From the Guidelines
The patient requires immediate attention to her chronic dysphagia, esophageal pain, and worsening buttock/hip pain, with a comprehensive care plan that prioritizes her post-stroke care and addresses her financial barriers to specialist follow-up. Given her history of stroke and current symptoms, it is essential to consider the potential for neurological involvement and aspiration risks associated with dysphagia, as highlighted in the study by 1. The patient's dysphagia symptoms, such as food getting "stuck" after swallowing, necessitate a thorough evaluation, potentially including a modified barium swallow study, as suggested by 1. Additionally, her chronic hip/buttock pain requires appropriate pain management, which could start with non-opioid options like scheduled acetaminophen or an NSAID, if not contraindicated. Considering her financial constraints, initiating a referral to a hospital-based financial assistance program or patient advocacy service is crucial to address her inability to pay for specialist care, including cardiology and neurology follow-up. The most recent study by 1 emphasizes the importance of patient-clinician shared decision-making and integrating treatment for atherosclerotic cardiovascular disease and multimorbidity, which is relevant to this patient's care. Key aspects of her care plan should include:
- Renewing her current medications while reviewing for potential interactions or adjustments needed post-stroke
- Evaluating her dysphagia through a modified barium swallow study
- Prescribing appropriate pain management for her chronic hip/buttock pain
- Coordinating with social services to navigate workforce services and insurance options
- Addressing her financial barriers to specialist follow-up through hospital-based financial assistance programs. By prioritizing her post-stroke care and addressing her financial constraints, we can improve her outcomes and quality of life, as emphasized by the studies 1.
From the Research
Patient's Current Condition
The patient is a 62-year-old female with a history of stroke, presenting with chronic dysphagia and esophageal pain. She reports food getting "stuck" after swallowing, which has led her to process all food before eating. She denies respiratory symptoms during these episodes.
Dysphagia after Stroke
- Dysphagia affects the vast majority of acute stroke patients, although it improves within 2 weeks for most, some face longstanding swallowing problems that place them at risk for pneumonia, malnutrition, dehydration, and significantly affect quality of life 2.
- Elder age, hypertension, diabetes, and brainstem stroke are associated with the development of dysphagia in patients with ischemic stroke 3.
- Swallowing therapy may reduce the proportion of participants with dysphagia at the end of the trial, improve swallowing ability, and reduce the incidence of chest infection or pneumonia 4.
Medication Management
- The patient is taking her medications, but the complexity of the regimen may be challenging, particularly for those with cognitive impairment or limited dexterity 5.
- Oral antiplatelet therapy, such as aspirin, may be beneficial in reducing the risk of early recurrent ischemic stroke and improving long-term outcomes in survivors 6.
Ongoing Care
- The patient is attempting to reconnect with her specialist, Dr. Soap, for ongoing care of her dysphagia and other issues.
- She has been referred back to GI and is seeking assistance through workforce services for medical management.