Talya Schaeffer - Region 4

​During my advanced clinical rotation, I had the opportunity to shadow a speech-language pathologist. The most interesting case was an elderly female who was recovering from RSV and needed a swallow study after failing her bedside swallow evaluation. I was invited to join and observe in the radiology room while the speech-language pathologist prepared the different consistency barium drinks.
 
I’ve watched videos of Modified Barium Swallow Studies, but it was so much more informative and fascinating to watch a swallow study in person. The speech-language pathologist took the time to explain the anatomy and physiology of the soft palate, the pharynx, the epiglottis, and the esophagus and how these structures work together to protect our airway from aspiration when swallowing food. During the swallow study, she made sure to point out on the fluoroscope exactly where the patient was aspirating during the swallow process and where the food was getting caught within the patient’s esophagus, endangering her airway.
 
What made this encounter even more interesting is that the speech-language pathologist initially suspected the patient’s coughing during her bedside swallow evaluation may have been related to residual symptoms of RSV rather than aspiration. However, the imaging showed that the patient was aspirating, which led to a downgrade from a regular diet to an IDDSI-modified diet with thickened liquids. She also explained that because the patient was recovering from RSV, slept poorly the night before, and was elderly, fatigue and weakness may have contributed to her swallowing difficulty. She clarified that in the future the patient could have another swallow study when she is stronger and if she passes, her diet could be upgraded. 
 
This experience helped me better understand the importance of following through with the appropriate imaging tests when bedside findings are unclear. This also underscored the importance of interdisciplinary collaboration to ensure patient safety.

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