May 4, 2026 • 36 mins
On this episode, we're joined by a head and neck surgeon and a speech-language pathologist from the University of South Florida and Tampa General Hospital who have built a self-dilation program that is changing lives for head and neck cancer patients with recurrent esophageal strictures. Their program currently has 20 patients self-dilating, and the outcomes are remarkable: 80% of patients who came in with feeding tubes have had them removed. We talk about how their multidisciplinary clinic model works (surgeon and SLP evaluating patients together, in the same room), how they identify good candidates for self-dilation, what the training process looks like, the role of the infinity balloon in initial dilation, how they navigated the cost barrier of a $3,400 dilator, and patient stories that show what's possible when you keep the esophagus open long enough for therapy to actually work. If you work with head and neck cancer patients dealing with recurrent strictures, this episode is a must-listen.
Get the show notes: https://syppodcast.com/396
The post 396 – From NPO to Full Diet: Why Patients Are Dilating Their Own Esophagus appeared first on Swallow Your Pride Podcast.
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(00:00):
Hello, my friends. Welcome back to the Sawyer
Pride podcast. Today's guest, I'm so excited about.
Just love and adore these two and the
work that they do, and it's just incredible.
And I'm so excited for you to hear
this episode.
First, we have Jennifer Larson. She's an SLP
at the University of South Florida, division of
head and neck surgery. Her practice is dedicated
to advancing innovative evaluation and treatment approaches for
(00:22):
swallowing disorders and alternative voice
innovation options for head and neck cancer patients.
She particularly focuses on improving continuum of care
pathways
and understanding the impact of community and social
reintegration for individuals with head and neck cancer
with the goal of enhancing both functional outcomes
and overall quality of life for these individuals.
(00:42):
And she is joined by her wonderful ENT
colleague,
doctor Yasmin Abdelati.
Doctor Yasmin Abdelati is a head and neck
surgeon at the University of South Florida and
Tampa General Hospital. She received her training at
Mayo Clinic in Arizona and did a fellowship
in voice swallowing and airway disorders at a
joint Columbia Cornell program in New York City.
(01:04):
She works together in multidisciplinary clinics with speech
language pathologists to provide patients with medical, surgical,
and therapeutic care.
Welcome to the Swall Your Pride podcast. I'm
(01:26):
your host, Teresa Richard. I'm a board certified
specialist in swallowing and swallowing disorders, a mobile
thieves business owner, and founder of the MedSLP
collective.
This podcast is all about delivering the latest
evidence based practice to medical SLPs everywhere.
Whether you're a new clinician seeking tangible tools
for treatment or a seasoned vet stuck in
a rut, my goal is to help ditch
(01:47):
the old school ways of the past that
no longer serve you or your patients, to
reinvigorate your passion for our field, to broaden
your knowledge about our scope of practice, and
to inspire you to practice at the top
of your license. So if you're listening, I
encourage you to swallow your pride, be open
and willing to learn, because let's face it,
your patients deserve that kind of care. With
that, let's dive right in. Just a quick
(02:09):
disclaimer that all statements and opinions expressed in
this episode do not reflect on the organizations
associated with the speakers and are their own
opinions solely.
Alright. Good morning to both of you. Thank
you so much for joining me. Thank you
so much for having me. Yeah. Yeah. So
today, we are joined
by Jen Larson and doctor Abdulati.
(02:29):
Jen, I'll have you say a little bit
about yourself first. Yeah. So I am a
speech language pathologist at the University of South
Florida.
I specialize in head and neck cancer, mostly
for dysphagia
management,
creating pathways for our patients, voice restoration after
total laryngectomy.
And
now that we're talking about it, our our
(02:49):
new program for self dilation,
with doctor Abdelati.
Doctor Abdelati, a little bit about you? Yes.
So I am an ENT or head and
neck surgeon at USF and Tampa General.
I have a
specific specialty in the study of voice airway
and swallowing disorders, and I have,
(03:11):
an interest in the head and neck cancer
population, especially with rehabilitation of
swallowing,
as well as voice.
And working with Jen on our our self
dilation project that we are gonna chat about
today. Yeah. That's awesome. Can you guys share
a little bit? I know doctor Abdi Lotti,
before we started to hit recording, you just
talked about the multidisciplinary
(03:32):
structure of your clinic and why that sets
you guys apart. And I know that any
SLP on the outside looking in at your
guys' amazing institution, that's always one thing that
always comes up is how amazing it is
that the doctors work so well with the
SLPs, and there just seems to be such
this collaborative,
both diagnostic and therapeutic
treatments that go on. And and I would
love if you could share a little bit
(03:52):
more about that.
Of course. So all of our clinics are
set up so that there is a
surgeon
and an SLP,
present in the clinic at the same time.
And so
when we evaluate patients,
we evaluate them together. So I'm more looking
at structural, surgical, medical management,
(04:13):
and the SLP is looking more at, you
know, therapeutic, behavioral,
management. And then we discuss things together with
the patient. So we get the patient insight,
the therapeutic insight, and the medical surgical insight
at the same time.
We really like this model for a number
of reasons. One, it saves the patient a
lot of time,
(04:35):
because they don't have to be, you know,
shuttled between offices
seeing, you know, the doctor, and the doctor
sends them to the SLP or the SLP
sends them to the doctor, and then there's
this back and forth. All that communication happens
in real time, and the patient gets to
be involved in it. The other thing that's
really beneficial is the patient buy in. So
a lot of times,
(04:55):
they come to me because they want some
sort of surgical medical management, and there's none
I can offer. And, really, they need therapeutic
management.
And when the SLP is there and when
I'm, you know, saying, like, this is my
partner that, like, you know, we are equal
in this decision making and in this treatment
plan.
I think it gives the SLP a lot
of credibility
(05:16):
and makes the patient understand how important that
the therapeutic aspect is.
And I, you know, I don't have particular
data. I know there's some data in the
literature, but I I think there's more continuity,
with patients actually showing up to their therapy
when that happens.
Jen, do you wanna add on to that?
Yeah. No. I think the collaboration is great.
(05:38):
And like doctor Abdulati said, you know, we
get great buy in from our patients. They
trust us and our decision making together. If
we have something you know, if the patient
is,
you know, kinda skeptical about therapy, you know,
we always say, well, we're working with the
doctor, and the doctor is also in agreement.
So we're able to get that adherence to
(05:58):
our,
our plan of care.
Yeah. Awesome. I I I love that you
mentioned that about the the patient adherence and
the patient buy in. I think that's such
a huge thing. And like you said, the
time saving and how many times do patients
just get the runaround of sent from, you
know, doctor at this clinic to SLP at
this clinic to GI to
back to primary care. You know, it's just
always kind of a a wild goose hunt.
So I I love that you guys. Yeah.
(06:19):
Yeah. And it helps us too because, you
know, it just makes the plan of care
so much better. Like, having both the therapeutic
approach and the medical management is the best
outcome for the patient.
So it it's so great that we're able
to achieve that for our patients.
The other thing is I think with the
(06:39):
not wasting time per part is that sometimes
I can look at Jen or one of
our other SLPs and say, like, there is
nothing I can do. So you know, because
sometimes, you know, they see the patient and
they're like, well, therapy is not the best
option. They're like, I don't know if there
are medical options. I can just look at
them and be like, no. There is no
nothing I can do. So whatever you can
(07:01):
do is better than nothing. And then they
can look at me the same way. Like,
this patient
is not cognitively going to be able to
do therapy or not physically going to be
able to do therapy. So whatever you can
do medically,
please offer it because I am tapped out
here. And we can have that conversation
on the spot as opposed to the patient
(07:22):
being passed back and forth between us maybe
three times before we get to that point.
Yeah.
