Since Halloween is right around the corner, I thought I would share a scary story.
NPO or nil per os. Nothing by mouth. One day, a patient went into the hospital. They were found to have dysphagia. The doctors decided that the best course of action was NPO with a feeding tube. This patient was transferred to the next level of care and was kept strict NPO for months. This means absolutely nothing to eat or drink for months.
While NPO with a feeding tube is a viable and sometimes appropriate option for some patients, I would say this story above is terrifying! Unfortunately, for some, this story is all too real. Patients that I have encountered that have experienced this describe it like this:
“It was like a death sentence”
“Always hungry and thirsty”
“The worst thing I have ever been through in my life”
When I first left graduate school I thought that if you aspirate you die basically, so our job as SLP’s is to prevent aspiration by all means necessary. I know now that this isn’t the truth and “aspiration pneumonia” is not as clear cut as it is sometimes described. (This is a big topic. I plan on covering it sometime, but in the meantime look up the Three Pillars of Pneumonia by Dr. John Ashford. It’s career changing).
So back to NPO. Should anyone ever be made strict NPO? Unless they are having surgery the next day I would say no. From the comments from patients above, we know it is a horrible experience. But what else do we know?
Let’s think about our physical therapy colleagues. Let’s say that a patient has come to rehab following a stroke. They have trouble walking and is at risk for falling. Do the PT’s keep the patient bed bound and not allow them to walk because they might fall? No! They are there with the patient working their magic and allowing the patient to lose balance and try to walk in a safe way.
So now let’s look at the same patient and their swallowing. The patient is having trouble swallowing and they are at risk for aspiration. So the patient is made strict NPO and is not allowed to swallow. ….??? How do we expect a swallow to improve if the patient is not allowed to swallow?
Of course there is a lot more that goes into this, and I wasn’t even planning on wiring about this in this week’s blog. However, I saw a patient for a FEES that had been NPO for months. They were miserable and wanted so badly to be able to eat and drink. The picture below is what I saw when I started the FEES. This is before any food or liquids were given to the patient. I think this picture illustrates more than anything else I can say why patients should not be strict NPO. Should we put all patients on a regular diet with thin liquids immediately? Of course not. But should we disallow them from having ice or water. Also no.
I’ll leave you with the picture.