SWALLOWING DIFFICULTIES – A SERIOUS PROBLEM

SYMPTOMS, THERAPIES & TIPS

Especially during the holidays, swallowing issues need to be kept in check. Drinking plenty of fluids is critical, however, drinking the right texture of fluid is also critical. Liquid that is too thin for some swallowers will increase choking and cause aspiration as well as aspiration pneumonia. It is estimated that more than 100,000 Americans die each year from complications associated with swallowing difficulties Swallowing difficulties are a serious problem, not only for the person that has them, but it is a major stress factor for caregivers. Dysphagia (difficulty or discomfort in swallowing, as a symptom of disease) falls into four main categories, which have many of the same symptoms, but different causes and treatments.

• Preparatory Dysphagia is the loss of smell or taste sensation and saliva. It includes weak chewing muscles as well as painful gums and cheeks.
• Oral Dysphagia is caused when part of the tongue is missing which then causes impaired tongue control and sensory loss.
• Esophageal Dysphagia is the sensation of food sticking in the base of throat or chest. There are a few causes of this dysphagia, ranging from narrowing or weakening of the esophagus muscles to food or other objects causing obstruction.Oropharyngeal Dysphagia relates to nerves and weakened throat muscles, making it difficult to move food from the mouth to the throat and esophagus. This is mainly caused by neurological disorders or cancer, causing choking, gagging or coughing when one attempts to swallow.

Dysphagia can be debilitating to one’s daily life, but is often treatable. Naturally, each diagnosis and treatment is as unique as the person suffering from the swallowing disorder.

Symptoms

The signs and symptoms to be aware of if suspecting dysphagia include:

• Pain while swallowing
• Inability to swallow
• Sensation of food getting stuck in the throat or chest, or behind breastbone
• Increased drooling
• Hoarseness
• Bringing food back up (regurgitation)
• Frequent heartburn
• Food or stomach acid backing up into a loved one’s throat
• Unexpected weight loss
• Coughing or gagging when swallowing
• Constant clearing of the throat

What to do

It’s important to seek immediate help if obstructions are interfering with breathing or swallowing. If occasional swallowing difficulty is ongoing or accompanied by weight loss, regurgitation or vomiting, seek medical treatment. If left untreated, dysphagia can lead to serious issues such as malnutrition, dehydration and respiratory problems. When preparing for the initial doctor’s appointment to discuss swallowing issues, a caregiver can help make the most of the short time with the professional by preparing information. Make sure that there are no pre-appointment conditions such as diet restrictions. Prepare a list of the symptoms (including severity and frequency). Take lists of current medications and questions for the practitioner. Things to discuss with a health care provider are cause, treatments, longevity of issue, side effects from treatment, alternatives, existing health conditions, resources, etc.

Therapies

Swallowing disorders affect each person differently and a specialist (A speech-language pathologist who is a Board Certified Specialist in swallowing and swallowing disorders maintains exceptional, high-level skills and clinical experience in the evaluation and treatment of swallowing disorders) will look at those particulars to come up with a specific treatment plan. It’s not a “one size fits all” way of addressing the issue. A plan will be tailored to swallower’s needs. The goals of treatment, however, are standard: 1) To be at a place where swallowing is done as safely as possible, and minimizes the risk of choking or aspiration, and 2) Ensure that the correct amount of nutrition and hydration is provided. 3) An important thing to realize is that treatment for dysphagia involves the swallower’s family and other support systems. 4) Swallowing can be improved by addressing the overall condition, including strength, stamina, motivation and emotional state. The patient and the caregiver will need to understand what is wrong with the swallowing. A basic understanding will help them connect with the therapies the specialist recommends.

For oropharyngeal dysphagia, a speech or swallowing therapist may be recommended by the doctor. Common therapy includes exercise and learning swallowing techniques. For esophageal dysphagia, treatment may be more aggressive, including esophageal dilation, surgery or medications. If a medical professional recommends medications, they may also suggest the patient sit upright, stay calm and take one pill at a time during administration. Use plenty of liquid and applesauce to help with the swallowing of pills. Most often these medications are taken early in the day, and the patient remains upright for 30 minutes after swallowing. Treatment for a swallowing disorder most likely will include a diet modification. Caregivers should make sure their patient is avoiding foods that may have caused problems in the past, such as tough meats, crusty breads, raw vegetables, whole nuts, some fruits, and sticky foods like peanut butter or frosted treats.

Another thing to monitor is food with mixed consistency, meaning both liquid and solid elements. An example is cereal with milk. The milk can get to the throat sooner and cause swallowing issues. Mushy cereal may be a good fix. Salad is another big no-no for those with swallowing concerns. Lettuce is very difficult to make manageable. The dressing is the other concern, as with the milk and cereal scenario. It can get to the throat sooner and be swallowed before the person is ready. Fruit is many times a mixed consistency food, with skin and juices blending, as may be ice cream and gelatins that start out as solids and melt to a thin liquid in the mouth. Lifestyle changes may be necessary and many people with swallowing issues find ways to manage the concern and live full, social lives.

A caregiver can help with the embarrassment factor, especially in public settings, by planning ahead, whether it’s calling the restaurant, talking to the party host or feeding the patient before going to the social event.

Ongoing treatment & evaluation

Even if treatment is going well, caregivers and patients must not let themselves feel that the dysphagia has been overcome and therefore get comfortable. It’s still a very dangerous, life-threatening condition if not monitored properly and regularly.

Some tips for living with chronic dysphagia:

• Watch for respiratory difficulties such as coughing, rapid breathing, wheezing, chest pain or changes in voice.
• Continue with the therapist-approved swallowing exercises that involve breathing, coughing and chewing.
• Continue to work on overall fitness, muscle strength, balance and posture.
• Keep the mind and body active with reading, games and word puzzles, etc.
• At bedtime, keep a loved one’s head elevated to 30 degrees to minimize aspiration and reflux.

Prevention of dysphagia is not usually possible. While some of the symptoms cannot completely be erased, especially if neurological, early detection and treatment can help minimize the lasting effects. Eating and chewing slowly is an important technique for those already diagnosed. A lesson in patience is required for caregivers, albeit a lesson well worth the time. Treatment of swallowing problems is ongoing, and must be understood that the initial plan is likely not the final one. The swallowing specialist will cater the treatment to a person’s progress and also changes in health.

Always keep the health care provider in the loop, including (and perhaps especially) of the patient’s advance directives, changes in condition, and if the treatment is no longer necessary or pertinent.