Giraffe Neck

Dysphagia – A Bitter Pill to Swallow

Recently, J had another Modified Barium Swallow (MBS) test to determine if she was aspirating what she was drinking or eating — that is, allowing liquids or solids into her trachea or windpipe rather than directing it all into her esophagus leading to her stomach. Since this is a potentially dangerous situation that could result in choking or pneumonia, I thought I’d write about it while it is fresh in my mind.

Dysphagia is the medical term used to describe difficulty swallowing. Dysphagia includes difficulty starting a swallow (called oropharyngeal dysphagia) and the sensation of food being stuck in the neck or chest (called esophageal dysphagia). Dysphagia is a common problem for stroke survivors.

J doesn’t display a lot of symptoms that would indicate she has a swallowing problem. She is on a regular diet, eats regular sized pieces and doesn’t cough or choke. The hint came from carefully watching her drink. She has a tendency to hold the liquid in her mouth, and occasionally, once she swallows, she will cough a bit. She has had problems with her swallow all along and has progressed from a nasal gastric tube to a PEG (percutaneous endoscopic gastrostomy) tube to a pureed diet and ultimately to a regular diet. Her current speech therapist was concerned about the liquids and ordered another MBS. The MBS is an easy test where the therapist administers barium-laced liquids and solids and examines the person’s swallow using a fluoroscope. Here’s an interesting example from YouTube.

J’s test showed liquids leaking into her esophagus. Just a small amount but enough to be concerned about it. The approach to deal with J’s problem is twofold:

  1. Thicken the liquids to nectar thick — We’re currently trying out a gel product that we are using to thicken coffee and juice. I’ll report on it once we have more experience. You can also thicken water but there’s less danger in aspirating water, so if you’re careful, and make sure the water is carrying anything else with it, you don’t need to thicken it
    There are also powdered thickening agents and you can buy pre-thickened liquids, but I felt that the gel was most convenient and flexible.
  2. Swallowing exercises — In J’s case, she could ultimately regain a perfectly safe swallow with enough practice. Yes, I said practice. There are a variety of exercises designed to build swallowing strength and timing. Right now, we are focused on doing “hard swallows'” Think about trying to swallow something the size of a golf ball — do a hard fast swallow where you try to force it down. The first one is easy — but then try 10 in a row. It’s quite a workout.

As a caregiver, I find it especially difficult to stay diligent about J’s swallow. Swallowing comes so naturally, and it’s difficult to discern from the outside, but I need to monitor her closely to ensure that her mouth is free from solids when she’s drinking liquids. General oral care is very important as well since bacteria in the mouth can travel to the lungs. Dysphagia is just another complication that makes caregiving so darn exhausting for both of us.

In future posts, I will review/recommend some of the cups and thickening agents we’re using.

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