Welcome to this episode of The Missing Link for SLPs. I’m here with Melissa Farrow and we are so excited to have you Melissa!  Thanks for jumping on. 

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I’m glad to be here. 

You were introduced to me through a friend and she said you were just so passionate about what you do. So tell us who you are and what you do.!

I would love to do that. Again, my name is Melissa. I am a medical speech language pathologist. I earned my degree in 2012 from Duquesne University, and that’s in Pittsburgh, Pennsylvania. I actually I live in Texas now. I’ve lived in Texas for many years but I was born and raised in the suburbs of Pittsburgh. I I’ve been married for almost 22 years. So my husband Joe is also a speech language pathologist and also born and raised in the Pittsburgh area, not in the same neighborhood as me, but in the same suburb area. We have a super cool 16 year old daughter, Nyah, and a little Cavalier King Charles Spaniel, puppy, Lucy Lou. And that’s our little family. Speech pathology was actually my second career, believe it or not. I was a professor for many years in the Earth Sciences field. I taught geography and geology, meteorology, all those fun things for many years. And then my daughter came along. It was really evident from the very beginning of her life that she had some special needs. So I decided to put that career aside and stay home with her and support her. She had to have some early intervention services and things like that. So I stayed home and we did that fantastic fun stuff of OT PT, Speech. People often ask me why did you become a speech pathologist? Was it because your husband’s a speech pathologist?  As much as he loved to say, “Yes!”, the answer’s “No”. It was really my experiences with early intervention speech pathology and an amazing speech pathologist that worked with my daughter. My husband knew right away that he was he was a father, not a therapist. So we got a therapist instead of him was probably the smartest thing we ever did, right?

Absolutely.

Yes. You’re gonna not be your your spouse’s therapist or your parents therapist or your kids therapists, You have to get professionals who have objective views. And so that’s what he did. And we did that for, oh, three, four years. And it sparked my interest in this field. I knew that I’m always been a person who has just wanted to live this life helping people but and I felt like I was doing that in the field that I was in and I enjoyed it very much. I saw a lot of similarities between speech pathology and education because that’s what the speech therapist was doing in my home three days a week:  She was teaching me she was more than she was teaching my daughter. And I just knew that this was something that I felt like I could really get into and do. And I, of course, thought I was going to work with children because hey, that’s where it all started. 

That’s probably the wonderful thing about this field is that there’s so much you can do in it.!  You think you might be in one area, but actually fall in love with another you just never know. So once my daughter progressed in her therapy to a place where she didn’t  need as intensive as it was in the beginning, I went back to school and went to to Duquesne University, like I said, and I graduated.   And I’ve been practicing as a medical speech pathologist ever since I never actually did work with kids. In my clinical rotation, I was introduced to the world of swallowing and swallowing disorders and fell in love with it. And I’ve been doing that ever since.

And you’ve been gone and became board certified in it?

Yes, I did. I I realized very early on in my graduate work that

I really wanted this area of medical speech pathology and there was something that was really drawing me and like I said, when I was introduced to the aspects of swallowing disorders, and I saw the amazing impact that it had on the patient’s, the families. 

Just the change of life!  I just immediately knew that this is where I could really make an impact in people’s lives and help them and that’s why I was doing this career in the first place and so I graduated and I just kept educating myself on the in the field of swallowing and in dysphasia management, because I had a great program, no doubt about it. My my coursework was really good and my instructor was very strong in the area of dysphasia. 

But it was not enough. I absolutely knew that I had to continue on with educating myself and part of that was becoming board certified. I got certified in the Modified Barium Swallow Study Impairment Profile, which is a standardized way to do modified barium swallow studies. One of the things you learn so quick in this field is that you have to do things in a very standardized ways. So you can have objective measures to say this is this is the baseline of where you’re at, or this is where your your disorder lies and this is how we can get you better. 

And if you don’t have it standardized ways of doing that.  You don’t have a way as to help your patients or prove that you’re helping your patients.

So I look for opportunities to do things that offer ways for me to help my patients in standardized ways. And I think that’s the sciency side of me. I was like the scientist, yeah, the scientist side of me that likes those numbers and objective measures, rather than “Oh, I think that worked”. And it does that just doesn’t jive with my brain very well. I love the science side because I have this idea. Then I’ll run my numbers meme and “Aha, it doesn’t work.”

I’m totally with you on the science side of thing!  Yeah, absolutely!   It is probably why you started your company Global Flow Life. It sounds like a very sciency type company. Tell me about that.

I would love to tell you about that. I love that science. Isn’t that great? Mm hmm. Global Flow Life.

