My Dad - Swallowing Disorder with Aspiration

[larrye]

Hi. My Dad is 90 y/o and has just been diagnosed with Swallowing Disorder and resultant aspiration pneumonia. He failed all swallowing tests and is going to have a PEG (feeding tube) implanted. There has been no stroke that we know of.

My question is this. I have been told that it is possible he may be able to restore some of his swallowing function with Physical Therapy. But none of the doctors have told us yet exactly what the nature of the disorder is (e.g. neurological, muscular,etc). I have also read that some swallowing disorders can be corrected surgically.

He is being treated by a gastroenterologist, but no ENT has been brought in to consult.

Can anyone help me understand what options are reasonable for a 90 y/o ... and what I should push the doctors to do? I can't help but feel that other options (other than PT) may be possible.


Thanks in advance.

Larry

[Londres70]

You are welcome and I do wish you all the best with this.  

[larrye]

I find that very interesting because he's had multiple surgeries in the past few years - inguinal hernia, bladder cancer TURBT ... and has come through them just fine. Surgery on elderly people doesn't come completely without risks (and I do agree that he has comorbidities), but it does not have the stigma that it used to have. When I spoke to the anesthesiologists each time, they told me there is nothing to be concerned about and that they do this all the time not only on elderly people but on people with worse CHF than he has. If the surgery is simply a tightening of a sphincter or muscle, I'm thinking it isn't like opening up his chest wall or abdominal wall.

I will inquire about an ENT consult and if they say it wouldn't add anything, I'll defer. But it seems to me that this is the type of surgery that an ENT would do, and if one searches ENT websites, I find that swallowing disorders is something frequently listed as a specialty.

In any case, thank you for your help and good wishes.

[Londres70]

To add:  Just briefly skimmed your other posts in regards to your father.  Giving all his comorbidities and this you probably will have a difficult time finding any surgeon who will be willing to do any major surgery on him especially if they feel it will NOT improve the situation.

I would once again recommending doing the PT.  

All the best.  

[Londres70]

Well, if you don't feel this falls in their "specialty" and you feel you are getting nowhere with these current physicians, why don't you consult an Otolaryngologist or a Head/Neck Specialist on your own?  

I am not exactly sure how you can state "I don't believe that this truly falls into their specialty" when you don't KNOW the exact cause or the root of this.  

Sorry, I will have to concur with the physicians that have been consulted taking in consideration the info you have provided.  To add, it is customary to consult a GI Specialist and Speech therapy NOT an ENT Specialist.  I have seen this situation so many times in my career.  

Trust me and keep in mind, EVEN if this was something for an ENT Specialist most surgeons are NOT eager to operate on a man of his age; WAY too risky as I stated in my initial post.

All the best and good luck.  

[larrye]

Thank you.

I have no problem with being told that surgery is not an option on someone of his age, but that in fact is NOT what we are being told. The gastroenterologists are throwing up their hands and saying that nothing can be done. I expect them to find out exactly what is causing the problem and then to offer options with risks - not to dismiss it off and throw up their hands. And a surgeon that would operate on this area of the body would be an ENT. An ENT is a throat surgeon. While I'm sure gastro enterologists have some knowledge of this disorder, I don't believe that this truly falls into their specialty.

[Londres70]

Well, I am sure his age and/or any other medical issues are determining the option of surgery is not a viable option for him. Surgery on a 90 year old man is extremely risky.

I would be finding out exactly the "nature" of this problem/disorder as there may NOT be a surgical option available for it.  

I am not understanding why you think he should be seen by an ENT Specialist?  Definitely a GI Specialist should be on this case and sorting this out.  

I would recommend doing the PT and going from there.