Local pathologist promotes ‘free water’

One in 17 Americans have a swallowing difficulty, also known as dysphagia, which predisposes them to life-threatening dehydration, according to Shefali Patel, a Wilton speech-language pathologist.

“Eight in 100 people in nursing homes drink water that is thickened with starch or gum-based thickeners. Thickened liquids will not trickle down into people’s lungs and put them at risk of aspiration pneumonia,” said Ms. Patel, who provides in-home speech and swallowing services to patients of nearby towns through her private practice Ganga Learning and Rehab.

“The trouble with this is that those on thickened liquids don’t get enough of it, due to dislike and preparation effort issues.”

These patients do not drink enough water, said Ms. Patel, and dehydration leads to several negative health conditions including lethargy, confusion, poor wound healing, poor drug effects, altered cardiac function and acute renal failure.

Because of this, the Frazier Rehabilitation Institute, at the KentuckyOne Health Medical Campus in Louisville, Ky., implemented The Free Water Protocol in 1984, explained Dr. Patel.

“It’s a simple program whereby patients on thickened liquid diets can drink starch-free, un-thickened, or simply put, ‘free water.’” she said.

“As water has a neutral pH and most of our body is water, aspirating water does not hurt us, but care has to be exercised to drink free water with adequate oral hygiene and in correct postures recommended by a qualified speech-language pathologist.”

According to Ms. Patel, body tissue either “safely absorbs water or effuses it outside the organs — in this case, the lungs, [which] have aquaporin channels that act like a sieve and bring water to the bloodstream.”

“Since more than half the body is water, water causes no harm and is benign in our lungs,” she explained. “The pneumonia comes from bacteria or the food residue, which causes harmful bacteria to grow in our lungs.”

Ms. Patel said hydrating patients with free water not only improves their health, but is also “a crucial aspect in quality of life.”

Ms. Patel, who studied audiology and speech rehabilitation at the University of Mumbai and received her second master’s degree in speech therapy from SUNY Plattsburgh, said she has worked with both schools and nursing homes and enjoys working with both pediatric and geriatric populations.

“I am a holistic clinician, bringing benefits of yoga, acupressure, music and other such modalities in my therapeutic care,” said Ms. Patel, who cited one of her free water success stories, in which she serviced an elderly client, who had been drinking “honey thick” liquids, and implemented The Free Water Protocol.

“In five months, not only did this person maintain clean lungs status, but [the client’s] caregiver reported improvement in alertness, recall, food intake, as well as regularity.”

Ms. Patel said she got into speech-language pathology after growing up in India and witnessing her aunt take care of her cousin who was paralyzed at birth and non-verbal all his life.

“I do not recall any services or help being available to him or his family. The experiences planted a seed within me, which is why I am a speech-language pathologist today,” she said.

“Over the years, I have gained experience in both the educational and medical model of my profession so that I can leverage my clinical skills to assist whom I can and where I can to the best of my abilities.”

Ms. Patel said the goal of rehab is to “enable people to meet life needs,” which is why she uses “a life needs analysis’ approach” to evaluate her patients and design interventions.

“For example, if the biggest challenge a teenager with a stuttering difficulty faces is ordering a sandwich at the deli, then therapy should be at the deli and the task should be desensitization to requesting a sandwich and making eye contact with the store keeper,” said Ms. Patel.

“In order to meet this goal, I may use fluency-shaping techniques for stuttering, yogic breathing, meditation and stuttering videos. Music, yoga, aromas, massage and vital stimulation are some of the tools in my kit.”

To learn more about Ganga Learning and Rehab, visit speechct.com or call 203-563-0700.