I love that. It's just if you think
about even just in the big realm of,
like, public health dollars too, you know, how
much public health dollars is that to save
by just having everybody in the room to
be able to make one consensus
in that moment.
So what are we here to talk about
today? So,
doctor Abilotti,
posted a a few days ago about this
(07:43):
this new self dilation program that you guys
are doing. And I just I love talking
about new and innovative things, but I also
just love talking about how we can help
patients
how we can make them more in charge
of their care, if that sounds right. But,
also, you know, I I think
I'm getting ahead of myself. I'm gonna let
you guys talk about the program, and then
I'll I'll I'll share why I think it's
wonderful. So, who wants to start? So I
(08:05):
can start. So self dilation in itself is
not novel. You know, that's been something that's
been available for
probably over a hundred, two hundred years and,
was probably utilized more in the past
than presently.
But I think the the novel part is,
number one,
(08:25):
we're working together to get this to patients.
Number two, I think a lot of physicians
just dilate the patients over and over again,
or just tell them that they're just gonna
have to live with g tubes, and they
don't offer this. So I think the multidisciplinary
part is
novel,
and kind of the size of the program,
the fact that we've been able to
(08:47):
collect. At this point, we have 20 patients
self dilating.
I think that's the more the more new
part. So the article that was posted with
our our patient,
she had a hundred percent stenosis.
So she had to have a surgery to
first cannulate her esophagus.
And then to keep it open, we said
that she really should self dilate because otherwise,
(09:09):
it's gonna close again. And so she went
from zero like, completely NPO
to
we removed her g tube, and she's fully
fully eating by mouth. And so I think
one of the reasons why we had talked
to this patient about sharing her story is
because,
her, like, some of
(09:30):
actually, half of our patients have had their
g tubes removed,
which is, I think,
eighty percent of the people with g tubes.
Eighty percent of our so fifty percent of
our patients had g tubes, and eighty percent
of them had their g tubes removed and
have now progressed to being fully,
orally fed
is
just putting it out there for patients to
(09:51):
know that there are some options for them.
Because she basically was told, you know, your
esophagus is a 100% closed. There's nothing we
can do. You're just gonna have to be
g tube fed forever.
And this program
allowed her to be able to eat. Amazing.
Can you talk about you know, doctor Abdi
Lotti, have you have you been instructing patients
on this for a long time? Is this
(10:13):
you know, you know, I know you said
that this has been around for hundreds of
years and, you know, I know that we've
heard of it before, but it just almost
does seem novel now. Is it you know,
what was what was the new approach here?
The the new approach is number one, reoffering
it because a lot of patients had never
heard of it, and I think a lot
of providers,
(10:33):
it doesn't really occur to them even though
this has been around.
And then the other part that's new is
working really closely with Jennifer Larson. So,
I mean, she can talk a little bit
more about that. But Jen sees head and
neck cancer patients, and they're all you know,
not all of them, but a lot of
them have had radiation. And she works with
a lot of doctors.
And so one of the biggest things is
(10:55):
she's she's the biggest recruiter because she's evaluating
these patients and looking at them and being
like, what? You're getting dilated every three months?
Like, that's a lot of, you know,
time and wasted money and wasted effort. And
in her I mean, Jen, you can talk
about this more than I can, but
your therapy keeps getting halted when they need
(11:17):
a dilation.
Yeah. Exactly.
So, you know, we do a swallow study
on our patients that have head and neck
cancer. You know, obviously, we see stenosis.
And so
they also have stenosis, but they also have
weakness of their swallowing muscles. So
I can't I mean, yeah, I can work
and, you know, do therapy for their swallowing
(11:40):
muscles, but, I mean, we're not going anywhere
if the esophagus is not opening up.
And so, yeah, our patients, you know, we
do offer the dilations, but sometimes
our patients going to the OR and having
to go under anesthesia
all the time,
does halt them. Like, they
they have to pretty much at that point,
(12:00):
when they have to get another dilation, they
can't get anything down. They're, like, doing really
well, and then they're stenosed again, and they're
only on thin liquid. So, you know, it's
really important for this program so we can
maintain the esophagus to stay open.
So then they can continue to get stronger
for their swallowing muscles, but then they can
(12:20):
continue to eat over
time. Now one thing that I've run into
is that, you know, when we talk about
esophageal dilations and we review these swallow studies
with our patients,
this has just come up more frequently is
that,
you know, we point out to the patient
that, yeah, your esophagus, you know, it has
a stricture.
And then they're like, oh, well, that's gonna
(12:42):
fix everything.
And I'm like, oh, no. Like, you could
get a dilation, but that's not gonna fix
everything. Like, you need to work too.
So the I always have to tell the
patient, like, yeah. We have this issue going
on with the esophagus, but you still need
to strengthen up because both of those go
hand in hand. If you have one without
the other, it does not work. So I've
(13:03):
had a frequently counseled patients about that. So
now that they know that, okay, I can
continue to strengthen
and self dilate,
all is good.
I love that. Love that. The other the
other part is the the delay with getting
dilations. And so, you know, if a patient
needs dilations every three months, like, we don't
(13:24):
have the operative time for that. We're, you
know, a very big department with lots of
surgeons and,
you know, the patient says, okay. I can't
swallow anymore. So then they see one of
us and we book them for their case.
Again, you know,
airway, cancer, that kind of stuff gets priority,
so their dilation is booked out.
(13:45):
And then now they haven't swallowed in two
months,
and now their throat is weak again. And
then
they get a dilation. They go back to
Jen. She starts from scratch.
So I think this keeps people out of
the Operating Room,
and it also keeps
the esophagus open so Jen doesn't get these
delays,
(14:05):
because she's all she tells them, like, okay.
You have to do your exercises
and whatnot. But
do they actually do them when they can't
eat? And even if they're doing their exercises,
I mean, eating is the best way to
rehabilitate
swallowing.
And so
they then see a decline therapeutically,
and then there's a lot of reinventing the
wheel every time they get a dilation. So
(14:27):
the the delay the delay in care is
substantial if we just can't keep them open.
Yeah. I think so much of this too
is I mean, I've just seen countless patients
that
got dilated before, you know, one to two
years ago and and didn't realize it was
something they need to to keep revisiting.
You know? So I feel like this is
a conversation that you can probably have with
patients
pretty early on to let them know, like,
(14:49):
this is going to be a recurring thing.
This is might be something you wanna learn
now as opposed to, like you said, having
to keep coming in every so often. But,
yeah, I'd I'd love to hear about, you
know, what does this actual process look like?
Is it, you know, counseling education from both
of you guys? Yep. Talk me through what
that looks like. Well, on my part, it
just starts with, you know, them telling me
(15:10):
they they have a problem. Sometimes I'll have
a patient come in that's had radiation
ten, fifteen years ago, and I'm like, oh,
we need to do a swallow study.
And so we'll do do a swallow study,
and there, you know, there is a a
a structure there. So then I talked to
doctor Abdilati,
and she reviews the imaging. And,
(15:30):
we then just,
you know, consolidate and say, hey. This person
needs a dilation.
And then that gives a
we automatically send her the patient to the
clinic, and then she talks to them and
does the pre op counseling on dilation.
And take it from there, doctor Abdulati. Tell
them the about the the Infinity Balloon that
(15:53):
you do. We're taking it a step back
before we even get to the self dilating
part because, really, we offer that for patients
who get recurrent,
who need recurrent dilations.
So if the patient's coming from an outside
provider and they're coming to us and telling
us that they keep getting dilated every three
months or if they're completely NPO because the
(16:13):
dilation only lasts them a few weeks before
they
need another one, but they're just they've given
up and they're not going every few weeks.
That's when we counsel them on the self
dilation.
But for starters, if it's a new patient
that's sent to us who hasn't really had
a history
of dilations, then we just talk to them
about their initial dilation.