My husband also isn’t medical speech pathologist. and myself, we now work at the same facility. But prior to this, we never worked together. We worked in hospital settings and skilled nursing facilities and long term acute care, things like that. We’ve had experiences in those areas and evidence based practice. That is using the evidence that we have in our field based literature to guide our clinical decision making to give us the foundation for what we want to do with our patients. That’s been then the backbone of my clinical practice and my husband’s clinical practice. So the things that we do as clinicians since the get-go, and when I heard about this thing called the International Dysphasia Diet Standardization Initiative. Some people call it IDDSI, but the easy thing to call it is it’s D. That’s the new term we’re hearing. So IDDSI is how I refer to it. 

I thought, wow, this really is resonating with me because it’s objective. It is number based.  It is saying it’s standardized so I’m going to read about it. And so I started to delve into the literature on it. I knew a lot about the the scientists and clinicians that were developing it Dr. Catarina still is an amazing, world renowned clinician in our field of swallowing and swallowing disorders, I knew that anything she was associated with was going to be something that was very worthwhile to dig into. 

My husband and I both started reading the literature on it and we went to the Dysphasia Research Society conference.  They were unveiling it see and talking about it. I I went and talked to the cook, the the researchers, and said, “This is amazing! Here are my questions:… And we were sold.”  

I knew that standardized measures for modified diets was so so important to dysphasia management because right now,  before IDDSI, we had the National Dysphasia Diet, right?  NDDS and then we had anything else you felt like calling whatever you wanted to call it. Right?

I remember those years! 

 It kind of looks like this:  You know when you pull your spoon up in the tomato juice or the apricot juice, “That’s nectar thick. Right?” So, jack?  And the people we were educating were like, “Yeah, uh huh. Sure.Yeah. Right.” And if as long as it’s mushy as puree. 

That’s right! 

And you know, that’s not good enough. And why is it not good enough? Not because I say it’s not good enough. But what the literature says the literature says that.   You know, people that are require modified diets and we do a modified barium swallow study on them and we say this is what the problem is and this is what they have difficulty with that. And then you don’t give them that that prescribed diet because yours (facility’s diet levels) doesn’t match mine and and that next facility that they (the patient) goes to doesn’t even have that. 

How are we ensuring that our patients are are safe and actually that we’re rehabilitating them because we keep changing the the the medium that we’re using, right. And so that’s a big problem. And it’s always been a big problem in terms of modified diets. And I think one of the other things the literature demonstrated clearly was we rely on modified diets is a mainstay of dysphasia management. But we know very little about it. As a matter of fact, most of the literature done on modified diet efficacy is on pureed. And so we don’t have any information on what about the other types of diets? Do we need to do those or not? 

We don’t have those answers, because there’s no (diet) standard. And one of the things you know, in research is that you have to be able to compare your study to my study to everyone else’s study to say, yeah, there’s a standard But when you’re using a different measure than me, I can’t compare mine to yours. And so we have no no evidence, no valid evidence to say this is or is or is not working. And it’s he is now a way that we can all be saying the same thing and have that standard. So maybe moving forward, we can have more research to say, yes, we’re relying on modified diets. And it’s a good thing, because here’s the evidence now that we say that we have to say this is helping our patients, or this isn’t helping our patients and we need to make change a change in our practice.

So for new students, or those moving into the medical SLP world, it’s vital to know what you’re working with what you’re recommending and have those numbers behind everything.

Absolutely, absolutely. That that’s your very, very baseline. Start in it, see it in is a way to do that the framework that they have is standardized. It’s been validated. And it is something that is, can be used from one clinician to the other. So when I say IDDSI level four, you will have a picture in your head of exactly what that is.  You have a vocabulary of terminology and know that okay,  IDDSI level four is going to look like this. It’s going to behave like this. It’s going to do this in the oral cavity and it’s going to do this when it goes down the pharynx.   is wonderful, right?   Versus puree or ground or mechanical, soft or NDD 3.  

Those are all very different things. And so that we need as clinicians because as a new clinician, when you get out there, you’re going to see that your patient goes from one clinician to one setting to another setting to another setting and each one of us are treating that dysphasia.  That dysphasia hasn’t changed. The person setting has changed. But the treatment needs to remain the same because the dysphasia hasn’t changed.

So the common denominator is the dysphasia. The variables are the clinicians. 

Yes.

By introducing the IDDSI standards, you’re minimizing variables.

Absolutely. And that science right.

So question: this is something I don’t know. I like to fancy myself knowing a bit about it. But this is something I don’t know. When we do a modified barium swallow study, is the Varibar and the barium aron trials we use, are they IDDSI Do they line up with the IDDSI standards?

