This article originally appeared in Saskatoon Star Phoenix.
Jennifer Cameron-Turley’s Fiberoptic Endoscopic Evaluation of Swallowing test is available at her Saskatoon clinic with or without a doctor’s referral.
Businesses and non-profit organizations regularly open and move in Saskatoon. Today the StarPhoenix talks to Jennifer Cameron-Turley, a licensed speech-language pathologist, who opened Saskatchewan Swallowing Diagnostics in downtown Saskatoon.
Cameron-Turley, a healthcare worker for almost 30 years, opened her new business at the beginning of May to conduct outpatient tests and provide direction for people with certain swallowing issues.
She says that she is not only the first business in Saskatchewan but actually, the first independent business in Canada to provide the FEES test (Fiberoptic Endoscopic Evaluation of Swallowing), which is an instrumental swallowing test with several unique advantages. FEES is available at her clinic with or without a doctor’s referral, and without having to arrange travel to an outpatient appointment at an acute care hospital.
Part of Cameron-Turley’s mission is to educate people because she has found a general lack of knowledge about what to do about swallowing issues. She is eventually hoping to offer on-site services to remote and rural areas throughout Saskatchewan. For now, she is open by appointment two days a week at Wall Street ENT Clinic.
How common are swallowing problems in Canada?
Swallowing problems are quite prevalent in people over the age of 50, but they can happen at any age. People also might have a neurological issue or an acute or chronic disease that affects their swallowing. I would say probably 10 per cent of people over 50 have dysphagia or swallowing disorder. And the vast majority of people over 80 in nursing homes, probably 70 per cent of them have a swallowing disorder of some kind.
What are some signs that someone may have a swallowing disorder?
Big signs are persistent coughing and choking when you’re eating and drinking, or having food get stuck in your throat. This happens to everyone once in a while, but persistent difficulties are a red flag. Changes in your voice quality while eating or drinking can also be a sign of an issue. Sometimes it can feel like a persistent lump in the throat. When we do the FEES test we can sometimes see that people might be regurgitating some stomach acid or food into their throat.
If I can see what’s going on, I can refer people to different medical specialists who can help them out. Another thing is getting chest infections because you have food going down the wrong way. That can really put people at risk of ending up in the hospital if they end up with chest infections because they’re aspirating, or having food and liquid go into the lungs. Aspiration does not always lead to aspiration pneumonia, but it is certainly a risk factor, especially if you’re elderly, frail, your immune system is compromised, or you have pre-existing lung disease.
What steps can people take if they notice swallowing problems?
A lot of people don’t know where to go. Up to this point, you really did have to get a doctor’s referral to get an outpatient instrumental swallow test at an acute care hospital. But now with Saskatchewan Swallowing Diagnostics, outpatient instrumental assessments won’t need to be hospital-based and people can self-refer. It’s always a good idea to talk to your doctor anyway because there’s more than one cause of swallowing disorders. But with FEES people can certainly self-refer if they think they are having an issue, and then I can send the report to their physician once the examination is completed. If a person is unsure if this test is for them, I can certainly discuss the situation with them over the phone and see if this is appropriate for them, or tell them if I think a different test or a different medical specialist would be more appropriate.
How does the FEES test work that you conduct at Saskatchewan Swallowing Diagnostics?
FEES involves a slender nasal endoscope that goes into the nose and allows the speech-language pathologist to clearly view the patient’s pharynx (throat) and larynx (voice box) and oesophagal opening while the patient is eating and drinking to see exactly how the muscles are moving. That way we can see if there’s anything we can do in terms of manoeuvres or therapy that will make swallowing better over time. Or there might be diet recommendations for a person to alter their diet to make it safer and have them be less likely to aspirate or have things go down into the lungs.
The test typically takes around 15 to 20 minutes, then I would talk to the person about what I found. I’d make recommendations, introduce any therapeutic exercises and do any teaching that I need to do with them or the family. The visit would be about an hour.
Are other tests available to assess swallowing disorders?
Right now there are two “gold-standard” instrumental swallowing evaluations. One of those instrumental studies is FEES, and the other is a Modified Barium Swallow study (MBS), which is done in radiology in an acute care hospital. That test is excellent for diagnosing certain types of swallowing disorders but there are some disadvantages to it, too. The radiation dose of an MBS is relatively low — and speech-language pathologists and radiologists are always very careful to keep the doses as low as possible — but there are situations in which it’s best to minimize one’s exposure, especially if you have a history of head and neck cancer treatment with prior radiation, for example.
So I think my FEES service will really open things up to centres that do not have acute care hospitals, especially in rural and remote locations, and people in nursing homes and things like that where people might not be so mobile.
How does FEES compare to the other test?
It stands out very favourably. There are different indications and contraindications for each test but there are a lot of advantages to FEES for some patients. If you primarily have trouble chewing or moving food around in your mouth, or if your oesophagus or food tube is the cause of your swallowing problems, doing an MBS (Modified Barium Swallow) is the preferred test for you. There are some contraindications for FEES, such as a history of facial or nasal surgery or trauma, blocked nasal passages on both sides or a history of severe nosebleeds, or a history of vasovagal episodes or fainting.
What training have you had in conducting the FEES test?
Not many speech-language pathologists in Saskatchewan are trained to do FEES yet, but I hope to see the exam become more available over time. I went down to the United States to get trained in the technique and the interpretation. And then there was an ear, nose and throat doctor that oversaw my training in Canada for quite a few months and deemed me competent to scope and interpret results independently.
I’ve been doing FEES with in-patients in the hospital for a few years. I’ve done hundreds of them now but of course, there is always more to learn and I’m always trying to learn more to be a better clinician. There’s only one speech pathologist I know that’s doing this in an outpatient setting in Toronto. It’s certainly not common. But in the U.S., mobile FEES providers are getting increasingly common.
This interview has been edited and condensed.
Saskatchewan Swallowing Diagnostics
Owner: Jennifer Cameron-Turley
Address: 140 Wall Street (Wall Street ENT Clinic)
Hours: Mondays and Fridays, 9 a.m. to 5 p.m.