(16:35):
For patients with laryngectomies,
those,
I typically dilate with a single balloon,
because when we recreate their
throats,
or the head and neck cancer recreate their
throats, they recreate it as a circle because
there's no larynx there anymore.
And
for patients with larynxes,
(16:56):
their throats actually aren't a circle, and that's
where the double balloon comes into effect. So
the double balloon
is
originally, we were putting two balloons next to
each other because the upper esophageal sphincter is
actually a kidney bean shape.
So the the two sides of the throat,
the two piriforms, they dump into the the
(17:17):
upper esophageal sphincter.
And because the larynx is pushing in the
middle, it actually looks more like a kidney
bean than a circle.
And so putting two balloons next to each
other had
us recreating that shape and dilating it the
way the anatomy actually looks,
which has, you know, been compared to to
show,
(17:38):
improvement
in the initial dilation and also,
increasing the length of time between dilations.
The Infinity Balloon was then invented,
I think three years ago now,
approximately,
or at least it was on the market
at that time. And that
is two balloons stuck together. So that actually
(18:00):
made it where it's super easy to do
because instead of having two separate balloons and
two separate inflation devices
and you need two assistants
to inflate them, it's now just one balloon
that is in the correct shape,
of a double balloon. It's in that already,
like, kidney bean shape. It's called infinity because
it looks like an infinity sign because it's
two circles next to each other.
(18:22):
And that actually made it so much easier,
to do,
a dilation. And just to give you an
idea, the largest single balloon is about 20
millimeters.
The largest double balloon is 38 millimeters. So
it's almost twice as big as the largest
dilation we were able to offer before.
Wow. That's amazing. Okay. Yes. And oh, go
(18:44):
ahead, Jen.
Yeah. So for those who, you know, doctor
Aptilotti does the dilation the initial dilation for,
what's really neat,
that she does is that she's able to,
size up the dilator to the size that
she had dilated in the OR,
and then the patient is able to go
(19:05):
home with that dilator.
And then what we do is we strategically
schedule our,
the clinic appointment together, and we see the
patient at the same time. The patient will
then bring in their dilator,
and then we begin our training.
And doctor Abduladi
runs the training, and I prep,
(19:25):
the dilator and and get it ready for
the patient.
Yeah. So the patients that we've selected beforehand
that probably will need self dilation, we do
the counseling together
because you have to imagine that
no one wants to put a dilator down
their throat every day. So you have to
be a certain amount of desperate
to be like, yes. This is a great
(19:46):
option. Our self dilating patients are thrilled.
And the reason for that is because they
have their, I mean, more than half of
them are completely NPO, and then a lot
of them aren't able to eat what they
wanna eat.
And so
you have to really
select the patients.
Like, people are gonna be successful if they're
(20:07):
really bad because they're the ones that are
gonna be motivated to dilate every day. So
that's the selection process. I would say
Jen probably does most of the recruiting
because she sees head and neck cancer patients
from all of our surgeons and even other
surgeons in the community.
And so she's she sees the ones that
are at that MPO status or, you know,
(20:28):
having a lot of trouble.
So she probably brings most of the patients
to the table.
And then
she's the one that tells me, is this
gonna be a good candidate as far as,
like, are they motivated?
And then I tell her if this is
going to be a good candidate based on,
you know, their physical abilities. Like, is this
a patient that can do this? Because they
have to be
(20:49):
physically able.
Once we've established that they're gonna be a
good candidate, then we dilate them in the
OR, and I size them, and we provide
them with a dilator.
Because we aren't a
DME,
facility at USF,
the dilator
is
purchased as part of their surgery.
(21:09):
And that actually is a big issue because,
there we had a self dilation program through
our GI at my residency at Mayo,
and they have lots of money. And so
they have a closet full of dilators and
all the sizes.
And they can try, like, four sizes on
the patient
before
(21:29):
they decide which one, and they can do
it all in the clinic. We don't have
that kind of resource,
so we actually
have to decide the size at the time
of their operation or even before their operation
so that it can be ordered as part
of their surgery.
And then like Jen said, they come to
us after surgery, usually within a week, preferably
(21:49):
around, like, you know, three to five days.
And,
I teach them how to do this side
of dilation. So first, I
have them swallow some lidocaine to numb them.
And it helps with the gag, although a
lot of radiated patients have limited gag reflex
because of their treatment.
And then we put lubrication on the dilator,
(22:12):
and then usually, I pass it first to
make sure that it passes easily, and so
the patient can see how it's done and
see how it feels.
And then we hand it over the patient,
and we have them
go ahead and try. Oftentimes,
they do really well the first time and
we're do. Surprisingly. Yeah. We're amazed. And then
other times, there's a little bit of coaching,
(22:33):
but it's mostly psychological. So that's when Jen
really is helpful because she's the one that's
like, okay. You gotta breathe. You know, you
can do this. Just focus on your breathing.
And there and then,
they go home with the dilator and they
practice. And most of the follow-up after that
is with Jen. And so she's the one
that checks in with them because all of
(22:54):
these patients need therapy as well.
And if there are issues, most of the
time, she can triage them. And then if
there,
are issues that I needed, then we bring
them back to the multidisciplinary
clinic.
And usually, that's,
it's pretty rare. I feel like Jen can
typically triage,
(23:15):
most of the situations and help them,
figure out what they need to do if
they're having issues. Amazing. So the so this
is something that they do every day? Yes.
So we start them off every day,
and then we wean them
from there.
So what I discuss with my patients, and
Jen
discusses this ad nauseam too, is if the
(23:37):
dilator passes super easy, very comfortably,
very smoothly, you can try skipping a day
and going to every other day and seeing
if the dilator is still passing smoothly.
Great.
If they're skipping days and they're noticing a
little bit more resistance,
then we say go back to whatever you
previously were doing. So if they were doing
(23:59):
every day and they tried every other day
and they're noticing there's more resistance,
then we have them go every day. The
dilator is meant to hold them open, not
dilate them. So the patient can't tolerate
being dilated
by themselves
awake if they're actually
stricturing. That's painful.
(24:19):
So if they're experiencing more resistance, then they're
not doing it often enough. And we often
tell them to to dilate from both sides.
So sometimes we can put the dialer,
you know, down more to the left and
then to the right side because, like doctor
Abdulati said, it's like a kidney bean.
And so we often, you know, tell them
(24:39):
to to every day when they dilate, go
down the left side, and then the next
thing go down the right side.
Not when they're able to do that. Or
sometimes if they're not, they just go down
one side, and that's still good enough for
them. Mhmm.
That's awesome.
Yeah. Joan Joan, I'd love to hear if
you could, you know, share some some stories,
some outcomes of some patients because I think
this is just so I think it's great.
(25:00):
I think it's wonderful.
Yeah. We recently
just had one guy get his feeding tube
removed. That was great.
He was,
just another head and neck cancer,
post radiation,
and NPO.
And so what we did is,
(25:20):
we did a fees and
and noticed that, you know, you know, there's
things coming up through The US, and,
so then we did the dilation.
He was petrified.
He was like, oh, no.
I am not doing this. He's like, really?
I'm like, come on, man. I'm like, it
is changing lives here. So I'm I'm a
huge advocate of this, obviously.
(25:42):
And so he did it, and
he he did it. He was like, oh,
okay. And so then he was able to
do it again and again. And now
it's like his party trick. Like, he shows
his, like, grandchildren.
I'm like, okay. Like, what a visual.
But, like, he's like, oh, watch this and
just write down that. And he is awesome.
And he just told he just got his
(26:04):
feeding tube removed,
and now he's only dilating,
two to three times a week and still
with ease, which sometimes, you know, I always
we wanna know what the frequency is. You
know? Right now, you know, we say if
you're able to, you can go every other
day.
