Dust Bunnies and Dysphagia: How James Dyson Would Fix Dysphagia

Ever feel like you're trying to explain dysphagia to a room full of people who think "aspiration" is a fancy type of vacation? Yeah, me too. We've all been there, standing in a room with a patient and their family, trying to make sense of a medical mess that's about as clear as a dust bunny storm. It's like trying to explain quantum physics to a goldfish - you're talking, but is anyone really listening?

Remember Fred from this article? 104 years young and periodically lethargic, his team was all about sticking a feeding tube in him to "prevent aspiration pneumonia,” when a feeding tube is more likely to increase the risk than it is to lower it. This is treating a headache with a shovel over the skull. We all know that feeding tubes can cause the very thing they’re supposed to prevent. It's like using water and soap to wash away dry skin. But hey, they meant well. Just like those vacuum cleaner companies who swore that bags were the only way to get it done.

James Dyson is the genius behind the Dyson vacuum cleaner, which, if you’re like me, you thank God for every day after feeding your kids banana bread and granola for breakfast (If you know, you know). Dyson is a wild-haired genius who turned dust into gold. I recently read Dyson’s autobiography and became fascinated by the way he saw the world, and more importantly, how he saw dirt. He transformed the way we conquer something seemingly so simple and mundane. He didn't just accept the status quo; he tore apart the vacuum cleaner, literally, and asked, "Why are we doing this the dumb way?" He'd look at Fred's case and say, "Hold up, folks. Is this really about what Fred wants, or is it about what's easy for us?"

And that's where we, the mighty SLPs, come in. We're not just swallowing experts; we're translators and guides to make sense out of the nonsense. We're the ones who can take the medical mumbo jumbo and turn it into something Fred and his family can actually understand. Let’s see how the SLP can use Dyson’s principles and put them to use in dysphagia management.

Let's break it down, Dyson-style:

1. Find the Frustration:

Fred's frustration wasn't just about not eating; it was about losing control. He didn't want to be poked and prodded anymore. He wanted to live his last days on his own terms. Just like Dyson saw the frustration of a vacuum losing suction, we saw Fred's frustration with a system that wasn't listening.

2. Prototype, Prototype, Prototype! (But with Words):

Dyson didn't get it right on the first try, or the thousandth. We shouldn't expect to either. We had to sit down with Fred and his daughter, talk about his prognosis (yeah, that scary word), his advance directives (or lack thereof), and the risks and benefits of every option. It wasn't a one-and-done deal; it was a series of conversations, like testing different prototypes until we found what resonated with Fred to find the best path forward.

3. Challenge the "Experts" (Even if they wear those intimidating, pristine, white coats):

All the experts told Dyson that he was crazy. If there was a better vacuum with a better technology, it would have already been invented by all of the other experts in the field. Dyson didn’t buy it though, and we shouldn’t either.

Everyone said Fred needed a feeding tube. But we challenged that. We looked at the evidence, we looked at Fred, and we said, "Hold on a minute." We used the PARTNERS© framework, just like a blueprint, to guide us:

• Prognosis: We didn't sugarcoat it. Fred wasn't going to live forever, and we needed to be honest about that. We brought the physicians in to have an open, honest discussion about Fred’s medical situation and what the expectations should be.

• Advance Directives: Fred didn't have any, but we helped his daughter understand his wishes.

• Risk: We laid it all out with Fred, his daughter, and the physician team. We discussed the risk of aspiration with and without a tube (hint, hint: The tube wasn’t going to help) and we talked about the risk of complications. It wasn't pretty, but it was real.

• Talk: We didn't just throw medical terms around. We used stories, analogies, and sometimes, even a little humor to make it stick.

• Nonoral Feedings: We discussed the feeding tube, but we also talked about other options, like modified diets, pleasure PO, and compensatory strategies.

• Expectations: We helped Fred and his daughter understand what the next few months might look like with the various options they were considering.

• Recommendations: We didn't just tell Fred what to do; we explained why, and we made sure they understood, which allowed Fred to make the ultimate decision. 

• Summary and Support: We didn't just walk away. We gave them our contact info, told them we were there for them, and made sure they knew they weren't alone.

4. Build Something Better

In the end, Fred didn't get a feeding tube. He ate small amounts of puree and thickened liquids, enjoyed a few sips of thin liquids when he was alert, and spent his last days comfortable, even happy at times, and surrounded by his family. Maybe it wasn't the "standard" approach, but it was the right one for Fred.

The Dyson Lesson for SLPs:

We're not just clinicians; we're innovators. We're the ones who can look at a problem, tear it apart, and build something better. We're the ones who can turn dust bunnies into gold just like Dyson.

So, the next time you're in a room full of "experts" who are all pulling in different directions, remember Fred. Remember Dyson. And remember that you have the power to change the conversation. One story at a time.

How do you approach tough situations like this one? Comment below!

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