Stroke Rehabilitation - Dysphagia, Speech & Swallowing with Smruthi Venkat

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In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel interviews dietitians Jamie Leung and Sam Ogundere about blended diets in transitional care. Jamie and Sam discuss their roles supporting patients needing enteral feeding, as they observe  an increasing number of adults requiring blended diets. They highlight the variety of conditions necessitating enteral feeding tubes, including stroke, MND, Parkinson's, and cancer.

The conversation explores the use of homemade blended diets, with Jamie estimating that around 5% of their paediatric caseload relies entirely on blended diets, while 30% use them partially. They share positive experiences regarding tolerance and the natural inclination of parents to blend familiar foods. Challenges include inconsistent support from schools and the resource demands of administering blended diets.

The discussion shifts to tube feeds with food-derived ingredients, which both dietitians embrace as a valuable option, particularly for parents with limited time, small kitchens, or financial constraints. They acknowledge that awareness of these options is still growing, and that initial management often focuses on medical solutions.

Jamie and Sam emphasise the importance of open-mindedness, flexibility, and parental involvement in blended diet management. They recommend the EPSGHAN guideline for children and the BDA toolkit as helpful resources. The need for risk assessment forms, information leaflets, and nutritional analysis programs is also highlighted.

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In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel interviews Professor David Wright and Jan Flynn about improving medication administration for people with dysphagia.

The conversation highlights the challenges faced by patients with dysphagia around swallowing medication, particularly tablets. Therefore, emphasising the importance of considering dysphagia when prescribing medications in dysphagia management. David stresses the need to first assess whether the medication is still necessary and effective. If so, alternative routes (e.g. patches) and formulations should be explored before resorting to crushing tablets. Both experts caution against routinely crushing tablets, as it can alter drug release, cause side effects, and increase the risk of medication errors. They highlight the complexities of liquid medications, including stability issues and the potential for interactions with thickeners used for dysphagia management.

Both experts share their own professional experience of supporting patients with dysphagia and the challenges they have faced with the medicine management in this patient group.  Examples of projects and addressing knowledge gaps in this area of dysphagia management are also shared.

The podcast concludes with a call for greater awareness and education among healthcare professionals regarding dysphagia and medication administration. They emphasise the need to prioritise patient safety and quality of life by carefully considering medication options and seeking expert advice when needed.

Listen to the full podcast episode to learn more about administering medication to patients with dysphagia.

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In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel speaks with Mikayla Profe-Fuchsloch, a dietitian and assistant professor at the University of Coventry, about the impact of fibre inclusion in enteral nutrition for paediatric patients.

Fibre, which is classified by solubility, viscosity, and fermentability, increases stool weight, improves bowel regularity, and can balance stool frequency in both diarrhoea and constipation cases. All these features make it a useful addition to enteral nutrition.

It is not uncommon when managing paediatric patients with complex medical needs to have issues related with the gastrointestinal system.  There can be issues with gut dysmotility and symptoms such as gastroesophageal reflux, delayed gastric emptying, diarrhoea and constipation.

In clinical practice, adding in a fibre supplement or choosing a fibre containing enteral feed can help to manage these issues. Current guidance from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition on how much fibre per day paediatric patients require recommends an increased fibre intake in children with neurodisabilities of 17-21g of fibre per day.¹ This may be provided by the fibre from an enteral feed as well as the addition of a fibre supplement.  Fibre supplements that are partially hydrolysed, such as Partially Hydrolysed Guar Gum (PHGG), which can help to improve bowel motions1. PHGG has been shown to work as a prebiotic, supporting the growth of beneficial gut bacteria^2,3,4.

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In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel interviews Marie Watson, a paediatric specialist dietitian, about her experience managing enteral nutrition patients in the community. Marie shares her journey into dietetics and her passion for working with children.

Marie shares her knowledge about peptide feeds compared to whole protein enteral feeds and the clinical benefits of these types of feeds.  Peptide feeds are commenced in response to poor tolerance to whole protein enteral feeds.

Marie outlines the process of transitioning patients to peptide feeds, emphasising a slow, gradual approach to monitor for adverse effects such as worsening tolerance/gastrointestinal symptoms. She notes that while most patients experience improved symptoms, it is crucial to be prepared to revert to whole protein feeds if necessary.

The discussion explores the use of low-calorie peptide feeds for patients prone to excessive weight gain, highlighting the importance of achieving adequate protein and micronutrient intake while managing calorie levels, helping to overcome the challenges of balancing feed volume and tolerance with meeting nutritional needs. Examples of the use of peptide feeds in clinical practice are also discussed.

Marie stresses the significance of a multidisciplinary team approach, involving gastroenterology consultants and tube feeding nurses, to provide comprehensive care for enteral nutrition patients.

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In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel interviews Harriet Farr, a paediatric home enteral feeding dietitian, about navigating blended diets on a budget amidst the current cost of living crisis. Harriet shares her journey into dietetics and her passion for supporting children requiring tube feeding.

The conversation begins with a definition of what is a blended diet, emphasising the use of real food ingredients blended to a suitable consistency for administration via gastrostomy tubes. Harriet also mentions commercially made feeds with food-derived ingredients. She then delves into the practical aspects of supporting families on blended diets, including liaising with medical teams, providing information on benefits and potential problems, and ensuring safe preparation and administration.

