December 10, 2024 • 41 mins
What happens when you get 6 speech pathologists with 150 years of collective experience stuck together in a room?
You’ll have to listen to find out!
Join Julie Blair, Laurie Sterling, Dr. Deb Suiter, Dr. Barbara Messing, Jo Puntil, and Dr. Tim Stockdale (that’s 1, 2, 3, 4 ASHA fellows!) in a special edition episode, as we enjoy a laid-back evening conversation at the 2024 ASHA Convention in Seattle, Washington.
Reflections include Swallowing Cinema, patient choice, and growing through vulnerability.
Sponsor:
This episode is sponsored by the Milton J Dance Endowment – a sponsor dedicated to support of head and neck cancer patients and swallowing disorders in all populations.
Background photo credit: Daniel Schwen (https://commons.wikimedia.org/wiki/File:Seattle_4.jpg)
Gap Education:
https://swallowthegap.com
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Instagram:
https://www.instagram.com/swallowpatho
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
This episode of Swallow the Gap is sponsored by
the Milton J Dance Endowment, asponsor dedicated to the support
of head and neck cancerpatients and swallowing
disorders in all populations.
Speaker 2 (00:10):
My name is Lori Sterling and this is a special
edition of Swallow the Gap ASHA2024.
That was really good.
I like it.
Speaker 1 (00:22):
So, in case you missed it, that was Lori
Sterling, and this is a specialedition of Swallow the Gap at
ASHA in 2024.
Lori Sterling, who are you?
Speaker 2 (00:31):
I am a speech pathologist at Houston Methodist
Hospital in Houston, Texas.
I'm like why am I saying that?
Because it's pretty obvious Iam in Houston.
I have been an acute carespeech pathologist for over 30
years now.
I did a fellowship in Baltimoreat the same place.
One of our other guests here,Barbara Messing, did hers.
(00:51):
It was like a residency and wayback before CF residencies were
popular, Before they were known.
Yeah, it was a clinicalfellowship, but it was only for
a year.
Yeah, but it was only for a yearit was still called clinical
fellowship yeah, but it was onlyfor a year, so it was kind of
like a residency.
Then you moved on.
That's right, but I have beenvery involved with ASHA for a
number of years, beginning withSIG 13.
(01:13):
And it's still a division.
When it was a division, yeah,way back when became like the
director of what I don't knowwhat it was of education and
became director of what I don'tknow what it was of education
and became involved withconvention and co-chaired
convention in 2019 and I'm goingto co-chair convention 2025,
our centennial, our centennialand, yeah, with uh, four other
(01:36):
wonderful, four other wonderfulum clinicians, audiology and
speech pathology, but they'rehaving four this year.
We're having a total of five.
It's a co-chair council justsomething special for the
centennial, yeah, and it's goingto be held in washington dc so,
yeah, get it on your calendar.
Speaker 3 (01:52):
Is it going to be the week before thanksgiving?
Speaker 2 (01:53):
it's going to be the usual time it is but no, I've
been a clinician for a number ofyears.
It's always been acute care,critical care and swallowing,
except for a late midlife crisiswhen I did some pediatrics.
I wanted to learn more aboutbirth to adult.
I mean, I knew about adult togeriatrics, but I wanted to
(02:14):
learn about swallowing andbabies.
Speaker 1 (02:16):
So a little kickstart there you go.
And who else we have.
Speaker 2 (02:20):
This is I'm Deb Suter .
I am currently at theUniversity of Kentucky.
We're the director of the Voiceand Swallow Clinic.
So right now I am doing clinicfive days a week and teaching
dysphagia.
I've taught dysphagia tograduate students for over 20
years and then I do research aswell, probably best known for
(02:42):
developing Yale Swallow Protocolwith Steve Leder, which is a
protocol to assess for dysphagiarisk and aspiration risk for
people with dysphagia.
And then I have been in variouspositions throughout the years
with ASHA.
That's actually how I metLaurie and most of the people
that are here in the room.
Laurie and I met through SIG 13years ago where we were trying
(03:06):
to break into working with ASHAand trying to figure out how we
could get more involved, andthen kind of worked my way up
through becoming B6C chair, sochair over all the special
interest groups, and then gotinvolved with CFCC and then
became chair of CFCC, and sothat's kind of where I am right
now.
Deb and I served as she waseditor and I was a CE
(03:29):
administrator for 613 back whenit was all paper, and that's how
Julia met you.
Yeah, through Bing, yeah.
Speaker 1 (03:36):
All right, who are you?
Speaker 2 (03:37):
So I'm Julie Blair.
I'm at the University inCharleston, South Carolina.
It was my first job.
My last job, you work withJanina.
I do.
I love her.
She's great.
She is amazing.
She's got to be one of thenicest people on this planet.
Speaker 1 (03:50):
Oh, she's a jerk, don't lie, she's very nice.
Speaker 2 (03:53):
She's actually way nicer than me.
Speaker 1 (03:58):
Janina Wimskill.
Speaker 2 (03:59):
Janina, I still can't say her last name.
Speaker 1 (04:02):
She's awesome, she's super great.
Speaker 2 (04:04):
But yeah, I was at MUSC, lori was there with me for
a while.
Speaker 1 (04:07):
That's how.
Speaker 3 (04:07):
I know, julie.
Yes.
Speaker 2 (04:09):
My wedding and then she left us, but she was my
introduction into ASHA.
So when she stopped being theCEA, she asked do you want to do
this role?
I forgot about that and so Igot pulled in right before they
transitioned away from the paper, which was which is a pretty
sweet to go go into that, thatrole.
(04:32):
And then I applied for SIG 13to be on the board and got to
work with Deb, where it was thefirst time I joined Facebook, so
that she would poke me.
Oh, look at that.
Oh, the pokes.
I forgot about the pokes, oh mygosh.
So that was my first Facebookexperience.
I've had just a lot of reallyawesome opportunities because of
(04:54):
the people that I've workedwith or been around.
Bonnie Martin Harris was atMUSC for a number of years and
so through her I got to be partof some research and got to do
some things at the va to work, aparty too I worked with marty
broski.
It was so funny he would answerthe call smarty broski, I'm
gonna call him when he does thatyou better look out kind of
(05:19):
gets blurred together smartybroski smarty broski.
I like it.
Speaker 1 (05:25):
That's very funny marty, if you're listening, you
better watch out marty, yeah, um, but uh so.
Speaker 2 (05:32):
So I've been there.
I've teach the head neck cancercourse there.
I work predominantly with head,neck cancer, voice and
swallowing all grown-ups.
Occasionally I'll do like ascope on a small person, but
that is only to be a helper to acolleague otherwise yeah, yeah,
all all big people, okay, bigpeople all right, who are you?
(05:52):
so I'm barbara messing and whata journey it's been.
As a speech pathologist I neverwould have anticipated all the
little changes in life events.
Yeah, that I and recreation ofmy career.
But I started at shock traumaas la, as Lori had mentioned,
and that's when I really fell inlove with dysphagia, because we
would do dysphagia rounds withDr Bosma and the team and look
(06:14):
at the video studies you knowvideo fluoroscopy studies and it
was just so intriguing.
And so that was many years ago.
I worked with TBI patients.
Then I found the world of headand neck cancer in my next
position and also fell in lovewith stroboscopy and voice
disorders, so laryngeal thosewith the larynx and those
(06:35):
without the larynx and airwayissues.
So it's just been a reallywonderful journey Along the way.
I got my PhD through theUniversity of Queensland with
Liz Ward and Kathy Lazarus as myadvisors, and what an
experience that was.
And so I learned about research, how to do research, and that's
another love of mine, and so Ireally feel I've just had a
(06:56):
great career and I've been veryfortunate.
Speaker 1 (06:57):
I've met these wonderful women and we've
journeyed through all of it, alot of it.
Speaker 2 (07:03):
And here we go, joe Pantel, all right here's, joe,
lay it down.
Speaker 3 (07:08):
I'm always the caboose.
Sorry, no, julie's the caboose,no, I'm the caboose and I'm the
caboose.
So I have worked in criticalcare my whole life.
Events and traits kind of aremy love or high flow or delirium
and all that kind of stuff.
And I'm trying to think of whenI met all these wonderful women
Throughout the career.
(07:28):
I did do a lot of stints inASHA with SIG 13, when it was a
SIG 13.
And I think I was just Division13 when it was looking, either
writing something for Division13 or reviewing something for
Division 13.
Way back when I absolutely hatedswallowing, like I went to
school in Illinois and JerryLogerman trained me.
(07:50):
And when I moved to Californiathe last thing I wanted to do
was swallowing.
But I worked in the ThousandBend Trauma Center.
I was low man on the totem pole, I was 15 speech pathologist
and they basically said to me ifyou want a job, you're going to
(08:12):
have to start a swallowingprogram.
And I was like I don't likeswallowing, that's just not,
that's not.
I liked head neck cancer, Ilike cleft palate.
I liked all these things and Ithought, well, I have to have a
job because it clearly I neededto pay bills and so my father
always taught me to be hangaround with people who were a
lot smarter than you, and I did.
You're pretty smart yourself.
Well, thank you, thanks.
(08:34):
So I developed a team ofphysicians and nurses and
respiratory therapists andthought I know about swallowing,
but I don't know about all ofthe things that happen with
swallowing.
I don't really know about thepulmonary system or the gut
system.
So I proctored classes at UCIand it was wonderful to go to
med school and not have to takea test, like I could go to med
school and go to any class, andall these positions that I
worked with were teachingclasses like come learn about
the pulmonary system.
(08:55):
So I sat and took their classesand I didn't have to take a
test, which is wonderful.
So I learned a lot about thingsthat I never thought I'd learn
about.
And now I love swallowing andI've met these women through
years of our case studies andwe're also lifelong friends,
which I know may not beimportant to some people.
It's important to us.
So, yeah, I've done ASHA stuff,I've done state stuff.
(09:18):
I've seen so many differentclinicians do such wonderful
things in our field and I likethe things that are happening
coming up.
These people coming up in theirtwenties and thirties are
coming up with some fantasticresearch and I just, I just want
to pass that baton to peopleabout love, the love of the
field and the love of mentorshipversus, you know, and just
(09:38):
exploring and expanding.
It's pretty much where.
Speaker 2 (09:41):
I'm at.