That is a fantastic question. And doctors still did a study using Varibar mediums in order for us to have a standard to say that this is level 1, level 2, level 3. She hasn’t done it with the solid sections, but she’s done it with the liquid. So you know, the standard for Veribar is IDDSI standardized, but if you’re not using that, then the answer is no. So it’s only for that type of barium for the modified barium swallow study, and not every country uses Veribar, I think in Canada, they can’t get it.  So it really is dependent on on where you’re located. 

If you’re outside of the United States, you might not have access to it. But the cool thing about IDDSI is that even if your medium is not, doesn’t have the IDDSI labels on it, you can always test it. And that’s the key is that you can test whatever you’re using and say okay, this behaves like a IDDSI level 2 and Iddsi level 3  So you can be confident in saying that it in terms of being able to translate that to the next clinician who’s working at a skilled nursing facility to say, I gave this patient IDDSI level 2 drinks during a modified barium swallow study. And so what then I can take that patient say, okay, that I’m giving them IDDSI level 2 at the skilled nursing facility, and they should be the same as long as we’re using the same testing measures. Right. 

Something else interesting, fresh slps and nine different countries now. So conversations that we have today about international dysphasia diet. This is going to apply worldwide. 

Yes, yes. And it has been implemented in many, many countries. And it’s being implemented in many, many countries. The wonderful thing about it is it’s an all volunteer group that is actually translating the original work into all these different languages, which is so great. So, you know, we can all really, truly be speaking the same language and I can’t think of another standardized method in our field that is like that. It’s It’s a unique, wonderful, critical thing we have in dysphasia management that that I think is going to impact patients tremendously.

Excellent, excellent. We have 10 minutes left. So Oh, I it goes fast. But I, we you and I already decided we’re going to jump on again.  We may finish this conversation and I also want to talk to you about why it’s important to be board certified and have that or why that’s an option for clinicians. I could talk to you for a long time. Melissa, is exciting to me. This is exciting. So when I say I’m a passionate speech language pathologist, I so am!  This so gets me going!

I told you I could go on and on. 

Sowell, we’re speech pathologists we talk a lot. That’s good. That’s good. Okay, so, go ahead.

I was gonna say I started my company because we love IDDSI, obviously, and we we saw though the problems when we my husband and I started talking about, okay, how are we going to implement IDDSI in our clinical practice?   We saw the problems that would arise we saw what I think is probably one of the most important problems that we saw was quick and easy access to the tools or the framework and working in different settings and having experiences with not having access to things to supplies.   

Like you have to have the correct syringes in order to do the test. You can’t just grab any old syringe off the second shelf. It has to be the iIDDSI standardized syringe that was used during IDDSI standardized  testing. So it’s a specific type of syringe that has to be available. And the printouts for the framework for the instructions for testing are color coded for specific reasons. So you have to have that color print out in order to give to your patients so that you can you you can follow the instructions and sometimes, speech pathologists don’t even have access to a printer, let alone the color print out, right?  We can’t access those things at many times. And then even the time spent to get it all together. In this world of productivity, which I’ve experienced in my life, my husband’s experienced. 

We don’t have the 10 minutes in our day to to gather up all the things that we want to gather to give to our patients, because that’s not billable time. And so a lot of times clinicians run into the issue of time to put together the things they want. So, we envisioned this one stop solution, which was our, our IDDSI testing kits. And right now we have the drink test kit, which is all in one, it has a syringe, it has the color coded instructions, and it has a link for a YouTube channel where we have the actual video instructions as well. 

Eventually we’re going to be we want to come out with the food side of it as well. So we just really started our company in the last year so we’re still growing and learning and I don’t have a business degree so we’re not entrepreneurs by you know, all experience we’re learning as we go. So it’s slow, but it’s going and that’s where we want to to go with it. And I think that really why we started Global Flow was that we had a passion for serving patients with dysphasia. 

We really understood how swallowing impacts patients and caregivers and family members in their daily lives. And then just the devotion to standardized practice. And so all of those things came into perfect alignment for us to say, Hey, this is what I think we could do. And we started Global fFow for the for that reason. We started it in our living room. And all started from you know, just notebooks and writing logos and designs and drink test kit designs and everything all the way down to the research for becoming an LLC was in our little two bedroom apartment in our living room. So that’s how it all started. And then here we are today.

Wonderful story! Wonderful story! I think when something is fueled by passion and logic, Mm hmm. It’s the winning-winning combination.

I agree. Absolutely.

And there’s a need for what you’re doing.

I think so. I think so.

