Jay Paul, MD
Pulmonary and Critical Care Specialist
As a pulmonary and critical care specialist I see a lot of people, particularly older people, who have trouble swallowing and aspirate. Some because of stroke and other diseases. Some because they were on endotracheal tubes for a long time and developed dysfunction of their swallowing muscles. Some simply because age has robbed them of the coordination they need to swallow. Swallowing, after all, is a complex process involving 13 different muscles.
Unfortunately, there hasn't been much we have been able to offer patients with swallowing difficulties.
Therapies have been hard to implement. Many patients wind up on feeding tubes. Even those that can eat solid foods face an unpleasant future if they have to take thickened liquids to avoid aspiration problems. Imagine having to thicken all your water, pop and coffee to the consistency of Metamucil®. Imagine never again feeling that your thirst has been quenched. At first when Denise Dougherty told us about VitalStim Therapy, a colleague, Dr. Malcolm Berger, and I were very skeptical because the data was basically too good to be true.
But we tried it and it worked.
It doesn't help every patient, those who are demented, for example. VitalStim Therapy will help some only to a limited degree. And some patients, such as those with progressive neuromuscular diseases like Parkinson's, will only be helped for a limited amount of time as the disease progresses
But on the whole it appears that VitalStim Therapy can help 85% of the people who are treated with it.
We are so confident that now, if we have a patient who has swallowing difficulties, we send the person home or for rehabilitation with only a nasogastric feeding tube or an intravenous line in place. We know we can jump past a PEG or a jejunum tube because within a couple of weeks of VitalStim Therapy training, Denise will be able to improve their swallowing function.
The only problems we have experienced with VitalStim Therapy are economic ones.
When a patient has to be hospitalized, our hospital is reimbursed with a flat fee. So we cannot bill for the VitalStim Therapy because it is not included in that fee. If we have a patient whose disorder includes swallowing difficulties, we have to discharge him from the hospital and move him to an outpatient facility. That delays treatment.
If patients have to go to a nursing facility where there are no therapists trained in VitalStim Therapy, they do not get treated at all because the facility will not eat the cost of bringing in a trained therapist. Nor will nursing homes pay the $700 or so it would take to provide for ambulance transportation to and from a facility where VitalStim Therapy is available.
Nevertheless, VitalStim Therapy has been a major, major change for us. I can offer patients hope now, where before I had very little I could offer them.