Okay, I think we've all mentoredand gotten the value from that
I mean I love long empoweringyounger clinicians and getting
them more involved withswallowing, getting them
involved with ASHA.
You know what have you Well,and I think about all the
opportunities I was given and ifI had not had the people that
(10:04):
were part of my career, part ofmy work family, I would not have
been able to do any of thethings that I've done.
And I just had 30 years at MUSCCongratulations, thank you.
And the younger clinicians hada little thing for me and they
were asking you know what advicewould you give new clinicians?
(10:24):
And to me it's say yes, say yesto the opportunities.
You know what advice would yougive new clinicians?
And it was to me it's say yes,Say yes to the opportunities,
Say yes to be open toparticipate.
You know you want to be part ofthis research yes.
Do you want to present?
Yes.
Do you want to do a study?
Yes.
Speaker 3 (10:39):
You know, it's just true.
Do you want to see a patient atsix o'clock that needs your
help?
Yeah, I'll do it.
Speaker 2 (10:44):
Do it Right, because it makes an impression and
people remember and you'll getasked again.
Speaker 3 (10:52):
Right and doors open.
Speaker 1 (10:53):
Yeah Right, doors open yeah.
Speaker 2 (10:56):
So I would say we've learned.
I don't know about you guys,but I feel like we've learned so
much over the years.
Our field is still continuing.
Yeah, I think we have a lotmore to learn about swallowing
and you know, it's just everevolving.
But I think that growth isreally important and I think we
get that by connecting with eachother, by reviewing studies and
discussing.
(11:16):
That's why we got togetherevery year and did that Right.
We took our unusual cases andpresented them Things where your
nuts patient.
Speaker 1 (11:26):
Oh, not case.
Talk about that.
It's about an hour on case,yeah.
Speaker 2 (11:29):
Or my patient who swallowed the denture.
Speaker 1 (11:31):
You know, I mean we can learn from each other, right
yeah?
Speaker 3 (11:35):
Amazing.
But we learn from each other,right, right?
It's important, that's good.
Speaker 2 (11:39):
And learning from our maybe not so successful
interactions.
So, wow, this, oh wow.
I really thought that thispatient had this going on, but
boy, was I wrong.
And what did you learn from it?
Because I think everybody needsto realize even the experts
aren't necessarily always theexpert.
They're still learning, they'restill figuring it out, right.
(11:59):
I think admitting that we're notperfect shows our vulnerability
.
I can't say the word to people,but yeah, I think, admitting
that we don't know, we don'thave all the answers, I will
text any of you all in this room.
Speaker 3 (12:14):
Yeah, we send pictures we send videos.
Speaker 1 (12:17):
We send videos like what is this yeah?
I mean, it's 30 years into hercareer and I still don't think
I'm perfect, and I know I'm notwell, and on that note, aren't,
or I know, at least four of you,are, every one of you, an asha
fellow, everyone yes, yes,single one what no, you and you,
you will be.
We're gonna have a good timewe're gonna hang out and let
(12:39):
these losers do their own thing,you know yeah, laurie well,
okay, four out of six of thepeople here ash Asher Fellows,
and I don't count, so four outof five people here are Asher
Fellows.
There we go, and so there's one, but I lost my pin.
Speaker 2 (12:53):
I'm sorry you lost your pin.
I lost mine too Does that meanthat you lost your fellow.
I'm still over here and I'mwearing my pin.
I'm probably tonight.
Speaker 1 (13:03):
The point being is that you've been around, you've
been practicing for a long time,you've been honored by your
association and there's notperfection still there, but
you're willing to admit andreach out for help and so I
think a lot of us I can't say itanymore because I'm not the
young whippersnappers right Comein and we're like we got to
know it, we got to do it Versuscoming into it, learning from
(13:24):
our mistakes and being willingto make ourselves vulnerable and
ask questions.
We're not always trained thatway.
We're trained.
We're kind of sometimeschastised for imperfection,
which is a totally backwards wayof living that promotes a
facade and being pretentious anddoes not do what's best for
patients.
But anyway, I could go.
Speaker 2 (13:42):
I always said to my students that the minute you
think you know everything is theminute you need to get out of
the field.
We need to always questioneverything that we do.
I still do it, every singletime I do a modified.
Speaker 3 (13:54):
Yeah.
Speaker 2 (13:55):
Miriam Swalens.
Today I question everything Ido and if you get to the point
where you're comfortable, youhurt people, Right.
Speaker 1 (14:03):
You look at the progression of science and so
we're at a pretty good pointbecause 2024, like there's been
some very logarithmicexponential growth and we know a
lot.
But like, if you go back 200years, they probably thought
they knew their stuff Okay, andwe're probably pretty confident
in it.
And so, like, how do we knowwe're not there?
Like, how do we know we're notthere right now and in a hundred
(14:24):
years you're going to discoverso much more and we're going to
be like, oh yeah, it's prettydumb overall too.
So I you've got to have an openmind to and be humble about it.
But but about this thing thatyou all got together, it did for
17, 17, 15 years, 15 years, along time.
Yeah, swallowing cinema.
What is the swallowing cinema?
Speaker 3 (14:44):
well, it started out with Nancy Swigert who thought
that we should have say at leastone lecture every single ASHA
with board certified specialistsin swallowing and swallowing
disorders to give case studies,to just show that you have an
elevation of credentials andthat you show your vulnerability
(15:06):
, that you're going to show thiscase study.
That's kind of unusual and howyou reached out to a team to
figure out what to do with that.
And and that's where it startedand it evolved into something
that we just do every singleyear now and more people have
gotten involved in it.
We've been involved in it for Idon't know how many years yeah,
I was the newest addition, I'mthe two.
Speaker 2 (15:26):
Yeah, look the one that's.
Speaker 3 (15:27):
I mean nancy had me started with um donna edwards,
and I can't remember the otherperson.
I feel bad.
I don't remember who the otherperson was, but she was a board
certified specialist and then itwent on from there and it was
always something about bedsideswallows or clinical swallows of
ales and then instrumentals andwhat you do with patients.
Speaker 2 (15:48):
Right.
Speaker 3 (15:49):
From birth to.
Speaker 2 (15:50):
It was almost like before fees was really so much
in practice and then we broughtfees into it, right, right.
Speaker 3 (15:56):
And then you brought in high-resolution manometry.
Yeah.
Speaker 1 (16:00):
So, but it's basically these are case
scenarios, right, case studiesthat you build.
Speaker 2 (16:04):
We thought of the most Of cases that were
challenging to us from the year.
We were really thoughtful ofthe cases that I selected
because we wanted them to be alearning experience for the
attendees and we had I've donethings where, like, I've been
wrong you know which is like andthe patient thought he was
aspirin all the time.
He wouldn't eat because he wascoughing, coughing, coughing
constantly and it was actuallyjust his tumor pressing and when
(16:26):
it went through the, we finallyfinally did a modify.
They didn't do a modify rightaway.
I mean it's kind of sad hecould have kept eating, but they
like pegged, never mind, it'sjust.
But I don't know if they peggedhim or not, it's been so long,
but it was just like, as it as,as the bolus went through like
kind of the aortic arch area, hehad a mediastinal tumor and it
(16:48):
was kind of pressing on thenerves and stuff and so he
coughed.
When it went through there,everyone was fine, but he was
like I can't eat.
I can't eat.
I you know, I haven't eaten ina week and they found that great
justification for an apv.
Speaker 1 (17:02):
Yes, that, that's the other which we.
Speaker 2 (17:03):
You know which we did , but we could see that.
You know that's the other partof it that we'd like to bring
forward is how do you examine?
You know which we did, but wecould see that.
You know that's the other partof it that we'd like to bring
forward is how do you examine?
You know what do you do foryour instrumental.
It's it's not just a lateralview and it's lips to, I'm gonna
say it, lips to les.
Yeah, you have to look at thewhole system because it's
there's an interrelationshipbetween what's happening,
between the oral, pharyngeal andesophageal let me say the word
(17:24):
phase, because they are phases.
Speaker 3 (17:27):
But they're not really phases.
Speaker 2 (17:30):
It's just lip-steal-a-s and you have to
look at the whole system Becauseif the drain's not working,
you're going to have residue inthe ferret, you're going to have
pressure differential.
You're going to back up, yoursystem's going to back up.
It's all one tube is what I sayalmost daily.
Speaker 3 (17:44):
It's all one tube almost daily, one, two, one, two
, yeah, part of that.
With some chambers and valves,exactly, there's pressure
differentials and thosepressures are going to affect
the pressures in the esophagus,are going to affect the pharynx.
I'd like to pick, sometimes,cases where we allow people to
aspirate and then is the like.
What jim coyle and I talkedabout with one of your part
(18:05):
podcasts was you can't alwayseliminate aspiration, so can we
just do what's best for thepatient and then work on
pulmonary clearance tasks, workon oral stuff, keeping your
mouth clean, keeping peoplemobile and letting them?
Letting them aspirate andliving a life that they want to
live, instead of what our, whatwe think a patient should do?
Speaker 2 (18:25):
We do that, with so many of our patients that are
post-radiation patients, we do?
Speaker 3 (18:29):
We should do it with HUTNAP.
Speaker 2 (18:31):
ALS.
Als, I mean absolutely.
Thank you.
Speaker 3 (18:35):
But for some reason in the acute neuro world, if
they penetrate on a modifiedperson.
Speaker 2 (18:39):
People freak out, right Like whoa whoa, whoa whoa.
But we keep coming back and Irepeatedly come back to that
Langemore paper in 1998.
Speaker 3 (18:49):
That's a several years, I mean it's 25.
Speaker 2 (18:52):
More than 25.
It's just old.
I count the years.
You need to keep coming back tothat paper.
And why has that not caught onwith so many people?
But that's the paper I go backto repeatedly.
People, but that's the paper Igo back to repeatedly with with
the people, are the physicians,because you know, we, we are
facing an aging population ofchronic aspirators and they keep
(19:15):
coming into the hospitals andthere's no pathway for them and
you know that.
You know the doctor's like oh,if you're aspirating well, you
should be dnr and on hospice.
Speaker 1 (19:29):
I'm like what well, no, that too, yeah, yeah, so
that's, that's how things are,and but how do we?
How do we fix it?
What are the barriers to getthere?
Speaker 2 (19:38):
it's education well what are the patient's goals?