A significant portion of the discussion focuses on the impact of the cost-of-living crisis on families using blended diets. Harriet acknowledges the financial strain and the reluctance of parents to discontinue blended diets due to the positive impact on their children's gastrointestinal symptoms. She emphasises the importance of dietitians being aware of these challenges and offering practical solutions.

Harriet provides several budget-friendly tips, such as utilising more affordable protein sources like beans and lentils, which also offer added fibre. She suggests considering frozen fruits and vegetables and batch cooking to reduce costs and time. Harriet also highlights the importance of menu planning, shopping lists, and buying in bulk.

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In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel speaks with Lydia Collins Hussey, a specialist paediatric dietitian, about complementary feeding, weaning and allergen introduction for infants with food allergies.

The conversation delves into recent trends in food allergies, highlighting the need to translate research into clinical practice and policy. Lydia mentions the importance of maternal diets, the microbiome, and early allergen introduction. Cows’ milk allergy is identified as the most common, followed by egg and peanut allergies. Lydia outlines the process of managing a child with suspected allergies, including taking a detailed allergy-focused history, assessing symptoms (immediate vs. delayed), and considering family history and eczema.

The podcast then answers the question ‘What is complementary feeding’ and Lydia provides guidance around commencing weaning. This includes the numerous considerations that should be made regarding the safe commencement of weaning as well as the significance of food allergy management and early allergen introduction. 

For children with food allergies, Lydia advises starting allergen introduction between four and six months, especially for those with severe eczema or pre-existing allergies. She recommends introducing allergens in small amounts, mixing them with breast milk or formula, and ensuring the child is well during introduction. She also highlights the importance of maintaining tolerance by regularly including allergens in the diet.

Dr Rosan Meyer, a Paediatric Dietitian, discusses the Cow’s Milk related Symptom Score (CoMiSS) and how it can help healthcare professionals to be more aware of symptoms related to Cow’s Milk Allergy (CMA) and support the diagnosis of CMA. You can access the CoMiSS tool here.

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In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel interviews Simon Williams, chief executive of Anaphylaxis UK, to discuss the organisation's role in supporting individuals and families affected by serious allergies.

The conversation emphasises Anaphylaxis UK's comprehensive support system, encompassing information, training, and a helpline. The organisation aims to improve every aspect of life for those with allergies, from school and work to dining out. Simon stresses the importance of creating a welcoming environment for individuals with allergies, particularly in the food industry.

The podcast addresses the rising prevalence of allergies, especially among children such as peanut allergy and cows’ milk allergy, and the need for increased awareness and procedures in schools. While the exact cause of this increase remains unclear, Anaphylaxis UK focuses on providing resources and training to ensure the safety of those living with allergies and at risk of anaphylaxis.

Simon highlights the organisation's extensive online resources, including fact sheets reviewed by clinical experts and lay members. Anaphylaxis UK is also developing video and audio support for these resources to enhance accessibility. The organisation actively engages with the public through social media and a newsletter, providing updates on research, innovations, and product allergy alerts.

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In this episode of Inside Medical Nutrition, Dr. Linia Patel interviews Jacqui Lowdon, a paediatric specialist dietitian, about managing enteral nutrition patients in the community. Jacqui shares her journey into paediatric dietetics, starting with an interest sparked during a placement at a children's hospital. She discusses her current role as a clinical specialist in cystic fibrosis (CF) and her involvement with the British Dietetic Association.

The conversation delves into current trends in enteral nutrition, noting an increase in children with respiratory issues requiring long-term ventilation and tube feeding. Jackie explains the criteria for choosing a feed, considering factors like the duration of feeding, the patient's ability to take oral diets, and potential underlying conditions. She emphasises the importance of understanding the patient's overall nutritional needs and tolerance to support enteral feeding at home for children.

Jacqui highlights the evolution of available enteral feed formulas, from basic whole protein options to more specialised choices like fibre-containing, lower calorie, higher calorie, whey-based, and peptide-based feeds. She explains the use of peptide feeds for children who don't tolerate whole protein feeds and high-calorie feeds for those with high energy needs or limited tolerance for large volumes.

The discussion emphasises the crucial role of parents and carers in decision-making. Jacqui stresses the importance of open communication, considering cultural backgrounds and religious beliefs. She shares a case study illustrating the challenges of convincing resistant parents to switch feeds, ultimately succeeding through persistence and a bit of luck.

In this podcast Timira Naicker walks us through her journey as a dietitian and how she made the transition into the field of regulatory. Timira gives us great insights about her regulatory dietitian role, what are her interests, what does a typical day looks like and how you can think about a career in regulatory. Disclaimer: BDA endorsement applies only to the educational content of the learning activity.

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In this podcast Dr Michelle Harvie discuses the importance of research and setting research questions to test a hypothesis. One particular interesting area of work researched by Michelle is the very low-calorie diet and the 5:2 diet within diabetes. Disclaimer: BDA endorsement applies only to the educational content of the learning activity.

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In this podcast Dr Graeme O’Connor discusses his role as a research dietitian and how he made his first research move in the field of refeeding syndrome. After the success of developing clinical guidelines for the management of refeeding syndrome, Graeme went onto to research tube feeding formula containing food derived ingredients at Great Ormond Street Hospital. Graeme also highlights how dietitians can work with industry to test important questions such as 'how can a blended diet work in a hospital setting?'  Disclaimer: BDA endorsement applies only to the educational content of the learning activity.

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