A THERAPY 2000 VitalStim Success story
By MARC FAGNAN
Brady is a princess and she knows it.
She knows what she wants, and what Brady wants is her banana puffs. I say with a tone of gentle determination, “Brady, you need to finish your bottle.” Her piercing blue eyes communicate clearly and succinctly, “I want my puffs, give ’em to me NOW!” We go around and around, Brady and me. I win, but just barely.
Brady is an adorable, self-assured, independent, 9-month-old who does indeed reign in her kingdom as one of a set of triplets. Although both of her brothers are eating without difficulty, since birth Brady seems to associate eating with pain. Arching her back and refusing the nipple it became clear early that Brady has a noticeable challenge eating.
A swallow study gave Brady’s concerned parents the answer: Due to Brady’s immature suck-swallow-breath pattern and overall muscle weakness, she is not able to propel the liquid to the back of the throat into her esophagus. Instead the liquid is entering her lungs and causing Brady intense amounts of pain. Her cough reflex does not trigger causing Brady to silently aspirate.
Her eyes look back at me. “Did you not understand me the first time? I want those banana puffs!” “First bottle, then puffs,” I say back, as I point to the bottle then the puffs. There is a 10-second pause, a stare down. Who will win this battle? Nine-month-old female infant, against 34-year-old male speech therapist. She looks at the bottle and slowly reaches with both hands. The bottle gets knocked over on her high chair table. I pick it up. She tries again, this time grasping the bottle with both hands and bringing it to her mouth. A little help to tilt it to her mouth and voila, we both get our desired result. Brady self-feeds and Brady gets her reward, a banana puff.
With supportive parents such as Brady’s and with cutting edge treatments such as VitalStim, a form of Neuromuscular Electrical Stimulation (NMES), Brady is one of THERAPY 2000’s success stories. However, Brady’s outlook at one point was grim. She faced surgery for a feeding tube, but it was cancelled one day before a second swallowing study confirmed the feeding tube was not needed. VitalStim was indeed “doing the trick” leading up to the banana puffs Brady demands today.
I first met Brady when she was three months old. She was referred for dysphagia treatment after failing a swallow study. She aspirated on all liquid consistencies and was immediately recommended for alternative feeding methods. A naso-gastric tube (ng tube) is inserted and Brady was sent home with her mother and father, who were unsure what to expect regarding their daughter’s swallowing status. Both parents are professionals working full-time with a hired nanny in the home taking care of the triplets. Outpatient therapy is out of the question, making home health therapy the only alternative.
After attending a two-day course in June 2008 on VitalStim, I decide to see how Brady will tolerate electrodes on the muscles of her throat. My first attempt proves to be very successful. Brady does not show signs of discomfort or pain and she is able to swallow 10 CCs of her formula without resistance. Orders are immediately sent to the doctor for approval of an intense VitalStim treatment program three times per week for 30 minutes per session. Brady will continue with her tube feedings until her sucking coordination and strength improve.
Brady has made good progress and is now able to drink 20 CCs of formula without showing signs of fatigue or discomfort. She no longer resists the electrodes placed under her chin. She appears to enjoy the VitalStim treatments. Despite the progress, the swallow study appears to show aspiration on all liquid consistencies. At this point Brady’s parents are faced with a difficult decision. Will Brady be more comfortable with feeding if she has surgery for a g-tube due to all the irritation caused by the tube? The swallow study comes as disappointing news considering our high hopes Brady will no longer need alternative means of nutrition.
As Brady’s therapist I take the news especially hard. I am optimistic going into the study having worked with Brady and watching her progress. I feel certain the results are not consistent with the observations I make during therapy. Why is Brady’s oral intake improving and her signs of fatigue and discomfort dissipating if she is still aspirating? This is when a therapist is pulled between the opinion of another professional and his own gut feeling. After much thought I recommend a second opinion.
A second swallow study is scheduled the next week to see if taking the tube out will make a difference. A rush is put through on insurance and at the hospital, paperwork is a slow process to sort through but we all work together in order to avoid surgery the following day. The gut feeling pays off and Brady’s parents and I stand in the small room close to tears when a second swallow study proves Brady is indeed enjoying her food and surgery is not needed. The tube can be permanently removed. Brady can receive all nutrition orally.
I continue VitalStim until the middle of March and today Brady is the little princess I mention above, enjoying her banana puffs and causing a fuss. She has a look on her face when I walk in, hey speech therapist, where’s the stash, and isn’t it about time you stop putting that vibrating gadget on me? I’m swallowing just fine.
Indeed it is time. Brady is eating just fine. She is ready for discharge.
Marc Fagnan, CCC/SLP, is a Speech Therapist at THERAPY 2000. He has gained advanced experience and training as a Feeding and Swallowing therapist and completed certification to provide VitalStim therapy in April 2008.