Right, okay, you have to be anadvocate for the patient and
certainly we have to give themthe the most you know whatever's
going to be an advocate for thepatient and certainly we have
to give them the most you knowwhatever's going to be the
safest recommendation.
But what do they want?
As you were saying, it's reallyimportant and bring that into
this discussion with thephysician.
Speaker 3 (19:56):
Yeah Well, I've had lots of patients lately, where
the families are like we're notgoing to do thick and liquid,
we're not going to do a feedingtube, and I said, okay, then
we're going to do what we can do.
And so water brush your teeth,let's water aspirate.
Let's do some ems, ems t, let'sdo pulmonary clearance tests.
Let's get them motivated, our,our ots and pts.
When they know someone's anaspirator, they get them up and
(20:18):
moving faster.
The ots get them to brush theirteeth and feed them.
That's their goal is up in achair for meals.
Brush your own teeth, feedyourself looking at it
comprehensively.
Speaker 1 (20:28):
You're looking at why we care about aspiration, okay,
pneumonia, asphyxiation,whatever pulmonary sequelae but
then you're also considering allthe other variables that can
relate to those things andtrying to control those.
It makes sense.
It's multidisciplinary work.
It's like you're making sense Ialso.
Speaker 2 (20:45):
I also.
I also want to do a plug fortherapy, because in the acute
care setting right, we can'tjust diagnose, we can't just
assess Diagnose not use, yeah,diagnose, not use.
I say it all the time.
I think it's so important forus to use the skills that we've
learned for therapeuticinterventions and also use our
(21:06):
instrumental examinations, thefees, to see do those strategies
that we're implementing reallygoing to help the patient?
And I think that will guide howwe can optimally help the
patient.
But, the frustration that I have, though, with therapy is, if I
bring somebody back first, westill don't have guidelines for
how many repetitions doessomebody need to do these
(21:26):
exercises for how long?
So you bring them back andthere's no real there's no
improvement.
And so then it's like did I nottell you to do the right
exercise?
Are you not doing it correctly?
Did you not do it long enough?
Did you not do as manyrepetitions?
That's the frustration for me.
Speaker 1 (21:42):
There's a magic number, though I mean there's a
lot of visualize.
Yeah, there's no guidingprinciples but then there's a
lot of digital life.
There's not a lot of principles, but then there's variability.
Right yeah, we have to modify.
Speaker 2 (21:52):
When somebody comes back and doesn't improve.
You've got to that's the thingthat I as I've gotten further
into my career.
It's not like it's not theexercise didn't work, it's like
did I do something?
Is there something that Ididn't suggest for you that
would benefit?
Yeah, you well, sometimes weget to that point where there is
(22:12):
nothing.
You know we've done everythingright and but I think we should
do our best to use the skillsthat we have and the
interventions, whatever theymight be, and then guide it, you
know, based on that patient.
Speaker 1 (22:23):
Yeah, exactly, do something, try so, you, you,
there are a lot of differentthings here.
There have been plenty ofthings that we could tangent and
talk about for a very long time.
So, like a moment ago, the ideawas mentioned doing what's safe
is what is as safe as possible,right?
However, I bet if I went backand said what do you mean by
that, that it would be more toit.
Speaker 2 (22:45):
What is safe?
Speaker 1 (22:46):
Well, what is safe it ?
Is life must be lived as safelyas possible.
I drive a car every day.
That's not very safe.
Speaker 2 (22:53):
Do you wear your seatbelt?
Speaker 1 (22:54):
I do.
Speaker 2 (22:54):
Yes, yeah, absolutely .
We rely on the tools that wehave right To make our best
clinical judgment, to be able torender a clinical decision to
the patient, and then we workwith the patient based on their
goals.
We implement our strategies,our our therapeutic
(23:15):
interventions.
We do the best that we can.
There's no magic wand.
I many times wish I had a magicwand for our head and a cancer
patients, and they're not.
You know that doesn't exist.
Speaker 1 (23:18):
So sometimes we have to understand that we live with
aspiration anyway right, yeah,right, and that's what I that's
what I'm going with is is it's?
It's more than safety, it'sjust multi-faceted.
Speaker 2 (23:32):
It's faster than like your article.
Speaker 1 (23:34):
Yes, exactly Well, cause if we're just safety,
safety, they aspirate, we stop.
Okay, that's not safe, theyaspirate, we stop.
Then we, you know, or we doonyxiclic acid, we transfer it
hospitalizations for pneumonia.
Speaker 2 (23:51):
This?
Who talks to them about?
This could happen.
I don't know, because we don'tknow how much somebody could
aspirate to get pneumoniaregularly and so keep going, and
here here are the best things Iknow to help you mitigate that.
I think most of the time thepatients are going to make,
they're going to make their owndecisions based on information
that they know that give fortheir own goals, their slp.
(24:13):
They're going to listen to ittoo.
I mean, they need to draw onthat.
But you have to be carefulbecause a lot of times people
are going to put their ownbiases in their recommendations.
Speaker 3 (24:21):
That's just what I'm saying.
Speaker 2 (24:22):
And you know you've got especially older populations
.
I think they are less likely toquestion whatever somebody
tells them they need to do froma healthcare standpoint.
One of the best things thathappened in our facility is we
got palliative care moreinvolved in the care of patients
to have goals of care,discussions with our patients
(24:43):
because our surgeons arewonderful but they want to fix
the patient Sometimes it's notfixable or the fix could
actually come to sometimes beworse than what they've got and
and having some discussions withpatients to where they really
really understand what are yourchoices and what are the choices
(25:04):
that's right, that's right,that's it.
That's part of our ethics,that's part of the basis of what
we were supposed to do asspeech and language pathologists
is first, do no harm, yeah.
Second, educate the patient.
Well, maybe not in that order,but educate the patient, educate
them on and balance betweenfunction and whatever quality.
Speaker 1 (25:23):
Yeah, you have to balance that I mean, ultimately,
they're in control and so we'rehelping them.
We're providing the informationbased upon our knowledge and
skill set to be able to make thebest decision.
Speaker 3 (25:35):
I think that's exactly it.
Speaker 2 (25:37):
We are there to provide education but, at the
end of the day, what they decideto do right is up to them.
Speaker 1 (25:43):
100 and what happens when we get into the mindset
that's like, okay, I'm gonnaprotect myself because I don't
want to get sued and so I'mgonna document.
I told this patient you need tobe on my lethally.
They said I'm not going to doit.
And I said but if you don't doit, you might get pneumonia, you
might die.
And they said oh, I'm still notgoing to do it.
Versus they said they're notgoing to do it, our
(26:15):
recommendation and if they don'tlike that, maybe finding
another way that they're okaywith right, I think it's
understanding.
Speaker 2 (26:22):
Are you protecting you?
Are you protecting yourpatients?
There you go, they're incontrol, right?
Yeah, there was actually areally there was a good
presentation today and they itwas, I'm sorry, I hate to like
only remember one of thepresenters, which was nicole
rogas pulia, but it was on withdementia and it was providing
the families with choices oflike okay, do you want to drink
(26:44):
mildly thickened liquids?
Do you want to do thin liquidsand start doing better oral care
?
You know, and it was likeproviding the patients with
choices and they're like do youwant to do, you want to do emst,
or you want to do like aneffortful swallow and like some
exercises and stuff like that.
And they chose like emst.
And I'm like that.
(27:04):
I was like, wow, you know, yeah, it was, but it was out of her
lab in um university ofwisconsin and it was just like
you know, boom, boom.
I've been practicing forever.
I'm like this is excellent,because you know I'm dealing
with now that I've moved out ofthe texas medical center, I'm in
a community hospital much moreof an advocate for my patients,
(27:25):
because we don't have theresources, and just like for
being able to provide them.
Let's let.
That's an awesome like givethem an op, give them an option,
give them like two choices.
They're more likely to actuallyright for quality of life and
that's what they had like highadherence and you know, and I
don't like they're not adheringto my recommendations.
It's their choice.
(27:46):
I don't, you know, I'm not bigon that word, but it's better
than oh no maybe adherence isokay, it's the non-compliant
that drives me.
They're a prisoner.
Yeah like yeah, you're not,he's non-compliant.
I'm like no, he doesn't want todo it can we just a step
further?
Speaker 3 (28:02):
yeah, what you're saying is exactly take it a step
further for those that work inacute care that have to pass a
patient on.
So I had a patient parkinsonpatient I just presented this on
a tim's university and and hewas Parkinson's known aspirator
was in our hospital.
For COVID aspirator withinliquids pooled with pureed
(28:22):
esophageal issues went to a carecenter.
The therapist at the carecenter insisted he do thick and
liquids.
Of course he comes in thehospital.
He's an indwelling catheterbecause he's got a, an issue
that doesn't have anything to dowith speech pathology.
So he comes in the hospitalwith altered mental status and
the very first thing he verydelayed response altered all
that and he said I don't wantany thickened liquids.
(28:44):
So what we did was we didexactly what they wanted, like
you were just saying hispreferences.
Why I said no thickened liquids.
We knew he's a known aspiratorand then we passed it on to the
patient that was going to thecare center again different care
center to the speechpathologist.
I called the speech therapistand I said hey, you're going to
get a patient of mine, this iswhat's going on.
And they did the same thingthat we did so.
(29:05):
We followed up with withrespiratory staff keeping his
mouth clean yeah physicaltherapy involved.
We're going to let him aspirate.
And the wife was ecstaticbecause I said let me call the
speech therapist instead of yousaying the same thing over again
.
Right, we work with greattherapists.
And then he came back to thehospital a month later because
he was quote better.
Right Now he's going to do hismodified again, we're going to
(29:27):
repeat it and this modified isgoing to be better.
Guess what?
It wasn't that much better.
So he's still an aspirator.
I still showed everything tothe wife and the patient and he
hasn't come back with apneumonia.
So here's a guy who'sParkinson's.
Speaker 2 (29:39):
Everybody would freak out about him.
The question is who cares Right?
Who cares Right?
Speaker 3 (29:45):
He came back to the hospital like two weeks later
altered mental status, sepsis,because he had an indwelling
catheter.
I was going to do.
I said we're going to get himup in a chair, we're going to do
, we're not changing anything.
And they were good with thatbecause we kept the patient
preferences and we protected thepatient as much as we could.
(30:08):
Yeah, and follow through withwhat they wanted, what the
skilled nursing speechpathologist wanted, all of that.