But this was good news to hear that,
you know, he can dilate two to three
times a week and still
(26:24):
maintain his esophagus to be open.
So we you know, some other oh, and
then we had, another patient. She was a
total laryngectomy.
And, Yasmeen, she had
a a big pull up, a big reconstructive
surgery where her stomach was up here and
her esophagus was very short in length,
and it would stricture all the time.
(26:47):
And even just the self dilation for her.
I mean, this poor lady could've, I mean,
she was very soon to die, like, during
her surgery. So the and she's very young.
And for us to be able to, like,
save this woman at a very young age
who had this major reconstructive surgery,
like, that was a win win. She doesn't
(27:07):
have a feeding tube now, does she? No.
Her feeding tube fell out, and then she
was like, but I'm eating. I don't need
it.
That that was actually a really exciting
a really exciting story because, yeah, she's very
young. She was in her thirties.
Had
actually, one of our our partners, doctor Nickel,
(27:27):
had called me into the Operating Room,
and the goal was just because she was
spitting so much into a cup because her
esophagus was too small to swallow her own
saliva.
So we did, like, a very gentle, small
dilation just so that she can swallow her
own saliva.
And then
(27:48):
I was like, why don't we try this
dilation thing? Let's just see.
And, honestly,
Jenna and I were not expecting this lady
to eat a full diet. We were just
expecting, like, pleasure
feeding
for her.
But she really worked at it. She dilated
herself every single day.
Her and she says that she eats everything
(28:09):
she wants. I mean,
I
don't think she's eating meat,
but I don't think she
cares. Like, she's very happy with her what
her diet is. She's been able to maintain
her weight, and then her feeding tube fell
out, and she didn't even go to the
ER. Honestly, she didn't even tell us. She
made an appointment and came back a few
weeks later
and said, oh, by the way, my feeding
(28:30):
tube fell out. I'm maintaining my weight, and,
I'm doing pretty good.
That's awesome. I love that.
Love that. Love that.
Our patient from the article,
her husband had told her that they couldn't
travel to see her grandchildren
until,
you know, she was able to eat by
mouth and because he didn't wanna scare them
(28:52):
with the feeding tube.
And so she hadn't seen her grandchildren. She
had gotten pretty depressed.
And honestly, she was like, I can't do
this. I'm not gonna be able to do
this self dilation thing.
And she was pretty depressed.
But Jen and I, like, worked together and,
you know, empowered her and said we really
think that you'd be a good candidate for
(29:13):
this. Like, think about being able to see
your family and think about being able to
eat, and she loves cooking.
And so
she did it. She dilates. Now she's gone
to every other day,
and it's still going really easy. And we
took her g tube out, and we have
a little gong in our clinic that you
get to hit when you get your g
tube removed.
(29:33):
So she hit the gong,
and,
she's
eating. She's doing really, really well. And,
she, you know,
graduated from therapy with Jen too. So really,
swallowing wise, there's just this dilator every other
day right now, and we're gonna work on
weaning her a little bit more because I
think she can probably wean a little bit
(29:55):
more. But she's eating everything she wants to,
and her g tube is out. And she
is smiling. Like, before, she was super anxious,
and she's such a sweet,
lady and, yeah, just smiling. Whole new person.
So it really changed her life. Yeah. Amazing.
Oh, I love that. You guys are doing
amazing, amazing, amazing work. I love this. Anything
(30:16):
else you wanna cover
with regards to this? I think we did
a pretty good job.
Yeah. I think we went over everything. I
mean, the main thing that we wanted to
talk about was our team approach, I think,
is important.
And then also just, you know, letting providers
and patients know that this is an option,
and we're happy to see the patients.
(30:38):
We're happy to teach anyone if they want
to to implement this in their clinics.
It's not incredibly
difficult.
I think the biggest part is, you know,
Jen's part is the,
you know, patient advocate part because
it is a little weird,
for patients to do this at first. Once
(30:59):
they get the hang of it, they realize
it's no big deal.
But
it is
a little when you first tell them, you
know, I'm gonna give you a dilator. You're
gonna dilate yourself every day. They're like,
what?
Or when you show them the dilator in,
like, a consult for side of dilation,
they're they're like, woah. Really? That thing that
(31:19):
goes down and, you know, you hit the
sword swallowing jokes.
But I really just educate them on, like,
the benefits and, you know, talk to them
about, you know,
do you want it looks like you're gonna
have to go to the OR every three
months. Like, you know, no one really wants
to do that. I'm like, this is very,
like, simple. And so, you know, I kinda
buy get a buy in and rapport. I
(31:41):
never force them, but they are always like,
oh, might not be that bad. So Yeah.
And often, as we say, look. You're gonna
go for a dilation in the OR
anyways. We'll order you a dilator.
Just try it once.
And if it is horrific and you think
you can never do it, don't do it.
I mean, you're not losing anything by trying.
And then if it if it works and
(32:02):
it's not too uncomfortable, then,
the quality of life impacts are really, really
big.
Yeah. That's amazing. That's amazing. Can you share
a little bit, doctor Abilotti, about, like, the
cost of the dilator? Is that something how
often does it have to be replaced? Is
it insurance cover it? How does that work?
So that's a great question. That was our
biggest limitation, and I think that's the biggest
(32:23):
limitation in general. The dilator itself is about
$3,400.
And originally,
we were ordering them through our clinic, and
the patients were paying for them.
And that is
difficult
for most patients to do,
especially in our patient
population,
which is why I started ordering it as
(32:45):
part of their dilation surgery. So now it's
billed to their insurance through their surgery,
with all the other supplies
of the surgery, and that has helped a
lot with the cost factor.
As far as replacement
goes, these dilators live a long, long time.
And so
I've only had to replace a couple of
(33:05):
them in the past three years, and usually
is it's a storage issue. Like, if they
if they bend it, if it if they,
are not storing it properly, because it you
really have to keep it straight,
because if you bend it, it the there's,
sometimes it doesn't unbend, basically. And then it's
(33:26):
difficult to pass if there's bends in it.
So I have had to replace dilators.
Usually, what I do is I, you know,
exchange it out for them, or sometimes I
have to redialate them in the OR to
get them a new dilator.
Awesome. Thank you for answering that question. I'd
you know, of course, that stuff always
(33:46):
impacts the way patients make decisions. So Yeah.
I think it was harder to get patients
to do it back when it was like,
you're gonna do this and you have to
pay $400.
Like, that was a big barrier. But I
think we figured out a way to to
bill it to their insurance, and I think
that has helped a lot
as far as,
you know, patients trying it. Because if it
doesn't work, then
(34:07):
it doesn't work. At least they didn't have
to pay out of pocket.
Jen, any final thoughts? I just I think
it's great,
you know, for any SLP listening to to
talk with their providers or, you know, their
physicians that they work with and collaborate and
see if this is something that they can
implement
into,
their practice. It saves a lot of time.
(34:27):
It helps the patient
immensely.
And, you know, it's it's great to collaborate
with physicians and have that multidisciplinary
care.
And so yeah. So if anyone wants to
reach out and,
learn about our program and or how to
start up a program like that, I'm happy
to speak with them for sure. Because it
(34:49):
is I mean, I've seen it as life
changing for our patients that actually do it,
and I'm really thankful to doctor Abdulati for,
partnering with me and and teaching me about
self dilation because that's something, you know, in
the realm of of the SLP world, like,
you know, I didn't even know about before
I met doctor Abdulati. So thanks, doctor Abdulati.
(35:10):
You're the best. Thanks for being the best
partner.
Oh, love that. Well, thanks to both of
you for being on. I really appreciate you
guys sharing the story and your guidance and
wisdom. And, hopefully, this spreads, and we get
a lot more patients doing this and a
lot more SLPs and ENTs collaborating on it.
So thank you so much. You too. Yeah.
