Yes… Speech Pathologists have been specifically trained to make diet modifications, trial compensatory strategies, and teach evidence-based treatments to their patients.

BUT, we do not have x-ray vision! You just cannot see, what you cannot see. Research has shown a 70% error rate in bedside swallowing exams where recommendations were either too restrictive, leading to dehydration/malnutrition, or missing silent aspiration leading to pneumonia therefore increasing mortality rates.

Just imagine…

You start to have aching chest pain and some nausea with indigestion. You go to a hospital and see a doctor who diagnoses acid reflux, educates you on proper diet, prescribes a medication and sends you home. Only problem is that you were actually having a heart attack. The problem was that the doctor was treating the SYMPTOM instead of the CAUSE. We can’t fault the doctor because he wouldn’t know unless he ran the appropriate tests.

Well in the same way that Speech Pathologists can not make appropriate recommendations without imaging. We need to see the anatomical and pathophysiological deficits in order to make the appropriate recommendations. Some exercises and strategies such as thickened liquids have been shown to actually cause harm to a patient and potentially a subsequent re-hospitalization, if they are indicated unnecessarily. Once we have obtained baseline imaging, then we can use our clinical judgement to form an educated treatment plan with evidence-based interventions.

Who needs a FEES?

• A patient is suddenly having difficulty swallowing with reports from nursing staff that they are coughing or choking during meals. Or a patient is found to have a new respiratory infection, specifically right lower lobe. The Speech Pathologist comes in to evaluate them and subsequently makes diet recommendations. The appropriate next step is to schedule a mobile FEES. Why? Because we can then determine if there is a change in swallowing pathophysiology due to a number of underlying medical conditions, or it may be due to uncommon and overlooked reasons like: allergies, or even reflux- where the patient is actually aspirating on food coming back up. And like this there are many conditions that CANNOT be treated without knowing the underlying cause which can only be seen with imaging.

• A patient is admitted from hospital with a documented oropharyngeal dysphagia and recommendations for an MBSS however, did not have one done due to a number of reasons like: staffing issues, weekend discharges, or the radiologist denying anymore MBSSs for the week (or month). Now your facility is responsible for obtaining the imaging. Instead of calling the hospital, waiting 4-6 weeks to send them back for an MBSS (in the meantime risking aspiration pneumonia and a potential re-hospitalization), call us and we’ll be there in 24-48 hours.

• A patient is admitted with an MBSS completed at the hospital. Keep in mind, recommendations are made when the patient is acutely ill and is usually discharged to the next level of care as quickly as possible. After spending a few weeks at the rehab facility and regaining some strength, a patient may be ready for an upgraded diet. Speech Pathologists will reevaluate and trial various consistencies with strategies at the bedside to assess for compliance and tolerance, but again we do not have x-ray vision. Diet upgrades across all meals without imaging can increase the risk of aspiration due to fatigue and exacerbated by known underlying conditions. Silent aspiration is often missed at the bedside, and we aren’t certain if the strategies we are recommending are helping or hurting the patient.

Yikes!

No worry, that’s why we’re here!

The mobile FEES procedure is done right at the bedside in their natural environment, using their favorite foods and real medications to make the evaluation individualized to each patient. We speak with the SLP, nurses, and family immediately after the exam to ensure that the recommended strategies and diet consistencies are realistic and “FEESable”.