We all put the patient firstInstead of oh my gosh, he's
aspirating.
You've got to have thickenedliquids.
No, I was sneaking him coffeeevery morning.
I'm like, is she sneaking himcoffee every morning?
There's quality of life 100%agree with that.
Speaker 1 (30:29):
I had a thought.
It left me.
Speaker 3 (30:32):
Welcome to my life.
I just think you need to passon information to people not
just live in our silos but likeif I'm going to pass a patient
to you.
I'm going to call you and sayhey, I mean, I did that the
other day.
I said you're going to get this92 year old train wreck.
She's a doll, Her son doesn'tget it, but she's a doll.
And this is what we were doing.
(30:55):
And those guys call us and sayhey, you're going to get a
patient from us who's you knowhad another stroke.
Something's going on.
Make sure you follow them.
That communication to theperson passing back and forth, I
think is vital it's reallycontinuity, continuity of care
is really that's a huge issue Iforget.
Speaker 2 (31:07):
When we're discharging the patient that
they're going to in the midst,we have to think about where
they're they're going, how thoserecommendations are going to
help them carry on.
I think the hard thing in acutecare is like they're gone the
next morning.
I didn't know they were going.
I mean like I can monitor casemanagement, but I don't know
that they've gone.
Speaker 1 (31:25):
Well, but what if you have a good relationship with
the people in the community andthey know they can call you?
So you might not get to callthem preemptively, but they know
they can reach out to you.
Speaker 2 (31:31):
I have people call me and I know there's probably
HIPAA issues, but you know.
No, it's not as long as you'reinvolved in the care, okay, I
was going to say HIPAA, shmipa,but you know we're not going to
identify who that was.
Speaker 3 (31:45):
I asked the patient and I asked the worker yeah,
Like this 92-year year old I sawlast week.
I said is it okay if I contactthe people?
Yeah, I talked to them and talkto them and I documented it.
Patient and son, you areallowed.
Speaker 2 (31:59):
You're allowed.
Yes, I will tell anybody whocalls me.
Whatever I'd like to ask, is itokay?
You want me to?
Speaker 3 (32:06):
call them and I documented that.
The patient and the son saidit's okay.
And I just document it just sothat like nobody get Freaky
Friday on you.
Speaker 2 (32:13):
But it is called continuity of care.
It's something that we shouldbe doing.
It's not, you know, we don'thave.
You know it's something that'sreally important to help that
patient and the people in thecommunity.
Speaker 3 (32:23):
They appreciate it.
They call me all the time andsay, hey, you're getting someone
back, and then, once you getthat ball rolling, it doesn't
stop.
Stop, it just keeps.
It's a wonderful relationshipwith the people in the community
.
Speaker 2 (32:33):
Yeah, yeah I I want to go back to the mentorship
thing because for youngclinicians, if there are like
young clinicians listening tothis, find a mentor, reach out.
I did that early.
I reached out to barbarasunnies and would call her, like
all the time.
So find someone to, to help youto, you know bounce things off
of yeah, whoever that might bewhoever you feel that you
(32:54):
respecting clinically yeah,that's important, make those
connections, because there's alot of questions unanswered that
you, you know, you may findthat having a mentor is going to
really help you through yourcareer and I think all of us
here sitting here did that right.
I mean, yeah, I did that as aleader.
I mean we've all had peoplethat we had mentors with.
Speaker 3 (33:14):
Besides, each other.
Speaker 2 (33:15):
Right Besides each other.
I think right now we have eachother, but also we are very I
know we're all very passionateabout mentoring the next
generation of clinicians.
Speaker 1 (33:27):
It's a good continuity of care.
Speaker 2 (33:29):
And don't forget about PCSS, passing it on to
John.
Yeah passing it on andempowering people.
Speaker 1 (33:35):
Well, we've probably wrapped this up.
I don't think there's reallynecessarily a core theme to this
episode other than the fact Ihad something there.
I had something there, it wasgoing to come out, and I planned
to edit this episode.
It's going to be so perfect.
Speaker 2 (33:52):
Wait till you're 63.
Speaker 1 (33:54):
Wait till you're 63.
Speaker 2 (33:54):
Wait till you're 63.
It just like disappears.
Tell everyone you saved it.
I look good for 63.
I never tell so.
Anyway, you're older than me.
Speaker 1 (34:04):
Stop it.
Just to summarize A couple ofthings that we've gone through.
The importance of communicationyes, I think key.
You know the importance ofvulnerability, key.
You know the importance ofvulnerability.
Not faking it till you make itwhich man I don't know how many
episodes I've said that onpeople are gonna say, if you
said that one more time, I'mgonna shut this thing off.
But you know being vulnerableabout what you know.
And that goes with thementorship too finding a mentor
who will accept you for that andnot expect perfection, because
(34:28):
certainly they're not.
And so you know you have apretentious, dishonest
individual if you have someonewho's doing that but being open,
willing to communicate witheach other.
A speech pathologist when youneed help, but also when you're
handing off care to, so peoplefeel like they can reach out to
you and you can reach out tothem, man there's a lot more.
Speaker 3 (34:46):
Listen to your patient yeah, listen to your
patient read a room read a room.
Read the room that read the room.
If you're in acute care oroutpatient and someone comes in
with that patient, read the room, look at the person that's with
that patient, read, read theroom with that patient.
I think we don't get those softskills in school and we,
because we've worked for manyyears, can read a room really
(35:08):
fast, but those are skills thatare difficult to learn.
How to?
How much information do youreally give?
Like we're giving informationabout a modified and I said this
is easy peasy, this isn'trocket science.
I'm not a rocket scientist.
Let me show you your modifiedbarium swallow and I don't give
terms, unless they're inmedicine.
Do I give terms?
Right?
But I'll say you know I have asystem that you know, the TIM
system, so you can say on therelike here's your flapper, here's
(35:40):
yeah, you don't want this goinghere.
It's like a laundry shoot.
The more you understand whyyou're doing what you're doing,
the more you're going to be ableto to help, not do the things
that you're going to be able tofollow these compensatory
strategies easier.
But read a room like there'stimes I'll be talking, you can
tell the patient and the spouseare just yeah I would think I'm
processing anything else at thispoint, important not to take
those things for granted too,because they come so easy to you
after years and years ofexperience.
Speaker 1 (35:59):
But it took you a while to get there and so not
forgetting to break those thingsdown and to explicitly provide
instruction to students on thosethings too.
So not just the physiology, notjust what you see and why it
matters, but the importancecommunication, because if you're
handing off somebody from acutecare to a long-term care
facility or whatever you couldhave the best note.
(36:21):
They might not have the time toread it, but they have the time
to pick up the phone and you canexplain something to them in
two minutes and they can askquestions and whatnot.
It goes a long way, and so justnot forgetting about those
things.
So I guess I don't know what Ione thing that I'm pulling out
of this is is to look beyond theconcrete and the physiology,
the, what you see, but really toemphasize, like reading the
(36:42):
room and and the, thecommunication, why it matters.
It's just a lot of, a lot ofdifferent things.
Speaker 2 (36:50):
One little point I would like to make is don't
forget about the caregiver inthe room, right, because they
are so critical to therehabilitation of that patient.
They're living with it andoftentimes they are the ones
that's forgotten in the room,but they have to go and cook the
meals and help the patient soonce.
It's important to the patient,what's important to the
caregiver, absolutely.
(37:11):
But but what?
Why does?
What do they ultimately careabout?
I think is the thing that, as Iget closer and closer in age,
to many of my patients.
That's the thing.
It's like what?
What am I?
What am I doing to my patientwhen I'm making these
recommendations?
Speaker 1 (37:28):
yeah, it's real.
You can relate to them more andso you empathize with them more
and you're like what would Iwant if I were in their position
?
Yeah, no, it makes a lot ofsense.
And just a reminder, this is avery laid back episode.
This is, this is talking.
There's not something directlythat we're looking at other than
a bunch of people were verycomfortable speaking with each
(37:49):
other, who are bound by arelationship of doing not just
swallowing sin, but workingtogether in a number of
different ways in the past, andI think one of the reasons you
gel is because you've got a lotof pretty like laid back,
similar mindset on a lot ofthese things, and that's very
refreshing to hear from a lot ofyour perspectives.
With that, is there anything atall that you want to leave with
(38:10):
a lot of really good things toto draw out of that?
And looks like you got to takeoff.
Don't be ceremony huh, yeah, nothat's right.
Speaker 2 (38:19):
I'm ready to go breathe the room I mean the
relationships that we've formedover the years.
I mean we've all been friendsfor, at this point, over 20
years at least I mean, but welove each other because we all,
at the end of the day, caredeeply about the people that we
serve and care deeply about theimpact that we have on other
(38:41):
people.
And just Well said Dr Souter.
Speaker 1 (38:46):
Yes.
Speaker 2 (38:47):
Professional relationships are important.
They're really important to mylife.
Speaker 3 (38:51):
Yeah.
Speaker 2 (38:52):
But these are the most important relationships
that outside of my obviouslyintermediate family that I know.
Yeah, yeah, yeah, my husbandjust thinks I shove applesauce
in people's faces all day.
So I didn't.
I would say the other thing.
The last thing is that when Istarted my career, I thought I
needed to read everything, learneverything, and I felt
overwhelmed.
(39:12):
And somebody told me that'swhat you do every day is you
practice, practice, practice,and that's what.
That's what.
That's what it's all about.
It's just your practice and itgets better, but you learn as
you go.
Speaker 1 (39:24):
Yeah, Very cool.
Well, thank you all Reallyappreciate it.
Great to meet and hang out andlook forward to chatting again.
Speaker 2 (39:32):
Thank you, thank you, thank you.
Speaker 1 (39:40):
That's another episode of Swallow the Gap.
Special thank you to our guestsJulie Blair, lori Sterling, dr
Deb Suter, dr Barbara Messingand Joe Ponteel, and I'm excited
to announce a special two-hourwebinar coming in late February
involving most of these ladiesdiving into some fascinating
modified barium swallow studies,and this course continues the
(40:00):
15 or so year legacy ofswallowing cinema.
For more information, keeptuning in or sign up for the
mailing list at swallowthegapcom, or follow me on instagram at
swallowallow Patho, that is, atSwallow P-A-T-H-O.
Gap Education's last twowebinars for ASHA CEUs received
stellar ratings, at an averageof about 4.8 out of 5.