Thank you. Thanks for having us.
And that's our wrap for this episode.
(35:32):
As always, thank you so much for listening.
And if you'd like to download the show
notes from this episode, please visit swallowyourpridepodcast.com.
There, you can also sign up for our
email list so that you'll never miss another
episode.
If you do like what you hear, then
please subscribe and leave a review on iTunes
or share it on social media with your
friends and colleagues because that is what keeps
(35:53):
these episodes coming.
If you'd like to be a guest, share
feedback, or request a topic to be discussed
on the show, please email podcast@TeresaRichard.com.
Thank you so much for listening, and we'll
catch you next week.
Hello, my friends. Welcome back to the Sawyer
Pride podcast. Today's guest, I'm so excited about.
Just love and adore these two and the
work that they do, and it's just incredible.
And I'm so excited for you to hear
this episode.
First, we have Jennifer Larson. She's an SLP
at the University of South Florida, division of
head and neck surgery. Her practice is dedicated
to advancing innovative evaluation and treatment approaches for
(00:22):
swallowing disorders and alternative voice
innovation options for head and neck cancer patients.
She particularly focuses on improving continuum of care
pathways
and understanding the impact of community and social
reintegration for individuals with head and neck cancer
with the goal of enhancing both functional outcomes
and overall quality of life for these individuals.
(00:42):
And she is joined by her wonderful ENT
colleague,
doctor Yasmin Abdelati.
Doctor Yasmin Abdelati is a head and neck
surgeon at the University of South Florida and
Tampa General Hospital. She received her training at
Mayo Clinic in Arizona and did a fellowship
in voice swallowing and airway disorders at a
joint Columbia Cornell program in New York City.
(01:04):
She works together in multidisciplinary clinics with speech
language pathologists to provide patients with medical, surgical,
and therapeutic care.
Welcome to the Swall Your Pride podcast. I'm
(01:26):
your host, Teresa Richard. I'm a board certified
specialist in swallowing and swallowing disorders, a mobile
thieves business owner, and founder of the MedSLP
collective.
This podcast is all about delivering the latest
evidence based practice to medical SLPs everywhere.
Whether you're a new clinician seeking tangible tools
for treatment or a seasoned vet stuck in
a rut, my goal is to help ditch
(01:47):
the old school ways of the past that
no longer serve you or your patients, to
reinvigorate your passion for our field, to broaden
your knowledge about our scope of practice, and
to inspire you to practice at the top
of your license. So if you're listening, I
encourage you to swallow your pride, be open
and willing to learn, because let's face it,
your patients deserve that kind of care. With
that, let's dive right in. Just a quick
(02:09):
disclaimer that all statements and opinions expressed in
this episode do not reflect on the organizations
associated with the speakers and are their own
opinions solely.
Alright. Good morning to both of you. Thank
you so much for joining me. Thank you
so much for having me. Yeah. Yeah. So
today, we are joined
by Jen Larson and doctor Abdulati.
(02:29):
Jen, I'll have you say a little bit
about yourself first. Yeah. So I am a
speech language pathologist at the University of South
Florida.
I specialize in head and neck cancer, mostly
for dysphagia
management,
creating pathways for our patients, voice restoration after
total laryngectomy.
And
now that we're talking about it, our our
(02:49):
new program for self dilation,
with doctor Abdelati.
Doctor Abdelati, a little bit about you? Yes.
So I am an ENT or head and
neck surgeon at USF and Tampa General.
I have a
specific specialty in the study of voice airway
and swallowing disorders, and I have,
(03:11):
an interest in the head and neck cancer
population, especially with rehabilitation of
swallowing,
as well as voice.
And working with Jen on our our self
dilation project that we are gonna chat about
today. Yeah. That's awesome. Can you guys share
a little bit? I know doctor Abdi Lotti,
before we started to hit recording, you just
talked about the multidisciplinary
(03:32):
structure of your clinic and why that sets
you guys apart. And I know that any
SLP on the outside looking in at your
guys' amazing institution, that's always one thing that
always comes up is how amazing it is
that the doctors work so well with the
SLPs, and there just seems to be such
this collaborative,
both diagnostic and therapeutic
treatments that go on. And and I would
love if you could share a little bit
(03:52):
more about that.
Of course. So all of our clinics are
set up so that there is a
surgeon
and an SLP,
present in the clinic at the same time.
And so
when we evaluate patients,
we evaluate them together. So I'm more looking
at structural, surgical, medical management,
(04:13):
and the SLP is looking more at, you
know, therapeutic, behavioral,
management. And then we discuss things together with
the patient. So we get the patient insight,
the therapeutic insight, and the medical surgical insight
at the same time.
We really like this model for a number
of reasons. One, it saves the patient a
lot of time,
(04:35):
because they don't have to be, you know,
shuttled between offices
seeing, you know, the doctor, and the doctor
sends them to the SLP or the SLP
sends them to the doctor, and then there's
this back and forth. All that communication happens
in real time, and the patient gets to
be involved in it. The other thing that's
really beneficial is the patient buy in. So
a lot of times,
(04:55):
they come to me because they want some
sort of surgical medical management, and there's none
I can offer. And, really, they need therapeutic
management.
And when the SLP is there and when
I'm, you know, saying, like, this is my
partner that, like, you know, we are equal
in this decision making and in this treatment
plan.
I think it gives the SLP a lot
of credibility
(05:16):
and makes the patient understand how important that
the therapeutic aspect is.
And I, you know, I don't have particular
data. I know there's some data in the
literature, but I I think there's more continuity,
with patients actually showing up to their therapy
when that happens.
Jen, do you wanna add on to that?
Yeah. No. I think the collaboration is great.
(05:38):
And like doctor Abdulati said, you know, we
get great buy in from our patients. They
trust us and our decision making together. If
we have something you know, if the patient
is,
you know, kinda skeptical about therapy, you know,
we always say, well, we're working with the
doctor, and the doctor is also in agreement.
So we're able to get that adherence to
(05:58):
our,
our plan of care.
Yeah. Awesome. I I I love that you
mentioned that about the the patient adherence and
the patient buy in. I think that's such
a huge thing. And like you said, the
time saving and how many times do patients
just get the runaround of sent from, you
know, doctor at this clinic to SLP at
this clinic to GI to
back to primary care. You know, it's just
always kind of a a wild goose hunt.
So I I love that you guys. Yeah.
(06:19):
Yeah. And it helps us too because, you
know, it just makes the plan of care
so much better. Like, having both the therapeutic
approach and the medical management is the best
outcome for the patient.
So it it's so great that we're able
to achieve that for our patients.
The other thing is I think with the
(06:39):
not wasting time per part is that sometimes
I can look at Jen or one of
our other SLPs and say, like, there is
nothing I can do. So you know, because
sometimes, you know, they see the patient and
they're like, well, therapy is not the best
option. They're like, I don't know if there
are medical options. I can just look at
them and be like, no. There is no
nothing I can do. So whatever you can
(07:01):
do is better than nothing. And then they
can look at me the same way. Like,
this patient
is not cognitively going to be able to
do therapy or not physically going to be
able to do therapy. So whatever you can
do medically,
please offer it because I am tapped out
here. And we can have that conversation
on the spot as opposed to the patient
(07:22):
being passed back and forth between us maybe
three times before we get to that point.
Yeah.
I love that. It's just if you think
about even just in the big realm of,
like, public health dollars too, you know, how
much public health dollars is that to save
by just having everybody in the room to
be able to make one consensus
in that moment.
