Medical history: 71 year-old male with end stage esophageal CA s/p esophagectomy, CAD, PAD, GERD, anxiety, neuropathy, DMII, hypothyroidism, dyslipidemia, and HTN. Pt is on 2 LPM O2 via nasal cannula.

Current diet:  NPO; PEG


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Laryngeal penetration occurs with liquid portion of mixed consistency (at 2:48 trace liquid dips into interarytenoid space, 3:14 and 3:44 penetration via interarytenoid space).


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Pt was seen sitting up in chair. Primary SLP was present for exam. Pt demonstrated a mild pharyngeal dysphagia c/b: reduced/mistimed BOT retraction and suspected reduced/incomplete UES relaxation resulting in laryngeal penetration before the swallow with liquid portion of mixed consistency, laryngeal penetration before the swallow w/ serial straw sips of thins taken after a bite of solids, and mild residual at UES and inconsistently in valleculae after the swallow with pureed, mixed and solid consistencies. Pt cleared residual with reflexive, subsequent swallows at times. Liquid rinse was effective in clearing residual. Laryngeal sensation appeared to be intact as reflexive throat clear was noted in response to laryngeal penetration that did not strip from laryngeal vestibule with the swallow. Increased work of breathing was noted with intake, thus consider small portions to minimize fatigue. Also, given recent esophagectomy, pt will likely require small portions. Laryngeal edema was present, which may be suggestive of laryngopharyngeal reflux (LPR).

Diet:  Regular Diet/Thin Liquids
1. Sit upright with all intake. Remain upright for 20-30 minutes after intake.
2. Frequent oral care to minimize risk of aspiration pneumonia.
3. Sip liquids throughout meals to clear pharyngeal residue.
4. Avoid using straws.
5. Continue reflux management.
6. Ongoing ST to monitor diet tolerance, as needed.

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