(40:23):
And they were a lot of fun, sowe hope to see you there.
Additionally, visitSwallowTheGapcom for more
information about upcoming liveand recorded courses in 2025.
Many of them actually most ofthem on there toward the
beginning of the year.
And last but not least, aspecial shout out to this
episode's sponsor, the Milton JDance Endowment, a sponsor
(40:45):
dedicated to supporting head andneck cancer patients and
individuals with swallowingdisorders across all populations
.
Thank you for listening andwe'll see you next time.
This episode of Swallow the Gap is sponsored by
the Milton J Dance Endowment, asponsor dedicated to the support
of head and neck cancerpatients and swallowing
disorders in all populations.
Speaker 2 (00:10):
My name is Lori Sterling and this is a special
edition of Swallow the Gap ASHA2024.
That was really good.
I like it.
Speaker 1 (00:22):
So, in case you missed it, that was Lori
Sterling, and this is a specialedition of Swallow the Gap at
ASHA in 2024.
Lori Sterling, who are you?
Speaker 2 (00:31):
I am a speech pathologist at Houston Methodist
Hospital in Houston, Texas.
I'm like why am I saying that?
Because it's pretty obvious Iam in Houston.
I have been an acute carespeech pathologist for over 30
years now.
I did a fellowship in Baltimoreat the same place.
One of our other guests here,Barbara Messing, did hers.
(00:51):
It was like a residency and wayback before CF residencies were
popular, Before they were known.
Yeah, it was a clinicalfellowship, but it was only for
a year.
Yeah, but it was only for a yearit was still called clinical
fellowship yeah, but it was onlyfor a year, so it was kind of
like a residency.
Then you moved on.
That's right, but I have beenvery involved with ASHA for a
number of years, beginning withSIG 13.
(01:13):
And it's still a division.
When it was a division, yeah,way back when became like the
director of what I don't knowwhat it was of education and
became director of what I don'tknow what it was of education
and became involved withconvention and co-chaired
convention in 2019 and I'm goingto co-chair convention 2025,
our centennial, our centennialand, yeah, with uh, four other
(01:36):
wonderful, four other wonderfulum clinicians, audiology and
speech pathology, but they'rehaving four this year.
We're having a total of five.
It's a co-chair council justsomething special for the
centennial, yeah, and it's goingto be held in washington dc so,
yeah, get it on your calendar.
Speaker 3 (01:52):
Is it going to be the week before thanksgiving?
Speaker 2 (01:53):
it's going to be the usual time it is but no, I've
been a clinician for a number ofyears.
It's always been acute care,critical care and swallowing,
except for a late midlife crisiswhen I did some pediatrics.
I wanted to learn more aboutbirth to adult.
I mean, I knew about adult togeriatrics, but I wanted to
(02:14):
learn about swallowing andbabies.
Speaker 1 (02:16):
So a little kickstart there you go.
And who else we have.
Speaker 2 (02:20):
This is I'm Deb Suter .
I am currently at theUniversity of Kentucky.
We're the director of the Voiceand Swallow Clinic.
So right now I am doing clinicfive days a week and teaching
dysphagia.
I've taught dysphagia tograduate students for over 20
years and then I do research aswell, probably best known for
(02:42):
developing Yale Swallow Protocolwith Steve Leder, which is a
protocol to assess for dysphagiarisk and aspiration risk for
people with dysphagia.
And then I have been in variouspositions throughout the years
with ASHA.
That's actually how I metLaurie and most of the people
that are here in the room.
Laurie and I met through SIG 13years ago where we were trying
(03:06):
to break into working with ASHAand trying to figure out how we
could get more involved, andthen kind of worked my way up
through becoming B6C chair, sochair over all the special
interest groups, and then gotinvolved with CFCC and then
became chair of CFCC, and sothat's kind of where I am right
now.
Deb and I served as she waseditor and I was a CE
(03:29):
administrator for 613 back whenit was all paper, and that's how
Julia met you.
Yeah, through Bing, yeah.
Speaker 1 (03:36):
All right, who are you?
Speaker 2 (03:37):
So I'm Julie Blair.
I'm at the University inCharleston, South Carolina.
It was my first job.
My last job, you work withJanina.
I do.
I love her.
She's great.
She is amazing.
She's got to be one of thenicest people on this planet.
Speaker 1 (03:50):
Oh, she's a jerk, don't lie, she's very nice.
Speaker 2 (03:53):
She's actually way nicer than me.
Speaker 1 (03:58):
Janina Wimskill.
Speaker 2 (03:59):
Janina, I still can't say her last name.
Speaker 1 (04:02):
She's awesome, she's super great.
Speaker 2 (04:04):
But yeah, I was at MUSC, lori was there with me for
a while.
Speaker 1 (04:07):
That's how.
Speaker 3 (04:07):
I know, julie.
Yes.
Speaker 2 (04:09):
My wedding and then she left us, but she was my
introduction into ASHA.
So when she stopped being theCEA, she asked do you want to do
this role?
I forgot about that and so Igot pulled in right before they
transitioned away from the paper, which was which is a pretty
sweet to go go into that, thatrole.
(04:32):
And then I applied for SIG 13to be on the board and got to
work with Deb, where it was thefirst time I joined Facebook, so
that she would poke me.
Oh, look at that.
Oh, the pokes.
I forgot about the pokes, oh mygosh.
So that was my first Facebookexperience.
I've had just a lot of reallyawesome opportunities because of
(04:54):
the people that I've workedwith or been around.
Bonnie Martin Harris was atMUSC for a number of years and
so through her I got to be partof some research and got to do
some things at the va to work, aparty too I worked with marty
broski.
It was so funny he would answerthe call smarty broski, I'm
gonna call him when he does thatyou better look out kind of
(05:19):
gets blurred together smartybroski smarty broski.
I like it.
Speaker 1 (05:25):
That's very funny marty, if you're listening, you
better watch out marty, yeah, um, but uh so.
Speaker 2 (05:32):
So I've been there.
I've teach the head neck cancercourse there.
I work predominantly with head,neck cancer, voice and
swallowing all grown-ups.
Occasionally I'll do like ascope on a small person, but
that is only to be a helper to acolleague otherwise yeah, yeah,
all all big people, okay, bigpeople all right, who are you?
(05:52):
so I'm barbara messing and whata journey it's been.
As a speech pathologist I neverwould have anticipated all the
little changes in life events.
Yeah, that I and recreation ofmy career.
But I started at shock traumaas la, as Lori had mentioned,
and that's when I really fell inlove with dysphagia, because we
would do dysphagia rounds withDr Bosma and the team and look
(06:14):
at the video studies you knowvideo fluoroscopy studies and it
was just so intriguing.
And so that was many years ago.
I worked with TBI patients.
Then I found the world of headand neck cancer in my next
position and also fell in lovewith stroboscopy and voice
disorders, so laryngeal thosewith the larynx and those
(06:35):
without the larynx and airwayissues.
So it's just been a reallywonderful journey Along the way.
I got my PhD through theUniversity of Queensland with
Liz Ward and Kathy Lazarus as myadvisors, and what an
experience that was.
And so I learned about research, how to do research, and that's
another love of mine, and so Ireally feel I've just had a
(06:56):
great career and I've been veryfortunate.
Speaker 1 (06:57):
I've met these wonderful women and we've
journeyed through all of it, alot of it.
Speaker 2 (07:03):
And here we go, joe Pantel, all right here's, joe,
lay it down.
Speaker 3 (07:08):
I'm always the caboose.
Sorry, no, julie's the caboose,no, I'm the caboose and I'm the
caboose.
So I have worked in criticalcare my whole life.
Events and traits kind of aremy love or high flow or delirium
and all that kind of stuff.
And I'm trying to think of whenI met all these wonderful women
Throughout the career.
(07:28):
I did do a lot of stints inASHA with SIG 13, when it was a
SIG 13.
And I think I was just Division13 when it was looking, either
writing something for Division13 or reviewing something for
Division 13.
Way back when I absolutely hatedswallowing, like I went to
school in Illinois and JerryLogerman trained me.
(07:50):
And when I moved to Californiathe last thing I wanted to do
was swallowing.
But I worked in the ThousandBend Trauma Center.
I was low man on the totem pole, I was 15 speech pathologist
and they basically said to me ifyou want a job, you're going to
(08:12):
have to start a swallowingprogram.
And I was like I don't likeswallowing, that's just not,
that's not.
I liked head neck cancer, Ilike cleft palate.
I liked all these things and Ithought, well, I have to have a
job because it clearly I neededto pay bills and so my father
always taught me to be hangaround with people who were a
lot smarter than you, and I did.
You're pretty smart yourself.
Well, thank you, thanks.
(08:34):
So I developed a team ofphysicians and nurses and
respiratory therapists andthought I know about swallowing,
but I don't know about all ofthe things that happen with
swallowing.
I don't really know about thepulmonary system or the gut
system.
So I proctored classes at UCIand it was wonderful to go to
med school and not have to takea test, like I could go to med
school and go to any class, andall these positions that I
worked with were teachingclasses like come learn about
the pulmonary system.
(08:55):
So I sat and took their classesand I didn't have to take a
test, which is wonderful.
So I learned a lot about thingsthat I never thought I'd learn
about.
And now I love swallowing andI've met these women through
years of our case studies andwe're also lifelong friends,
which I know may not beimportant to some people.
It's important to us.
So, yeah, I've done ASHA stuff,I've done state stuff.
(09:18):
I've seen so many differentclinicians do such wonderful
things in our field and I likethe things that are happening
coming up.
These people coming up in theirtwenties and thirties are
coming up with some fantasticresearch and I just, I just want
to pass that baton to peopleabout love, the love of the
field and the love of mentorshipversus, you know, and just
(09:38):
exploring and expanding.
It's pretty much where.
Speaker 2 (09:41):
I'm at.
Okay, I think we've all mentoredand gotten the value from that
I mean I love long empoweringyounger clinicians and getting
them more involved withswallowing, getting them
involved with ASHA.
You know what have you Well,and I think about all the
opportunities I was given and ifI had not had the people that
(10:04):
were part of my career, part ofmy work family, I would not have
been able to do any of thethings that I've done.
And I just had 30 years at MUSCCongratulations, thank you.
And the younger clinicians hada little thing for me and they
were asking you know what advicewould you give new clinicians?
(10:24):
And to me it's say yes, say yesto the opportunities.