So what are we here to talk about
today? So,
doctor Abilotti,
posted a a few days ago about this
(07:43):
this new self dilation program that you guys
are doing. And I just I love talking
about new and innovative things, but I also
just love talking about how we can help
patients
how we can make them more in charge
of their care, if that sounds right. But,
also, you know, I I think
I'm getting ahead of myself. I'm gonna let
you guys talk about the program, and then
I'll I'll I'll share why I think it's
wonderful. So, who wants to start? So I
(08:05):
can start. So self dilation in itself is
not novel. You know, that's been something that's
been available for
probably over a hundred, two hundred years and,
was probably utilized more in the past
than presently.
But I think the the novel part is,
number one,
(08:25):
we're working together to get this to patients.
Number two, I think a lot of physicians
just dilate the patients over and over again,
or just tell them that they're just gonna
have to live with g tubes, and they
don't offer this. So I think the multidisciplinary
part is
novel,
and kind of the size of the program,
the fact that we've been able to
(08:47):
collect. At this point, we have 20 patients
self dilating.
I think that's the more the more new
part. So the article that was posted with
our our patient,
she had a hundred percent stenosis.
So she had to have a surgery to
first cannulate her esophagus.
And then to keep it open, we said
that she really should self dilate because otherwise,
(09:09):
it's gonna close again. And so she went
from zero like, completely NPO
to
we removed her g tube, and she's fully
fully eating by mouth. And so I think
one of the reasons why we had talked
to this patient about sharing her story is
because,
her, like, some of
(09:30):
actually, half of our patients have had their
g tubes removed,
which is, I think,
eighty percent of the people with g tubes.
Eighty percent of our so fifty percent of
our patients had g tubes, and eighty percent
of them had their g tubes removed and
have now progressed to being fully,
orally fed
is
just putting it out there for patients to
(09:51):
know that there are some options for them.
Because she basically was told, you know, your
esophagus is a 100% closed. There's nothing we
can do. You're just gonna have to be
g tube fed forever.
And this program
allowed her to be able to eat. Amazing.
Can you talk about you know, doctor Abdi
Lotti, have you have you been instructing patients
on this for a long time? Is this
(10:13):
you know, you know, I know you said
that this has been around for hundreds of
years and, you know, I know that we've
heard of it before, but it just almost
does seem novel now. Is it you know,
what was what was the new approach here?
The the new approach is number one, reoffering
it because a lot of patients had never
heard of it, and I think a lot
of providers,
(10:33):
it doesn't really occur to them even though
this has been around.
And then the other part that's new is
working really closely with Jennifer Larson. So,
I mean, she can talk a little bit
more about that. But Jen sees head and
neck cancer patients, and they're all you know,
not all of them, but a lot of
them have had radiation. And she works with
a lot of doctors.
And so one of the biggest things is
(10:55):
she's she's the biggest recruiter because she's evaluating
these patients and looking at them and being
like, what? You're getting dilated every three months?
Like, that's a lot of, you know,
time and wasted money and wasted effort. And
in her I mean, Jen, you can talk
about this more than I can, but
your therapy keeps getting halted when they need
(11:17):
a dilation.
Yeah. Exactly.
So, you know, we do a swallow study
on our patients that have head and neck
cancer. You know, obviously, we see stenosis.
And so
they also have stenosis, but they also have
weakness of their swallowing muscles. So
I can't I mean, yeah, I can work
and, you know, do therapy for their swallowing
(11:40):
muscles, but, I mean, we're not going anywhere
if the esophagus is not opening up.
And so, yeah, our patients, you know, we
do offer the dilations, but sometimes
our patients going to the OR and having
to go under anesthesia
all the time,
does halt them. Like, they
they have to pretty much at that point,
(12:00):
when they have to get another dilation, they
can't get anything down. They're, like, doing really
well, and then they're stenosed again, and they're
only on thin liquid. So, you know, it's
really important for this program so we can
maintain the esophagus to stay open.
So then they can continue to get stronger
for their swallowing muscles, but then they can
(12:20):
continue to eat over
time. Now one thing that I've run into
is that, you know, when we talk about
esophageal dilations and we review these swallow studies
with our patients,
this has just come up more frequently is
that,
you know, we point out to the patient
that, yeah, your esophagus, you know, it has
a stricture.
And then they're like, oh, well, that's gonna
(12:42):
fix everything.
And I'm like, oh, no. Like, you could
get a dilation, but that's not gonna fix
everything. Like, you need to work too.
So the I always have to tell the
patient, like, yeah. We have this issue going
on with the esophagus, but you still need
to strengthen up because both of those go
hand in hand. If you have one without
the other, it does not work. So I've
(13:03):
had a frequently counseled patients about that. So
now that they know that, okay, I can
continue to strengthen
and self dilate,
all is good.
I love that. Love that. The other the
other part is the the delay with getting
dilations. And so, you know, if a patient
needs dilations every three months, like, we don't
(13:24):
have the operative time for that. We're, you
know, a very big department with lots of
surgeons and,
you know, the patient says, okay. I can't
swallow anymore. So then they see one of
us and we book them for their case.
Again, you know,
airway, cancer, that kind of stuff gets priority,
so their dilation is booked out.
(13:45):
And then now they haven't swallowed in two
months,
and now their throat is weak again. And
then
they get a dilation. They go back to
Jen. She starts from scratch.
So I think this keeps people out of
the Operating Room,
and it also keeps
the esophagus open so Jen doesn't get these
delays,
(14:05):
because she's all she tells them, like, okay.
You have to do your exercises
and whatnot. But
do they actually do them when they can't
eat? And even if they're doing their exercises,
I mean, eating is the best way to
rehabilitate
swallowing.
And so
they then see a decline therapeutically,
and then there's a lot of reinventing the
wheel every time they get a dilation. So
(14:27):
the the delay the delay in care is
substantial if we just can't keep them open.
Yeah. I think so much of this too
is I mean, I've just seen countless patients
that
got dilated before, you know, one to two
years ago and and didn't realize it was
something they need to to keep revisiting.
You know? So I feel like this is
a conversation that you can probably have with
patients
pretty early on to let them know, like,
(14:49):
this is going to be a recurring thing.
This is might be something you wanna learn
now as opposed to, like you said, having
to keep coming in every so often. But,
yeah, I'd I'd love to hear about, you
know, what does this actual process look like?
Is it, you know, counseling education from both
of you guys? Yep. Talk me through what
that looks like. Well, on my part, it
just starts with, you know, them telling me
(15:10):
they they have a problem. Sometimes I'll have
a patient come in that's had radiation
ten, fifteen years ago, and I'm like, oh,
we need to do a swallow study.
And so we'll do do a swallow study,
and there, you know, there is a a
a structure there. So then I talked to
doctor Abdilati,
and she reviews the imaging. And,
(15:30):
we then just,
you know, consolidate and say, hey. This person
needs a dilation.
And then that gives a
we automatically send her the patient to the
clinic, and then she talks to them and
does the pre op counseling on dilation.
And take it from there, doctor Abdulati. Tell
them the about the the Infinity Balloon that
(15:53):
you do. We're taking it a step back
before we even get to the self dilating
part because, really, we offer that for patients
who get recurrent,
who need recurrent dilations.
So if the patient's coming from an outside
provider and they're coming to us and telling
us that they keep getting dilated every three
months or if they're completely NPO because the
(16:13):
dilation only lasts them a few weeks before
they
need another one, but they're just they've given
up and they're not going every few weeks.
That's when we counsel them on the self
dilation.
But for starters, if it's a new patient
that's sent to us who hasn't really had
a history
of dilations, then we just talk to them
about their initial dilation.
(16:35):
For patients with laryngectomies,
those,
I typically dilate with a single balloon,
because when we recreate their
throats,
or the head and neck cancer recreate their
throats, they recreate it as a circle because
there's no larynx there anymore.
And
for patients with larynxes,
(16:56):
their throats actually aren't a circle, and that's
where the double balloon comes into effect. So
the double balloon
is
originally, we were putting two balloons next to
each other because the upper esophageal sphincter is
actually a kidney bean shape.
