Answer to Question 1
An SLP is a speech-language pathologist, who diagnoses and treats communication and swallowing disorders in patients. SLPs have a master's degree and are licensed in the state in which they are working. They should be aware of the physiology and physiopathology of swallowing and the principle disorders that cause dysphagia, as well as the maneuvers, exercises, and techniques used in rehabilitation.
FEES: Fiberoptic endoscopic evaluation of swallowing is a first choice for studying swallowing disorders because of its various advantages (it is easy to use, well-tolerated by the patients, and economical and allows bedside examination).
The FEES is limited in the information it can provide compared to a videofluoroscopy; it can only investigate the pharyngeal stage with a moment of white-out in the swallow. The evidence from FEES correlates well with other tests to detect pathological aspects such as aspiration of the bolus into the airways and the presence of bolus residue in the pharynx and pharyngeal-laryngeal area.
Answer to Question 2
Eating fish and taking supplements are the most common ways to obtain fish oils.
- Mackerel, tuna, salmon, sturgeon, mullet, bluefish, anchovy, sardines, herring, and trout are especially rich in omega-3 fatty acids (1 gram of omega-3 fatty acids in about 3.5 ounces of fish).
- Fish oil supplements are usually made from mackerel, herring, tuna, halibut, salmon, cod liver, whale blubber, or seal blubber. A small amount of vitamin E is often added to prevent spoilage.
Researchers believe fish oil may reduce triglycerides by 20-50.
- Lovanza, a fish oil supplement, has been approved by the FDA to lower triglyceride levels.
- Lovanza is sold in 1-g capsules and contains EPA and 375 mg DHA.
- 1-4 g/day are recommended for treatment of high triglyceride levels.
- Mr. Garcia's triglyceride levels are WNL.
Fish oil may be beneficial in protecting healthy persons from developing heart disease (6 g/d fish oil for first 6 months, then 3 g/d from then on).
Persons with heart disease may be able to lower their risk of dying from heart disease by taking fish oil capsules containing 0.3-6 g EPA + 0.6-3.7 g DHA. Mr. Garcia may benefit from this treatment dosage.
Obtaining large amounts of fish oils from some dietary sources, like shark, king mackerel, and farm-raised salmon, may be unsafe due to contamination with mercury and other industrial and environmental chemicals. Fish oil supplements do not contain these contaminants.