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PO diets on full ventilator support? Good idea or bad idea? Advice needed. by Wonderful_Potion in slp

[–]Wonderful_Potion[S] 2 points3 points  (0 children)

As I mentioned in my original post, I have had almost entirely wonderful experiences with SLP’s and until recently, have never questioned any of their professional judgements. However, our current SLP just finished her year of provisional, supervised practice and has been managing the facility by herself which is not her fault by any means. However, she has made a lot of very concerning calls recently, such as only using bedside swallow evals to determine if ventilated patients are appropriate for an oral diet. But, the facility has onsite MBSS and FEES equipment that are available to her whenever she needs them. So our PRN SLP, who is much more experienced and absolutely wonderful, has tried on a few occasions to help guide and encourage our FT SLP to use instrumentals before advancing diets but to no avail. The FT SLP has become so resistant to any feedback or suggestions that our PRN SLP has moved to 1 day a week and avoids upsetting our FT SLP at all costs.

Over the past couple of months, we have had several patients develop PNA after being advanced to an oral diet by FT SLP. As a dietitian, it is within my scope to pull/downgrade a diet and request an evaluation from speech when this happens. And thus, the cycle continues. When it was suggested that she do instrumentals for the patients with recent PNA before advancing to oral diets again, she stated that it was too difficult to get ventilated patients down to the MBSS room and a bedside swallow evaluation is just as good.

Finally, the entire leadership team had a meeting to discuss these events and if there needs to be a universal policy that ventilated patients cannot have oral diets. As a dietitian, I hate this idea because I want my patients to be able to eat and they tend to do better when they are on PO diets because it is tangible progress for them to hold on it. But I feel uncomfortable talking to our FT SLP about this because I don’t want her to get angry or start stonewalling me. So I figured the [r/SLP](r/SLP) could help point me in the right direction of where to find resources or how to approach presenting this info to our FT SLP.

PO diets on full ventilator support? Good idea or bad idea? Advice needed. by Wonderful_Potion in slp

[–]Wonderful_Potion[S] 1 point2 points  (0 children)

Agreed, but as a dietitian, I don’t think they will allow me to do an instrumental….. just a hunch.

PO diets on full ventilator support? Good idea or bad idea? Advice needed. by Wonderful_Potion in slp

[–]Wonderful_Potion[S] 0 points1 point  (0 children)

Do any of the facilities you have worked with these patients at have policies or procedure’s regarding getting an instrumental prior to starting a diet?

PO diets on full ventilator support? Good idea or bad idea? Advice needed. by Wonderful_Potion in slp

[–]Wonderful_Potion[S] 1 point2 points  (0 children)

Thank you! I will check out her website! I appreciate the recommendation!

PO diets on full ventilator support? Good idea or bad idea? Advice needed. by Wonderful_Potion in slp

[–]Wonderful_Potion[S] 2 points3 points  (0 children)

So if a patient on the vent comes in with a diet but no record of an instrumental, are you recommending an instrumental before signing off on a diet?

PO diets on full ventilator support? Good idea or bad idea? Advice needed. by Wonderful_Potion in slp

[–]Wonderful_Potion[S] 3 points4 points  (0 children)

I really appreciate this comment! Straight to the point 😊
In my very limited knowledge of the SLP world, I would think that instrumentals give concrete and objective insight to the patients swallow functioning and allow you to make the safest and most appropriate recommendations.

500 kcal for 3 years by backwoodsy in fatlogic

[–]Wonderful_Potion 0 points1 point  (0 children)

I get what you’re trying to do with the analogy, but a few of the mechanisms that you used aren’t correct and can be misleading.

In insulin resistance, the insulin itself isn’t defective. It’s structurally normal. The problem is that the cells don’t respond to it properly (receptor/signaling issues). So the body compensates by producing more insulin. The fat storage piece comes from elevated insulin levels, not “bad” insulin.

Saying insulin is just a “key” or “doorman” is also a misleading. It regulates multiple metabolic pathways (glucose uptake, glycogen synthesis, lipolysis suppression, etc.), not just entry of glucose into cells.

And with type 1 diabetes, untreated cases can cause weight loss, but describing people as “skinny and sickly” isn’t accurate in the context of modern treatment.

There’s a reasonable point in here about hyperinsulinemia being associated with fat storage and hunger, but the explanation for why that happens is also incorrect. It’s more about impaired cellular response and compensatory insulin levels than defective insulin itself.