So the the two sides of the throat,
the two piriforms, they dump into the the
(17:17):
upper esophageal sphincter.
And because the larynx is pushing in the
middle, it actually looks more like a kidney
bean than a circle.
And so putting two balloons next to each
other had
us recreating that shape and dilating it the
way the anatomy actually looks,
which has, you know, been compared to to
show,
(17:38):
improvement
in the initial dilation and also,
increasing the length of time between dilations.
The Infinity Balloon was then invented,
I think three years ago now,
approximately,
or at least it was on the market
at that time. And that
is two balloons stuck together. So that actually
(18:00):
made it where it's super easy to do
because instead of having two separate balloons and
two separate inflation devices
and you need two assistants
to inflate them, it's now just one balloon
that is in the correct shape,
of a double balloon. It's in that already,
like, kidney bean shape. It's called infinity because
it looks like an infinity sign because it's
two circles next to each other.
(18:22):
And that actually made it so much easier,
to do,
a dilation. And just to give you an
idea, the largest single balloon is about 20
millimeters.
The largest double balloon is 38 millimeters. So
it's almost twice as big as the largest
dilation we were able to offer before.
Wow. That's amazing. Okay. Yes. And oh, go
(18:44):
ahead, Jen.
Yeah. So for those who, you know, doctor
Aptilotti does the dilation the initial dilation for,
what's really neat,
that she does is that she's able to,
size up the dilator to the size that
she had dilated in the OR,
and then the patient is able to go
(19:05):
home with that dilator.
And then what we do is we strategically
schedule our,
the clinic appointment together, and we see the
patient at the same time. The patient will
then bring in their dilator,
and then we begin our training.
And doctor Abduladi
runs the training, and I prep,
(19:25):
the dilator and and get it ready for
the patient.
Yeah. So the patients that we've selected beforehand
that probably will need self dilation, we do
the counseling together
because you have to imagine that
no one wants to put a dilator down
their throat every day. So you have to
be a certain amount of desperate
to be like, yes. This is a great
(19:46):
option. Our self dilating patients are thrilled.
And the reason for that is because they
have their, I mean, more than half of
them are completely NPO, and then a lot
of them aren't able to eat what they
wanna eat.
And so
you have to really
select the patients.
Like, people are gonna be successful if they're
(20:07):
really bad because they're the ones that are
gonna be motivated to dilate every day. So
that's the selection process. I would say
Jen probably does most of the recruiting
because she sees head and neck cancer patients
from all of our surgeons and even other
surgeons in the community.
And so she's she sees the ones that
are at that MPO status or, you know,
(20:28):
having a lot of trouble.
So she probably brings most of the patients
to the table.
And then
she's the one that tells me, is this
gonna be a good candidate as far as,
like, are they motivated?
And then I tell her if this is
going to be a good candidate based on,
you know, their physical abilities. Like, is this
a patient that can do this? Because they
have to be
(20:49):
physically able.
Once we've established that they're gonna be a
good candidate, then we dilate them in the
OR, and I size them, and we provide
them with a dilator.
Because we aren't a
DME,
facility at USF,
the dilator
is
purchased as part of their surgery.
(21:09):
And that actually is a big issue because,
there we had a self dilation program through
our GI at my residency at Mayo,
and they have lots of money. And so
they have a closet full of dilators and
all the sizes.
And they can try, like, four sizes on
the patient
before
(21:29):
they decide which one, and they can do
it all in the clinic. We don't have
that kind of resource,
so we actually
have to decide the size at the time
of their operation or even before their operation
so that it can be ordered as part
of their surgery.
And then like Jen said, they come to
us after surgery, usually within a week, preferably
(21:49):
around, like, you know, three to five days.
And,
I teach them how to do this side
of dilation. So first, I
have them swallow some lidocaine to numb them.
And it helps with the gag, although a
lot of radiated patients have limited gag reflex
because of their treatment.
And then we put lubrication on the dilator,
(22:12):
and then usually, I pass it first to
make sure that it passes easily, and so
the patient can see how it's done and
see how it feels.
And then we hand it over the patient,
and we have them
go ahead and try. Oftentimes,
they do really well the first time and
we're do. Surprisingly. Yeah. We're amazed. And then
other times, there's a little bit of coaching,
(22:33):
but it's mostly psychological. So that's when Jen
really is helpful because she's the one that's
like, okay. You gotta breathe. You know, you
can do this. Just focus on your breathing.
And there and then,
they go home with the dilator and they
practice. And most of the follow-up after that
is with Jen. And so she's the one
that checks in with them because all of
(22:54):
these patients need therapy as well.
And if there are issues, most of the
time, she can triage them. And then if
there,
are issues that I needed, then we bring
them back to the multidisciplinary
clinic.
And usually, that's,
it's pretty rare. I feel like Jen can
typically triage,
(23:15):
most of the situations and help them,
figure out what they need to do if
they're having issues. Amazing. So the so this
is something that they do every day? Yes.
So we start them off every day,
and then we wean them
from there.
So what I discuss with my patients, and
Jen
discusses this ad nauseam too, is if the
(23:37):
dilator passes super easy, very comfortably,
very smoothly, you can try skipping a day
and going to every other day and seeing
if the dilator is still passing smoothly.
Great.
If they're skipping days and they're noticing a
little bit more resistance,
then we say go back to whatever you
previously were doing. So if they were doing
(23:59):
every day and they tried every other day
and they're noticing there's more resistance,
then we have them go every day. The
dilator is meant to hold them open, not
dilate them. So the patient can't tolerate
being dilated
by themselves
awake if they're actually
stricturing. That's painful.
(24:19):
So if they're experiencing more resistance, then they're
not doing it often enough. And we often
tell them to to dilate from both sides.
So sometimes we can put the dialer,
you know, down more to the left and
then to the right side because, like doctor
Abdulati said, it's like a kidney bean.
And so we often, you know, tell them
(24:39):
to to every day when they dilate, go
down the left side, and then the next
thing go down the right side.
Not when they're able to do that. Or
sometimes if they're not, they just go down
one side, and that's still good enough for
them. Mhmm.
That's awesome.
Yeah. Joan Joan, I'd love to hear if
you could, you know, share some some stories,
some outcomes of some patients because I think
this is just so I think it's great.
(25:00):
I think it's wonderful.
Yeah. We recently
just had one guy get his feeding tube
removed. That was great.
He was,
just another head and neck cancer,
post radiation,
and NPO.
And so what we did is,
(25:20):
we did a fees and
and noticed that, you know, you know, there's
things coming up through The US, and,
so then we did the dilation.
He was petrified.
He was like, oh, no.
I am not doing this. He's like, really?
I'm like, come on, man. I'm like, it
is changing lives here. So I'm I'm a
huge advocate of this, obviously.
(25:42):
And so he did it, and
he he did it. He was like, oh,
okay. And so then he was able to
do it again and again. And now
it's like his party trick. Like, he shows
his, like, grandchildren.
I'm like, okay. Like, what a visual.
But, like, he's like, oh, watch this and
just write down that. And he is awesome.
And he just told he just got his
(26:04):
feeding tube removed,
and now he's only dilating,
two to three times a week and still
with ease, which sometimes, you know, I always
we wanna know what the frequency is. You
know? Right now, you know, we say if
you're able to, you can go every other
day.
But this was good news to hear that,
you know, he can dilate two to three
times a week and still
(26:24):
maintain his esophagus to be open.
So we you know, some other oh, and
then we had, another patient. She was a
total laryngectomy.
And, Yasmeen, she had
a a big pull up, a big reconstructive
surgery where her stomach was up here and
her esophagus was very short in length,
and it would stricture all the time.
(26:47):
And even just the self dilation for her.