You know what advice would yougive new clinicians?
And it was to me it's say yes,Say yes to the opportunities,
Say yes to be open toparticipate.
You know you want to be part ofthis research yes.
Do you want to present?
Yes.
Do you want to do a study?
Yes.
Speaker 3 (10:39):
You know, it's just true.
Do you want to see a patient atsix o'clock that needs your
help?
Yeah, I'll do it.
Speaker 2 (10:44):
Do it Right, because it makes an impression and
people remember and you'll getasked again.
Speaker 3 (10:52):
Right and doors open.
Speaker 1 (10:53):
Yeah Right, doors open yeah.
Speaker 2 (10:56):
So I would say we've learned.
I don't know about you guys,but I feel like we've learned so
much over the years.
Our field is still continuing.
Yeah, I think we have a lotmore to learn about swallowing
and you know, it's just everevolving.
But I think that growth isreally important and I think we
get that by connecting with eachother, by reviewing studies and
discussing.
(11:16):
That's why we got togetherevery year and did that Right.
We took our unusual cases andpresented them Things where your
nuts patient.
Speaker 1 (11:26):
Oh, not case.
Talk about that.
It's about an hour on case,yeah.
Speaker 2 (11:29):
Or my patient who swallowed the denture.
Speaker 1 (11:31):
You know, I mean we can learn from each other, right
yeah?
Speaker 3 (11:35):
Amazing.
But we learn from each other,right, right?
It's important, that's good.
Speaker 2 (11:39):
And learning from our maybe not so successful
interactions.
So, wow, this, oh wow.
I really thought that thispatient had this going on, but
boy, was I wrong.
And what did you learn from it?
Because I think everybody needsto realize even the experts
aren't necessarily always theexpert.
They're still learning, they'restill figuring it out, right.
(11:59):
I think admitting that we're notperfect shows our vulnerability
.
I can't say the word to people,but yeah, I think, admitting
that we don't know, we don'thave all the answers, I will
text any of you all in this room.
Speaker 3 (12:14):
Yeah, we send pictures we send videos.
Speaker 1 (12:17):
We send videos like what is this yeah?
I mean, it's 30 years into hercareer and I still don't think
I'm perfect, and I know I'm notwell, and on that note, aren't,
or I know, at least four of you,are, every one of you, an asha
fellow, everyone yes, yes,single one what no, you and you,
you will be.
We're gonna have a good timewe're gonna hang out and let
(12:39):
these losers do their own thing,you know yeah, laurie well,
okay, four out of six of thepeople here ash Asher Fellows,
and I don't count, so four outof five people here are Asher
Fellows.
There we go, and so there's one, but I lost my pin.
Speaker 2 (12:53):
I'm sorry you lost your pin.
I lost mine too Does that meanthat you lost your fellow.
I'm still over here and I'mwearing my pin.
I'm probably tonight.
Speaker 1 (13:03):
The point being is that you've been around, you've
been practicing for a long time,you've been honored by your
association and there's notperfection still there, but
you're willing to admit andreach out for help and so I
think a lot of us I can't say itanymore because I'm not the
young whippersnappers right Comein and we're like we got to
know it, we got to do it Versuscoming into it, learning from
(13:24):
our mistakes and being willingto make ourselves vulnerable and
ask questions.
We're not always trained thatway.
We're trained.
We're kind of sometimeschastised for imperfection,
which is a totally backwards wayof living that promotes a
facade and being pretentious anddoes not do what's best for
patients.
But anyway, I could go.
Speaker 2 (13:42):
I always said to my students that the minute you
think you know everything is theminute you need to get out of
the field.
We need to always questioneverything that we do.
I still do it, every singletime I do a modified.
Speaker 3 (13:54):
Yeah.
Speaker 2 (13:55):
Miriam Swalens.
Today I question everything Ido and if you get to the point
where you're comfortable, youhurt people, Right.
Speaker 1 (14:03):
You look at the progression of science and so
we're at a pretty good pointbecause 2024, like there's been
some very logarithmicexponential growth and we know a
lot.
But like, if you go back 200years, they probably thought
they knew their stuff Okay, andwe're probably pretty confident
in it.
And so, like, how do we knowwe're not there?
Like, how do we know we're notthere right now and in a hundred
(14:24):
years you're going to discoverso much more and we're going to
be like, oh yeah, it's prettydumb overall too.
So I you've got to have an openmind to and be humble about it.
But but about this thing thatyou all got together, it did for
17, 17, 15 years, 15 years, along time.
Yeah, swallowing cinema.
What is the swallowing cinema?
Speaker 3 (14:44):
well, it started out with Nancy Swigert who thought
that we should have say at leastone lecture every single ASHA
with board certified specialistsin swallowing and swallowing
disorders to give case studies,to just show that you have an
elevation of credentials andthat you show your vulnerability
(15:06):
, that you're going to show thiscase study.
That's kind of unusual and howyou reached out to a team to
figure out what to do with that.
And and that's where it startedand it evolved into something
that we just do every singleyear now and more people have
gotten involved in it.
We've been involved in it for Idon't know how many years yeah,
I was the newest addition, I'mthe two.
Speaker 2 (15:26):
Yeah, look the one that's.
Speaker 3 (15:27):
I mean nancy had me started with um donna edwards,
and I can't remember the otherperson.
I feel bad.
I don't remember who the otherperson was, but she was a board
certified specialist and then itwent on from there and it was
always something about bedsideswallows or clinical swallows of
ales and then instrumentals andwhat you do with patients.
Speaker 2 (15:48):
Right.
Speaker 3 (15:49):
From birth to.
Speaker 2 (15:50):
It was almost like before fees was really so much
in practice and then we broughtfees into it, right, right.
Speaker 3 (15:56):
And then you brought in high-resolution manometry.
Yeah.
Speaker 1 (16:00):
So, but it's basically these are case
scenarios, right, case studiesthat you build.
Speaker 2 (16:04):
We thought of the most Of cases that were
challenging to us from the year.
We were really thoughtful ofthe cases that I selected
because we wanted them to be alearning experience for the
attendees and we had I've donethings where, like, I've been
wrong you know which is like andthe patient thought he was
aspirin all the time.
He wouldn't eat because he wascoughing, coughing, coughing
constantly and it was actuallyjust his tumor pressing and when
(16:26):
it went through the, we finallyfinally did a modify.
They didn't do a modify rightaway.
I mean it's kind of sad hecould have kept eating, but they
like pegged, never mind, it'sjust.
But I don't know if they peggedhim or not, it's been so long,
but it was just like, as it as,as the bolus went through like
kind of the aortic arch area, hehad a mediastinal tumor and it
(16:48):
was kind of pressing on thenerves and stuff and so he
coughed.
When it went through there,everyone was fine, but he was
like I can't eat.
I can't eat.
I you know, I haven't eaten ina week and they found that great
justification for an apv.
Speaker 1 (17:02):
Yes, that, that's the other which we.
Speaker 2 (17:03):
You know which we did , but we could see that.
You know that's the other partof it that we'd like to bring
forward is how do you examine?
You know which we did, but wecould see that.
You know that's the other partof it that we'd like to bring
forward is how do you examine?
You know what do you do foryour instrumental.
It's it's not just a lateralview and it's lips to, I'm gonna
say it, lips to les.
Yeah, you have to look at thewhole system because it's
there's an interrelationshipbetween what's happening,
between the oral, pharyngeal andesophageal let me say the word
(17:24):
phase, because they are phases.
Speaker 3 (17:27):
But they're not really phases.
Speaker 2 (17:30):
It's just lip-steal-a-s and you have to
look at the whole system Becauseif the drain's not working,
you're going to have residue inthe ferret, you're going to have
pressure differential.
You're going to back up, yoursystem's going to back up.
It's all one tube is what I sayalmost daily.
Speaker 3 (17:44):
It's all one tube almost daily, one, two, one, two
, yeah, part of that.
With some chambers and valves,exactly, there's pressure
differentials and thosepressures are going to affect
the pressures in the esophagus,are going to affect the pharynx.
I'd like to pick, sometimes,cases where we allow people to
aspirate and then is the like.
What jim coyle and I talkedabout with one of your part
(18:05):
podcasts was you can't alwayseliminate aspiration, so can we
just do what's best for thepatient and then work on
pulmonary clearance tasks, workon oral stuff, keeping your
mouth clean, keeping peoplemobile and letting them?
Letting them aspirate andliving a life that they want to
live, instead of what our, whatwe think a patient should do?
Speaker 2 (18:25):
We do that, with so many of our patients that are
post-radiation patients, we do?
Speaker 3 (18:29):
We should do it with HUTNAP.
Speaker 2 (18:31):
ALS.
Als, I mean absolutely.
Thank you.
Speaker 3 (18:35):
But for some reason in the acute neuro world, if
they penetrate on a modifiedperson.
Speaker 2 (18:39):
People freak out, right Like whoa whoa, whoa whoa.
But we keep coming back and Irepeatedly come back to that
Langemore paper in 1998.
Speaker 3 (18:49):
That's a several years, I mean it's 25.
Speaker 2 (18:52):
More than 25.
It's just old.
I count the years.
You need to keep coming back tothat paper.
And why has that not caught onwith so many people?
But that's the paper I go backto repeatedly.
People, but that's the paper Igo back to repeatedly with with
the people, are the physicians,because you know, we, we are
facing an aging population ofchronic aspirators and they keep
(19:15):
coming into the hospitals andthere's no pathway for them and
you know that.
You know the doctor's like oh,if you're aspirating well, you
should be dnr and on hospice.
Speaker 1 (19:29):
I'm like what well, no, that too, yeah, yeah, so
that's, that's how things are,and but how do we?
How do we fix it?
What are the barriers to getthere?
Speaker 2 (19:38):
it's education well what are the patient's goals?
Right, okay, you have to be anadvocate for the patient and
certainly we have to give themthe the most you know whatever's
going to be an advocate for thepatient and certainly we have
to give them the most you knowwhatever's going to be the
safest recommendation.
But what do they want?
As you were saying, it's reallyimportant and bring that into
this discussion with thephysician.
Speaker 3 (19:56):
Yeah Well, I've had lots of patients lately, where
the families are like we're notgoing to do thick and liquid,
we're not going to do a feedingtube, and I said, okay, then
we're going to do what we can do.
And so water brush your teeth,let's water aspirate.
