Vital Stim Success In A Patient with GERD

An active lady in her 70s, Ms. B lived at home alone. She had several friends in her community and enjoyed spending time with family and visiting with friends. Although she loved to eat, she was a healthy weight and walked for exercise regularly. Ms. B, however, had poorly controlled GERD (gastroesophageal reflux disease) that progressively worsened to include damage to her PES (pharyngoesphageal segment). She was scheduled for esophageal dilation, however, at the last minute, the procedure was aborted because, according to her, her doctor saw her PES and felt like the dilation was not the right thing to do, however, surgery was a possible option. Without having the esophageal dilation, and without surgery, patient was left suffering. Speech therapy was ordered for completing a dysphagia evaluation.

At the time of the initial evaluation, patient was in tears; she stated that she was scared to eat because "nothing went down" and she felt like she was choking. She had put herself on a puree diet (IDDSI level 4) and continued to drink thin liquids. She was losing weight; she consumed less than 25% of her meals. She constantly complained about her acid reflux. The evaluation was completed and she was diagnosed with severe pharyngoesphageal dysphagia.

Patient was fairly healthy. She only had two pertinent medical diagnoses, essential hypertension and GERD, and had one medication prescribed for each. Establishing goals was simple: 1) better control GERD 2) improve swallow safety 3) improve swallow function for safely swallowing a higher diet level.

Therapy included teaching on reflux precautions, including which foods to avoid and which foods to include for better managing reflux, compensatory safe swallow strategy training, laryngeal/pharyngeal exercises, therapeutic trials of higher level consistences, a HEP (home exercise program), and NMES with Vital Stim.

After 5 weeks of therapy twice a week (with Vital Stim for 40-60 mins. at each visit), a Modified Barium Swallow Study confirmed that patient was able to safely swallow a moist IDDSI diet level 7 easy to chew with a full range of liquids. She was already consuming > 75% of meals 2-3 times per day and her weight had stabilized. She was happier and resumed activities with family and friends, especially the social activities that included eating. Her GERD was not resolved, but it was better controlled and Ms. B was pleased with her progress, especially since she was no longer scared to eat. Goals met!