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Re: secretion management

Posted By CCF Neuro MD MJD on October 01, 1998 at 17:12:39:

In Reply to: secretion management posted by AMS on October 01, 1998 at 11:20:28:

I would appreciate any information you may provide on the following:
60 y/o male, 5 mos. post medullary infarct with severe pharyngeal
stage Dysphagia. He consistently has thick, glue-like secretions
which are expelled in large chunks throughout the day. These keep
him awake at night and are hampering swallowing therapy. Have you
any suggestions which may 1)reduce the amount of the secretions, and 2)make
them less viscous? He has tried Robinol without success. He is currently
on trial feeds of applesauce and cranberry juice(to cut the secretions). Any
suggestions you may be able to offer will be most appreciated. Thank you.

Secretions can be quite difficult, and often the medications used are note ideal.  Robinol (Glycopyrrolate) is pretty well tolerated though it doesn't seem to be helping here.  Tricyclic Antidepressants like Elavil (Amitryptiline) have properties that help secretions.  Stronger medications like Propanteline or transdermal Scopolamine can also be used, but can have more prominent systemic complications and can cause confusion (as all of these can) especially in the elderly.  If medications are of no help, suction devices can be used.  More expensive but quite effective are Inexsufflators which push air in to break up sputum then ***** it out like a vacumn.  The most important thing is evaluation by good speech/swallowing and respiratory car therapists.  They can give good advice on minimizing secretions and teach chest physical therapy methods that family can help with to break up the secretions. Good luck.

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