Let's do some ems, ems t, let'sdo pulmonary clearance tests.
Let's get them motivated, our,our ots and pts.
When they know someone's anaspirator, they get them up and
(20:18):
moving faster.
The ots get them to brush theirteeth and feed them.
That's their goal is up in achair for meals.
Brush your own teeth, feedyourself looking at it
comprehensively.
Speaker 1 (20:28):
You're looking at why we care about aspiration, okay,
pneumonia, asphyxiation,whatever pulmonary sequelae but
then you're also considering allthe other variables that can
relate to those things andtrying to control those.
It makes sense.
It's multidisciplinary work.
It's like you're making sense Ialso.
Speaker 2 (20:45):
I also.
I also want to do a plug fortherapy, because in the acute
care setting right, we can'tjust diagnose, we can't just
assess Diagnose not use, yeah,diagnose, not use.
I say it all the time.
I think it's so important forus to use the skills that we've
learned for therapeuticinterventions and also use our
(21:06):
instrumental examinations, thefees, to see do those strategies
that we're implementing reallygoing to help the patient?
And I think that will guide howwe can optimally help the
patient.
But, the frustration that I have, though, with therapy is, if I
bring somebody back first, westill don't have guidelines for
how many repetitions doessomebody need to do these
(21:26):
exercises for how long?
So you bring them back andthere's no real there's no
improvement.
And so then it's like did I nottell you to do the right
exercise?
Are you not doing it correctly?
Did you not do it long enough?
Did you not do as manyrepetitions?
That's the frustration for me.
Speaker 1 (21:42):
There's a magic number, though I mean there's a
lot of visualize.
Yeah, there's no guidingprinciples but then there's a
lot of digital life.
There's not a lot of principles, but then there's variability.
Right yeah, we have to modify.
Speaker 2 (21:52):
When somebody comes back and doesn't improve.
You've got to that's the thingthat I as I've gotten further
into my career.
It's not like it's not theexercise didn't work, it's like
did I do something?
Is there something that Ididn't suggest for you that
would benefit?
Yeah, you well, sometimes weget to that point where there is
(22:12):
nothing.
You know we've done everythingright and but I think we should
do our best to use the skillsthat we have and the
interventions, whatever theymight be, and then guide it, you
know, based on that patient.
Speaker 1 (22:23):
Yeah, exactly, do something, try so, you, you,
there are a lot of differentthings here.
There have been plenty ofthings that we could tangent and
talk about for a very long time.
So, like a moment ago, the ideawas mentioned doing what's safe
is what is as safe as possible,right?
However, I bet if I went backand said what do you mean by
that, that it would be more toit.
Speaker 2 (22:45):
What is safe?
Speaker 1 (22:46):
Well, what is safe it ?
Is life must be lived as safelyas possible.
I drive a car every day.
That's not very safe.
Speaker 2 (22:53):
Do you wear your seatbelt?
Speaker 1 (22:54):
I do.
Speaker 2 (22:54):
Yes, yeah, absolutely .
We rely on the tools that wehave right To make our best
clinical judgment, to be able torender a clinical decision to
the patient, and then we workwith the patient based on their
goals.
We implement our strategies,our our therapeutic
(23:15):
interventions.
We do the best that we can.
There's no magic wand.
I many times wish I had a magicwand for our head and a cancer
patients, and they're not.
You know that doesn't exist.
Speaker 1 (23:18):
So sometimes we have to understand that we live with
aspiration anyway right, yeah,right, and that's what I that's
what I'm going with is is it's?
It's more than safety, it'sjust multi-faceted.
Speaker 2 (23:32):
It's faster than like your article.
Speaker 1 (23:34):
Yes, exactly Well, cause if we're just safety,
safety, they aspirate, we stop.
Okay, that's not safe, theyaspirate, we stop.
Then we, you know, or we doonyxiclic acid, we transfer it
hospitalizations for pneumonia.
Speaker 2 (23:51):
This?
Who talks to them about?
This could happen.
I don't know, because we don'tknow how much somebody could
aspirate to get pneumoniaregularly and so keep going, and
here here are the best things Iknow to help you mitigate that.
I think most of the time thepatients are going to make,
they're going to make their owndecisions based on information
that they know that give fortheir own goals, their slp.
(24:13):
They're going to listen to ittoo.
I mean, they need to draw onthat.
But you have to be carefulbecause a lot of times people
are going to put their ownbiases in their recommendations.
Speaker 3 (24:21):
That's just what I'm saying.
Speaker 2 (24:22):
And you know you've got especially older populations
.
I think they are less likely toquestion whatever somebody
tells them they need to do froma healthcare standpoint.
One of the best things thathappened in our facility is we
got palliative care moreinvolved in the care of patients
to have goals of care,discussions with our patients
(24:43):
because our surgeons arewonderful but they want to fix
the patient Sometimes it's notfixable or the fix could
actually come to sometimes beworse than what they've got and
and having some discussions withpatients to where they really
really understand what are yourchoices and what are the choices
(25:04):
that's right, that's right,that's it.
That's part of our ethics,that's part of the basis of what
we were supposed to do asspeech and language pathologists
is first, do no harm, yeah.
Second, educate the patient.
Well, maybe not in that order,but educate the patient, educate
them on and balance betweenfunction and whatever quality.
Speaker 1 (25:23):
Yeah, you have to balance that I mean, ultimately,
they're in control and so we'rehelping them.
We're providing the informationbased upon our knowledge and
skill set to be able to make thebest decision.
Speaker 3 (25:35):
I think that's exactly it.
Speaker 2 (25:37):
We are there to provide education but, at the
end of the day, what they decideto do right is up to them.
Speaker 1 (25:43):
100 and what happens when we get into the mindset
that's like, okay, I'm gonnaprotect myself because I don't
want to get sued and so I'mgonna document.
I told this patient you need tobe on my lethally.
They said I'm not going to doit.
And I said but if you don't doit, you might get pneumonia, you
might die.
And they said oh, I'm still notgoing to do it.
Versus they said they're notgoing to do it, our
(26:15):
recommendation and if they don'tlike that, maybe finding
another way that they're okaywith right, I think it's
understanding.
Speaker 2 (26:22):
Are you protecting you?
Are you protecting yourpatients?
There you go, they're incontrol, right?
Yeah, there was actually areally there was a good
presentation today and they itwas, I'm sorry, I hate to like
only remember one of thepresenters, which was nicole
rogas pulia, but it was on withdementia and it was providing
the families with choices oflike okay, do you want to drink
(26:44):
mildly thickened liquids?
Do you want to do thin liquidsand start doing better oral care
?
You know, and it was likeproviding the patients with
choices and they're like do youwant to do, you want to do emst,
or you want to do like aneffortful swallow and like some
exercises and stuff like that.
And they chose like emst.
And I'm like that.
(27:04):
I was like, wow, you know, yeah, it was, but it was out of her
lab in um university ofwisconsin and it was just like
you know, boom, boom.
I've been practicing forever.
I'm like this is excellent,because you know I'm dealing
with now that I've moved out ofthe texas medical center, I'm in
a community hospital much moreof an advocate for my patients,
(27:25):
because we don't have theresources, and just like for
being able to provide them.
Let's let.
That's an awesome like givethem an op, give them an option,
give them like two choices.
They're more likely to actuallyright for quality of life and
that's what they had like highadherence and you know, and I
don't like they're not adheringto my recommendations.
It's their choice.
(27:46):
I don't, you know, I'm not bigon that word, but it's better
than oh no maybe adherence isokay, it's the non-compliant
that drives me.
They're a prisoner.
Yeah like yeah, you're not,he's non-compliant.
I'm like no, he doesn't want todo it can we just a step
further?
Speaker 3 (28:02):
yeah, what you're saying is exactly take it a step
further for those that work inacute care that have to pass a
patient on.
So I had a patient parkinsonpatient I just presented this on
a tim's university and and hewas Parkinson's known aspirator
was in our hospital.
For COVID aspirator withinliquids pooled with pureed
(28:22):
esophageal issues went to a carecenter.
The therapist at the carecenter insisted he do thick and
liquids.
Of course he comes in thehospital.
He's an indwelling catheterbecause he's got a, an issue
that doesn't have anything to dowith speech pathology.
So he comes in the hospitalwith altered mental status and
the very first thing he verydelayed response altered all
that and he said I don't wantany thickened liquids.
(28:44):
So what we did was we didexactly what they wanted, like
you were just saying hispreferences.
Why I said no thickened liquids.
We knew he's a known aspiratorand then we passed it on to the
patient that was going to thecare center again different care
center to the speechpathologist.
I called the speech therapistand I said hey, you're going to
get a patient of mine, this iswhat's going on.
And they did the same thingthat we did so.
(29:05):
We followed up with withrespiratory staff keeping his
mouth clean yeah physicaltherapy involved.
We're going to let him aspirate.
And the wife was ecstaticbecause I said let me call the
speech therapist instead of yousaying the same thing over again
.
Right, we work with greattherapists.
And then he came back to thehospital a month later because
he was quote better.
Right Now he's going to do hismodified again, we're going to
(29:27):
repeat it and this modified isgoing to be better.
Guess what?
It wasn't that much better.
So he's still an aspirator.
I still showed everything tothe wife and the patient and he
hasn't come back with apneumonia.
So here's a guy who'sParkinson's.
Speaker 2 (29:39):
Everybody would freak out about him.
The question is who cares Right?
Who cares Right?
Speaker 3 (29:45):
He came back to the hospital like two weeks later
altered mental status, sepsis,because he had an indwelling
catheter.
I was going to do.
I said we're going to get himup in a chair, we're going to do
, we're not changing anything.
And they were good with thatbecause we kept the patient
preferences and we protected thepatient as much as we could.
(30:08):
Yeah, and follow through withwhat they wanted, what the
skilled nursing speechpathologist wanted, all of that.
We all put the patient firstInstead of oh my gosh, he's
aspirating.
You've got to have thickenedliquids.
No, I was sneaking him coffeeevery morning.
I'm like, is she sneaking himcoffee every morning?
There's quality of life 100%agree with that.
Speaker 1 (30:29):
I had a thought.
It left me.
Speaker 3 (30:32):
Welcome to my life.
I just think you need to passon information to people not
just live in our silos but likeif I'm going to pass a patient
to you.
I'm going to call you and sayhey, I mean, I did that the
other day.
