Swallowing problems

A discussion of dysphagia, swallowing problems.
The reason this is newsworthy is that the courts are trying to starve a brain injured non comatose woman in Florida, and she has NOT had the rehab to swallow.
Too often, feeding tubes are placed because they are easier than slowly feeding a person. And it decreases aspiration pneumonia. Indeed, one institution where I worked was sued by the Federal government who claimed we needed to place MORE feeding tubes to prevent pneumonia.
But the dirty little secret is that if you have severe dysphagia, you aspirate anyway: You vomit and aspirate, or you aspirate saliva. The lady in Florida hasn't died of pneumonia so I suspect she would be able to eat (and she should have died of pneumonia, since her husband's DNR orders forbids antibiotic treatment...of course, he has a live in girlfriend and two kids by her, and stands to inherit the malpractice money settlement, but that doesn't mean he has a reason to starve his wife to death...but that's another story).
The second dirty little secret is that many neurologists will declare brain damaged people as "persistant vegetative state" after a quick look, when their caretakers (like those caring for the Florida lady) know these people are alert.
When I worked with the Indian health service, one of our patients had frontal lobe damage. She was alert, but hyper emotional. We asked a neurologist to suggest treatment:we asked: Should we use haldol, or would Propranolol or anti convulsants work better?
So the neurologist took one look at the lady, and spent 40 minutes telling the family why they should pull her feeding tube.
The family, like most traditional Chippewa, stayed quiet in respect and slowly got angrier and angrier. Finally, the neice, who was a nurses' aide, spoke up:
Yes, you would have us starve her to death. But that's the difference between you white people and we Indians. We respect our elders".
And they walked out.
The Chipewa considered such people as partly on the other side...which reminds one of the Pope's comment that when he was sick he was almost on the other side,,.
blessed Kateri pray for us...