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More MS news articles for March 2004

Swallowing therapy offers patients a second chance

VitalStim Therapy, now at Community Hospital in New Port Richey, aids those suffering with the swallowing disorder dysphagia.

March 7, 2004
Melia Bowie
St Petersburg Times

Albert Bergeron had not swallowed in more than a year.

Not since his treatment for the cancerous polyps that appeared on his voice box one day in 2002. Radiation and chemotherapy used to fight the cancer left his esophagus raw and constricted.

"Anything that went down there I choked," said Bergeron, an 81-year-old snowbird from Massachusetts who spends part of the year in Port Richey.

Unable to swallow his saliva, doctors inserted a feeding tube that he wore around the clock. His diet: seven cans of Ensure a day.

"One doctor said I might be this way for the rest of my life," he said.

Bergeron's companion, Jeannette D'Hondt, 75, disagreed after spotting an ad about a new treatment at Community Hospital in New Port Richey.

Approved for marketing by the Food and Drug Administration in 2001 and called VitalStim Therapy, the noninvasive program uses electrodes placed on the throat to exercise and trigger the swallowing muscles of patients suffering from "dysphagia."

A condition that makes it hard and sometimes painful to swallow, dysphagia often contributes to difficulty in taking in enough calories and fluids for nourishment.

An estimated 15-million people (many elderly) suffer from some form of dysphagia. The condition can affect those recovering from strokes, some cancers, cerebral palsy, muscular sclerosis and other ailments affecting the nervous system.

In November, Community Hospital introduced VitalStim to Pasco. Two certified therapists oversee the program, which has treated more than 20 patients, including Bergeron.

Currently, nearly 30 hospitals and medical centers in Florida offer the treatment. Among them are sites in Brandon, Bradenton and Hudson.

When it comes to swallowing, some 50 pairs of muscles and various nerves work to move food from the mouth to the stomach in multiple stages.

VitalStim Therapy positions external electrodes attached to a portable monitor along the front of a patient's neck. Swallows are practiced to retrain the muscles.

But some argue research on the technique is inconclusive and insufficient. Large scale studies have not been done and existing marketing of the therapy is based primarily on findings from its inventor.

"There's no empirical data to prove that this really works," said Erin Pearson, a clinician and a doctoral student in speech pathology at the University of Florida's Shands Rehabilitative Hospital in Gainesville. "Studies of effectiveness . . . with this is pretty scarce."

Officials with UF's Florida Dysphagia Institute are preparing to launch a full-scale research study on the therapy in April, said Cynthia Barnett, a clinical speech pathologist there. She noted institute patients now being treated with VitalStim appear to be doing well.

"There is nothing to say this doesn't work; we just want some good hard evidence," Barnett said.

Therapists with Community say the inability to swallow can make it hard to interact.

"Eating is such a social thing," said speech pathologist Debbie Moore. "What do you want to do tonight? Where do you want to eat? How many times do you say that?"

Items such as prescription medicine, coffee, even birthday cake become challenges for those with dysphagia.

"Most of the people we see are relying on modified foods," said Moore, who learned of VitalStim at a conferrence. "They (are on) pureed diets; they have to blenderize all their food."

Other options include cutting food into small portions, liquid thickeners and a feeding tube.

By comparison, said Moore, VitalStim sessions generally take about 45 to 60 minutes and offer longer-term solutions for patients.

VitalStim costs $150 per session and is covered by most insurance and Medicare, Moore said.

Bergeron finished the program last month, after 31 sessions. He progressed from swallowing a few teaspoons to eating Boston baked beans, broccoli and roast beef.

Now, "they tell me I'm on my own," he said.

Although he still does throat exercises and consumes two cans of Ensure through his feeding tube, he is being weaned off of the aids. Soon he will head home to Leominster, Mass.

His first stop there: the S.S. Lobster for some fresh steamed clams with a few old friends.

"That's a New England thing," he said, smiling, thinking about the clams. " . . . You boil them and put them in butter. They're my favorite."

Copyright © 2004, St Petersburg Times