I said you're going to get this92 year old train wreck.
She's a doll, Her son doesn'tget it, but she's a doll.
And this is what we were doing.
(30:55):
And those guys call us and sayhey, you're going to get a
patient from us who's you knowhad another stroke.
Something's going on.
Make sure you follow them.
That communication to theperson passing back and forth, I
think is vital it's reallycontinuity, continuity of care
is really that's a huge issue Iforget.
Speaker 2 (31:07):
When we're discharging the patient that
they're going to in the midst,we have to think about where
they're they're going, how thoserecommendations are going to
help them carry on.
I think the hard thing in acutecare is like they're gone the
next morning.
I didn't know they were going.
I mean like I can monitor casemanagement, but I don't know
that they've gone.
Speaker 1 (31:25):
Well, but what if you have a good relationship with
the people in the community andthey know they can call you?
So you might not get to callthem preemptively, but they know
they can reach out to you.
Speaker 2 (31:31):
I have people call me and I know there's probably
HIPAA issues, but you know.
No, it's not as long as you'reinvolved in the care, okay, I
was going to say HIPAA, shmipa,but you know we're not going to
identify who that was.
Speaker 3 (31:45):
I asked the patient and I asked the worker yeah,
Like this 92-year year old I sawlast week.
I said is it okay if I contactthe people?
Yeah, I talked to them and talkto them and I documented it.
Patient and son, you areallowed.
Speaker 2 (31:59):
You're allowed.
Yes, I will tell anybody whocalls me.
Whatever I'd like to ask, is itokay?
You want me to?
Speaker 3 (32:06):
call them and I documented that.
The patient and the son saidit's okay.
And I just document it just sothat like nobody get Freaky
Friday on you.
Speaker 2 (32:13):
But it is called continuity of care.
It's something that we shouldbe doing.
It's not, you know, we don'thave.
You know it's something that'sreally important to help that
patient and the people in thecommunity.
Speaker 3 (32:23):
They appreciate it.
They call me all the time andsay, hey, you're getting someone
back, and then, once you getthat ball rolling, it doesn't
stop.
Stop, it just keeps.
It's a wonderful relationshipwith the people in the community
.
Speaker 2 (32:33):
Yeah, yeah I I want to go back to the mentorship
thing because for youngclinicians, if there are like
young clinicians listening tothis, find a mentor, reach out.
I did that early.
I reached out to barbarasunnies and would call her, like
all the time.
So find someone to, to help youto, you know bounce things off
of yeah, whoever that might bewhoever you feel that you
(32:54):
respecting clinically yeah,that's important, make those
connections, because there's alot of questions unanswered that
you, you know, you may findthat having a mentor is going to
really help you through yourcareer and I think all of us
here sitting here did that right.
I mean, yeah, I did that as aleader.
I mean we've all had peoplethat we had mentors with.
Speaker 3 (33:14):
Besides, each other.
Speaker 2 (33:15):
Right Besides each other.
I think right now we have eachother, but also we are very I
know we're all very passionateabout mentoring the next
generation of clinicians.
Speaker 1 (33:27):
It's a good continuity of care.
Speaker 2 (33:29):
And don't forget about PCSS, passing it on to
John.
Yeah passing it on andempowering people.
Speaker 1 (33:35):
Well, we've probably wrapped this up.
I don't think there's reallynecessarily a core theme to this
episode other than the fact Ihad something there.
I had something there, it wasgoing to come out, and I planned
to edit this episode.
It's going to be so perfect.
Speaker 2 (33:52):
Wait till you're 63.
Speaker 1 (33:54):
Wait till you're 63.
Speaker 2 (33:54):
Wait till you're 63.
It just like disappears.
Tell everyone you saved it.
I look good for 63.
I never tell so.
Anyway, you're older than me.
Speaker 1 (34:04):
Stop it.
Just to summarize A couple ofthings that we've gone through.
The importance of communicationyes, I think key.
You know the importance ofvulnerability, key.
You know the importance ofvulnerability.
Not faking it till you make itwhich man I don't know how many
episodes I've said that onpeople are gonna say, if you
said that one more time, I'mgonna shut this thing off.
But you know being vulnerableabout what you know.
And that goes with thementorship too finding a mentor
who will accept you for that andnot expect perfection, because
(34:28):
certainly they're not.
And so you know you have apretentious, dishonest
individual if you have someonewho's doing that but being open,
willing to communicate witheach other.
A speech pathologist when youneed help, but also when you're
handing off care to, so peoplefeel like they can reach out to
you and you can reach out tothem, man there's a lot more.
Speaker 3 (34:46):
Listen to your patient yeah, listen to your
patient read a room read a room.
Read the room that read the room.
If you're in acute care oroutpatient and someone comes in
with that patient, read the room, look at the person that's with
that patient, read, read theroom with that patient.
I think we don't get those softskills in school and we,
because we've worked for manyyears, can read a room really
(35:08):
fast, but those are skills thatare difficult to learn.
How to?
How much information do youreally give?
Like we're giving informationabout a modified and I said this
is easy peasy, this isn'trocket science.
I'm not a rocket scientist.
Let me show you your modifiedbarium swallow and I don't give
terms, unless they're inmedicine.
Do I give terms?
Right?
But I'll say you know I have asystem that you know, the TIM
system, so you can say on therelike here's your flapper, here's
(35:40):
yeah, you don't want this goinghere.
It's like a laundry shoot.
The more you understand whyyou're doing what you're doing,
the more you're going to be ableto to help, not do the things
that you're going to be able tofollow these compensatory
strategies easier.
But read a room like there'stimes I'll be talking, you can
tell the patient and the spouseare just yeah I would think I'm
processing anything else at thispoint, important not to take
those things for granted too,because they come so easy to you
after years and years ofexperience.
Speaker 1 (35:59):
But it took you a while to get there and so not
forgetting to break those thingsdown and to explicitly provide
instruction to students on thosethings too.
So not just the physiology, notjust what you see and why it
matters, but the importancecommunication, because if you're
handing off somebody from acutecare to a long-term care
facility or whatever you couldhave the best note.
(36:21):
They might not have the time toread it, but they have the time
to pick up the phone and you canexplain something to them in
two minutes and they can askquestions and whatnot.
It goes a long way, and so justnot forgetting about those
things.
So I guess I don't know what Ione thing that I'm pulling out
of this is is to look beyond theconcrete and the physiology,
the, what you see, but really toemphasize, like reading the
(36:42):
room and and the, thecommunication, why it matters.
It's just a lot of, a lot ofdifferent things.
Speaker 2 (36:50):
One little point I would like to make is don't
forget about the caregiver inthe room, right, because they
are so critical to therehabilitation of that patient.
They're living with it andoftentimes they are the ones
that's forgotten in the room,but they have to go and cook the
meals and help the patient soonce.
It's important to the patient,what's important to the
caregiver, absolutely.
(37:11):
But but what?
Why does?
What do they ultimately careabout?
I think is the thing that, as Iget closer and closer in age,
to many of my patients.
That's the thing.
It's like what?
What am I?
What am I doing to my patientwhen I'm making these
recommendations?
Speaker 1 (37:28):
yeah, it's real.
You can relate to them more andso you empathize with them more
and you're like what would Iwant if I were in their position
?
Yeah, no, it makes a lot ofsense.
And just a reminder, this is avery laid back episode.
This is, this is talking.
There's not something directlythat we're looking at other than
a bunch of people were verycomfortable speaking with each
(37:49):
other, who are bound by arelationship of doing not just
swallowing sin, but workingtogether in a number of
different ways in the past, andI think one of the reasons you
gel is because you've got a lotof pretty like laid back,
similar mindset on a lot ofthese things, and that's very
refreshing to hear from a lot ofyour perspectives.
With that, is there anything atall that you want to leave with
(38:10):
a lot of really good things toto draw out of that?
And looks like you got to takeoff.
Don't be ceremony huh, yeah, nothat's right.
Speaker 2 (38:19):
I'm ready to go breathe the room I mean the
relationships that we've formedover the years.
I mean we've all been friendsfor, at this point, over 20
years at least I mean, but welove each other because we all,
at the end of the day, caredeeply about the people that we
serve and care deeply about theimpact that we have on other
(38:41):
people.
And just Well said Dr Souter.
Speaker 1 (38:46):
Yes.
Speaker 2 (38:47):
Professional relationships are important.
They're really important to mylife.
Speaker 3 (38:51):
Yeah.
Speaker 2 (38:52):
But these are the most important relationships
that outside of my obviouslyintermediate family that I know.
Yeah, yeah, yeah, my husbandjust thinks I shove applesauce
in people's faces all day.
So I didn't.
I would say the other thing.
The last thing is that when Istarted my career, I thought I
needed to read everything, learneverything, and I felt
overwhelmed.
(39:12):
And somebody told me that'swhat you do every day is you
practice, practice, practice,and that's what.
That's what.
That's what it's all about.
It's just your practice and itgets better, but you learn as
you go.
Speaker 1 (39:24):
Yeah, Very cool.
Well, thank you all Reallyappreciate it.
Great to meet and hang out andlook forward to chatting again.
Speaker 2 (39:32):
Thank you, thank you, thank you.
Speaker 1 (39:40):
That's another episode of Swallow the Gap.
Special thank you to our guestsJulie Blair, lori Sterling, dr
Deb Suter, dr Barbara Messingand Joe Ponteel, and I'm excited
to announce a special two-hourwebinar coming in late February
involving most of these ladiesdiving into some fascinating
modified barium swallow studies,and this course continues the
(40:00):
15 or so year legacy ofswallowing cinema.
For more information, keeptuning in or sign up for the
mailing list at swallowthegapcom, or follow me on instagram at
swallowallow Patho, that is, atSwallow P-A-T-H-O.
Gap Education's last twowebinars for ASHA CEUs received
stellar ratings, at an averageof about 4.8 out of 5.
(40:23):
And they were a lot of fun, sowe hope to see you there.
Additionally, visitSwallowTheGapcom for more
information about upcoming liveand recorded courses in 2025.
Many of them actually most ofthem on there toward the
beginning of the year.
And last but not least, aspecial shout out to this
episode's sponsor, the Milton JDance Endowment, a sponsor
(40:45):
dedicated to supporting head andneck cancer patients and
individuals with swallowingdisorders across all populations
.
Thank you for listening andwe'll see you next time.
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