot, and now they're not doing well. They must have aspiration pneumonia. And it's like, okay.

Eva (32:35): Well, chronic aspiration, they said, has to be separated or differentiated from several things, like pulmonary embolism, viral or bacterial pneumonia, acute respiratory distress symptom syndrome, heart failure, lung cancer, tuberculosis, GERD, idiopathic pulmonary fibrosis. Like, there are all these pulmonary issues that can occur or non ones. Like, heart failure is not a respiratory symptom. Right?

Unknown Speaker (33:02): Mhmm.

Eva (33:03): And but a lot of times, we go, oh, it seems like they're having difficulty. They have an infection now. What's going on? Somebody saw them coughing. It must be aspiration pneumonia.

Unknown Speaker (33:13): It's like, no. That that actually still has to be verified. Mhmm.

Emily (33:18): Yeah. It always seems like it's a like a quick draw reaction, especially in the SNF setting where or in the skilled nursing setting. People see them coughing, and they're sick, and it's it's just aspiration pneumonia. It's automatically aspiration pneumonia. But at the very least, I I always see people getting chest X rays in that event.

Emily (33:39): Yeah.

Eva (33:40): So I think if I wanted to kind of do a wrap up summary on a lot of things we've talked about, we have somebody. They are we have concern for chronic aspiration. Right? We have concerns for irritation in the lungs. We might make conservative treatment approaches like swallow strategies, food texture adjustments.

Eva (34:05): However, if those aren't working and it becomes a pneumonia, then we gotta deal with the pneumonia. Right? Maybe we're they have to go on antibiotics. They need oxygen. They need whatever else you need for pneumonia.

Eva (34:21): I'm not a doctor. Mhmm. In a really severe case, they may need a feeding tube.

Emily (34:27): And I feel it doesn't necessarily cure chronic aspiration.

Eva (34:33): It only works for protecting things that are going down because you're not swallowing, you know, like, from the oral cavity through the throat. If somebody has acid reflux or vomits or their saliva is there, like, there's plenty of things for you to aspirate on that aren't your food. Mhmm. And then, yeah, there's potential surgical approaches, but those are, like, pretty rare and not not often advised. Yeah.

Eva (35:06): And I think that was, like, kind of the main course of things.

Emily (35:09): Right. And I and, again, I I feel like this is all super important because this is something that we should be able to educate on. Our if our ultimate goal is to help our patients and our patients' families, if they happen to be our patients' POA, make an informed decision about continuing care or how we're treating their chronic aspiration, how we're managing these symptoms, and we're seeing some of these arise. We're seeing their lungs are starting to get fibrotic or they're showing they're now having to have increased need for supplemental oxygen or, you know, their their coughing is getting so bad all the time, it's interfering with their their zest for life. Right?

Unknown Speaker (36:04): Have to be

Unknown Speaker (36:05): able Zesty.

Emily (36:06): I know. We have to be able to educate them on all of the steps and make sure we're coming back and re educating patients so that, you know, their informed consent to a decision doesn't have to be a one off thing. If we are treating them at point A, we have caught our patient who at the time is acute aspiration, we've provided all the treatment, we've done all the exercises, despite the multiple instrumentals, we still see that they're aspirating trace amounts and they're refluxing their coffee, and they wanna keep it. Cool beans, man. Six months from now, they're still at our facility, and now they're suffering these things.

Emily (36:51): We wanna make sure that we can go back and say, it is potentially because we are chronically aspirating, and this aspiration event is going to further lead to increased damage. Let's get a repeat MBS or a fees and see how you're currently doing, if we can do more exercises to boost you up for the meantime.

Unknown Speaker (37:12): It just all comes down to access to imaging. I feel like

Unknown Speaker (37:14): that's I know. It is.

Unknown Speaker (37:15): Take away every time.

Emily (37:16): It is. It is access to imaging. And because I I get we can't tell them what we don't know. And if we think that they're aspirating, then that's not informed consent. We can't give someone the option to make a decision about their livelihood or about how their lungs will function on a a guesstimate.

Emily (37:40): As I

Eva (37:40): tell people regularly, I don't have X-ray vision. Listeners, if you have X-ray vision, call me. I need to know about it.

Unknown Speaker (37:48): Yeah. How did you get it? How much How did

Unknown Speaker (37:50): you get it? Where do I get it? Is that a deal at Costco by any chance?

Unknown Speaker (37:56): I feel like that's it. Do we feel educated? I

Eva (38:01): never feel educated. That's why I do this with you. When he's like, I know so little. Meeting adjourned.

Unknown Speaker (38:07): Meeting adjourned.

Eva (38:08): And for Emily and everybody else, go get some rest. Thank you for listening. Good night.

Unknown Speaker (38:15): You've been listening to Speech Talk.

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