What words of advice would you have for the new speech language pathologist

I’m so I’m going to say that and I am mean this with all the love in the world because I am a like I said, an educator at heart. I was a professor, I love students. I love teaching, I love learning. But one thing you need to know when you come out of your program is that you are not an expert in speech pathology.  You have…this is why you have to keep learning. Learning cannot stop on the day of graduation. It just cannot.  

There’s so much to know in our field and we need to keep applying that knowledge because things change as we learn more and as research grows, we need to grow with it. And that’s probably one of the things that I’ve seen that is a little bit hard for me is that sometimes I run into clinicians and I think you know, we really need to continue to grow. What you’re talking about is stuff that doesn’t apply anymore. And here’s why. So continue to learn after you graduate and continue to be open to learning. You know, don’t be feeling like, oh, that person thinks I just don’t know anything because they’re trying to tell me about some research article like I don’t read.  Don’t be defensive about it. Just be open to learning. To be an expert in the field, you need to keep learning so that you can keep growing and then you will be an expert in the field. That’s how it happens. It doesn’t happen from a piece of paper that you get when you graduate. Right? Right. And your speech pathology license is truly a license to learn.

I like that – license to learn! 

Yes, that’s what it is.

So maybe we can change LLCs for Limited Liability Companies to License Learning Companies, right? 

I like that! 

One of my favorite things about becoming a professor has just been the curiosity of the students I work with. 

Absolutely!

Hey, Professor!  What if this or what about that?  t’s just it’s wonderful to always have that sense of learning. And that’s what these podcasts are about. It’s how to learn how to continue to learn and how to just keep that light where you’re just like, what else? What else can I do? 

You mentioned before we jumped on that there are some resources you might want to share?

Yeah, the IDDSI website is a an amazing place with all of their literature that that supports what IDDSI was based on. So you can go and read all the literature.  It’s open access, so you don’t have to pay for it, which is great. They have the framework and descriptors and they have a links to resources. So it’s an amazing resource. So I would like to include that and make sure that everybody has that information available.  

It’s IDDSI.org. 

All right, and we’ll include that in the show notes, along with your links. You’ve got a nice little package of links. You’ve got your website, Facebook, Instagram and YouTube.

Yeah. This month for better Speech and Hearing month I’ve been posting all about IDDSI on Instagram and Facebook and just giving little snippets of information about each of the levels. And then next month is, of course, Dysphasia Awareness Month. So that’s going to be fun. I love literature so I’m going to be talking a lot about literature, but I want to talk about it in the frame of the patient. So patient outcomes, ethics with this diet modifications and things like that. So I’m excited about just talking about that next month too. 

Excellent!  So listeners can find you at globalflowlif.com and all these other links will be from there and they can follow and be as excited and passionate as we are right?

I hope so. 

Well, thank you so much for your time today. You and I have already decided we’re going to jump back on and you’re going to explain why it’s important to become a board certified swallowing specialist. 

Yes.  A Board Certified Swallowing Specialist.  I’d love to come back and talk about that and about the process of it. I am a mentor for people that would like to do the process and I help them kind of get ready for the big application. It’s pretty intensive but I think that if you go in with the right kind of mindset, it is doable. It is absolutely doable. I did it. So if I can do it, anybody can, I’m telling you.

Excellent. Excellent. So then until next time, take care and go find Melissa Farrow at globalflowlife.com.

I hope today’s conversation has created some “aha” moments for you and motivated you to become a better SLP continuing to connect some of those missing links between what you know and how to use that knowledge. Thank you for downloading The Missing Link for SLPs podcast and if you enjoyed the show, I’d love you to subscribe, rate it and leave a short review. Also, please share an episode with a friend. Together we can raise awareness and help more slps find and connect those missing links and get the information needed to help them feel confident in their patient care every step of the way. Follow me on Instagram and join the fresh SLP community on Facebook. Show notes are always available so come learn more at Fresh SLP and let’s make those connections.

Website – https://globalflowlife.com/

Facebook – https://www.facebook.com/globalflowlife/

Instagram – https://www.instagram.com/globalflowlife/?hl=en

YouTube – https://www.youtube.com/channel/UC_kfW0VPBevSzeMw4WnSb9A

I hope today’s conversation has created some aha moments for you and motivated you to become a better SLP, continuing to connect some of those missing links between what you know and how to use that knowledge. 

Keep the Conversation Going

Thank you for listening to The Missing Link for SLPs podcast! If you enjoyed the show, I’d love you to subscribe, rate it and leave a short review. Also, please share an episode with a friend. Together we can raise awareness and help more SLPs find and connect those missing links to help them feel confident in their patient care every step of the way.

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