I mean, this poor lady could've, I mean,
she was very soon to die, like, during
her surgery. So the and she's very young.
And for us to be able to, like,
save this woman at a very young age
who had this major reconstructive surgery,
like, that was a win win. She doesn't
(27:07):
have a feeding tube now, does she? No.
Her feeding tube fell out, and then she
was like, but I'm eating. I don't need
it.
That that was actually a really exciting
a really exciting story because, yeah, she's very
young. She was in her thirties.
Had
actually, one of our our partners, doctor Nickel,
(27:27):
had called me into the Operating Room,
and the goal was just because she was
spitting so much into a cup because her
esophagus was too small to swallow her own
saliva.
So we did, like, a very gentle, small
dilation just so that she can swallow her
own saliva.
And then
(27:48):
I was like, why don't we try this
dilation thing? Let's just see.
And, honestly,
Jenna and I were not expecting this lady
to eat a full diet. We were just
expecting, like, pleasure
feeding
for her.
But she really worked at it. She dilated
herself every single day.
Her and she says that she eats everything
(28:09):
she wants. I mean,
I
don't think she's eating meat,
but I don't think she
cares. Like, she's very happy with her what
her diet is. She's been able to maintain
her weight, and then her feeding tube fell
out, and she didn't even go to the
ER. Honestly, she didn't even tell us. She
made an appointment and came back a few
weeks later
and said, oh, by the way, my feeding
(28:30):
tube fell out. I'm maintaining my weight, and,
I'm doing pretty good.
That's awesome. I love that.
Love that. Love that.
Our patient from the article,
her husband had told her that they couldn't
travel to see her grandchildren
until,
you know, she was able to eat by
mouth and because he didn't wanna scare them
(28:52):
with the feeding tube.
And so she hadn't seen her grandchildren. She
had gotten pretty depressed.
And honestly, she was like, I can't do
this. I'm not gonna be able to do
this self dilation thing.
And she was pretty depressed.
But Jen and I, like, worked together and,
you know, empowered her and said we really
think that you'd be a good candidate for
(29:13):
this. Like, think about being able to see
your family and think about being able to
eat, and she loves cooking.
And so
she did it. She dilates. Now she's gone
to every other day,
and it's still going really easy. And we
took her g tube out, and we have
a little gong in our clinic that you
get to hit when you get your g
tube removed.
(29:33):
So she hit the gong,
and,
she's
eating. She's doing really, really well. And,
she, you know,
graduated from therapy with Jen too. So really,
swallowing wise, there's just this dilator every other
day right now, and we're gonna work on
weaning her a little bit more because I
think she can probably wean a little bit
(29:55):
more. But she's eating everything she wants to,
and her g tube is out. And she
is smiling. Like, before, she was super anxious,
and she's such a sweet,
lady and, yeah, just smiling. Whole new person.
So it really changed her life. Yeah. Amazing.
Oh, I love that. You guys are doing
amazing, amazing, amazing work. I love this. Anything
(30:16):
else you wanna cover
with regards to this? I think we did
a pretty good job.
Yeah. I think we went over everything. I
mean, the main thing that we wanted to
talk about was our team approach, I think,
is important.
And then also just, you know, letting providers
and patients know that this is an option,
and we're happy to see the patients.
(30:38):
We're happy to teach anyone if they want
to to implement this in their clinics.
It's not incredibly
difficult.
I think the biggest part is, you know,
Jen's part is the,
you know, patient advocate part because
it is a little weird,
for patients to do this at first. Once
(30:59):
they get the hang of it, they realize
it's no big deal.
But
it is
a little when you first tell them, you
know, I'm gonna give you a dilator. You're
gonna dilate yourself every day. They're like,
what?
Or when you show them the dilator in,
like, a consult for side of dilation,
they're they're like, woah. Really? That thing that
(31:19):
goes down and, you know, you hit the
sword swallowing jokes.
But I really just educate them on, like,
the benefits and, you know, talk to them
about, you know,
do you want it looks like you're gonna
have to go to the OR every three
months. Like, you know, no one really wants
to do that. I'm like, this is very,
like, simple. And so, you know, I kinda
buy get a buy in and rapport. I
(31:41):
never force them, but they are always like,
oh, might not be that bad. So Yeah.
And often, as we say, look. You're gonna
go for a dilation in the OR
anyways. We'll order you a dilator.
Just try it once.
And if it is horrific and you think
you can never do it, don't do it.
I mean, you're not losing anything by trying.
And then if it if it works and
(32:02):
it's not too uncomfortable, then,
the quality of life impacts are really, really
big.
Yeah. That's amazing. That's amazing. Can you share
a little bit, doctor Abilotti, about, like, the
cost of the dilator? Is that something how
often does it have to be replaced? Is
it insurance cover it? How does that work?
So that's a great question. That was our
biggest limitation, and I think that's the biggest
(32:23):
limitation in general. The dilator itself is about
$3,400.
And originally,
we were ordering them through our clinic, and
the patients were paying for them.
And that is
difficult
for most patients to do,
especially in our patient
population,
which is why I started ordering it as
(32:45):
part of their dilation surgery. So now it's
billed to their insurance through their surgery,
with all the other supplies
of the surgery, and that has helped a
lot with the cost factor.
As far as replacement
goes, these dilators live a long, long time.
And so
I've only had to replace a couple of
(33:05):
them in the past three years, and usually
is it's a storage issue. Like, if they
if they bend it, if it if they,
are not storing it properly, because it you
really have to keep it straight,
because if you bend it, it the there's,
sometimes it doesn't unbend, basically. And then it's
(33:26):
difficult to pass if there's bends in it.
So I have had to replace dilators.
Usually, what I do is I, you know,
exchange it out for them, or sometimes I
have to redialate them in the OR to
get them a new dilator.
Awesome. Thank you for answering that question. I'd
you know, of course, that stuff always
(33:46):
impacts the way patients make decisions. So Yeah.
I think it was harder to get patients
to do it back when it was like,
you're gonna do this and you have to
pay $400.
Like, that was a big barrier. But I
think we figured out a way to to
bill it to their insurance, and I think
that has helped a lot
as far as,
you know, patients trying it. Because if it
doesn't work, then
(34:07):
it doesn't work. At least they didn't have
to pay out of pocket.
Jen, any final thoughts? I just I think
it's great,
you know, for any SLP listening to to
talk with their providers or, you know, their
physicians that they work with and collaborate and
see if this is something that they can
implement
into,
their practice. It saves a lot of time.
(34:27):
It helps the patient
immensely.
And, you know, it's it's great to collaborate
with physicians and have that multidisciplinary
care.
And so yeah. So if anyone wants to
reach out and,
learn about our program and or how to
start up a program like that, I'm happy
to speak with them for sure. Because it
(34:49):
is I mean, I've seen it as life
changing for our patients that actually do it,
and I'm really thankful to doctor Abdulati for,
partnering with me and and teaching me about
self dilation because that's something, you know, in
the realm of of the SLP world, like,
you know, I didn't even know about before
I met doctor Abdulati. So thanks, doctor Abdulati.
(35:10):
You're the best. Thanks for being the best
partner.
Oh, love that. Well, thanks to both of
you for being on. I really appreciate you
guys sharing the story and your guidance and
wisdom. And, hopefully, this spreads, and we get
a lot more patients doing this and a
lot more SLPs and ENTs collaborating on it.
So thank you so much. You too. Yeah.
Thank you. Thanks for having us.
And that's our wrap for this episode.
(35:32):
As always, thank you so much for listening.
And if you'd like to download the show
notes from this episode, please visit swallowyourpridepodcast.com.
There, you can also sign up for our
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If you do like what you hear, then
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(35:53):
these episodes coming.
If you'd like to be a guest, share
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on the show, please email podcast@TeresaRichard.com.
Thank you so much for listening, and we'll
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