Tag Archives: Swallow

The Proverbial Last Straw

The poor little innocuous plastic drinking straw is under attack in the war against pollution. The problem started when a 9-year-old did the math and computed that roughly 500 million straws are used in the US each day. No one knows if this number is too high or too low but that’s not the point. The issue is that these straws, which comprise only 0.025% of the plastic waste flowing into the oceans, are something most people can do without.

Most people can easily adapt to other types of straws, be they paper, metal, or silicone, or they can elect to just not use one at all. My disabled wife, J, is one person who may feel a negative impact from the demise of the plastic straw because of its bendy, flexible nature. The loss of this feature could just be the straw that breaks the camel’s back. Between J’s dysfunctional motor control and her problems with the aspiration of liquids. a flexible straw is the best way to keep her healthy and hydrated.

Our community along with an increasing number of towns and cities across the country and around the world are banning plastic straws. Even chains like Starbucks and McDonald’s are jumping on the bandwagon evaluating alternative cup caps and eco-friendly straw materials. I’m all for making even the slightest difference when it comes to doing something good for the environment, I’ve started my own non-scientific evaluation of plastic straw alternatives for J’s use.

Here a Straw, There a Straw …

We regularly encounter paper straws when we go to local establishments and I’ve bought a few brands to try at home. I’ve also bought an assortment of metal and silicone rubber straws for home use, and I’m always on the lookout for a cup that doesn’t require a straw that would fit J’s needs. There are also bamboo, wooden, reed, glass, copper, silly, Krazy, and hay straws that we haven’t tried — though we did have a glass straw until it broke. Here’s a summary of what I’ve discovered:

  • Paper straws — I give paper straws a B- grade. Sure, they may – and I emphasize may be more environmentally friendly than plastic straws, but they get soggy too quickly. They aren’t flexible at all until they get soggy and I haven’t found any with a bend in them. The drinking end gets saturated and collapses especially when drinking hot liquids like coffee. (Yes, J drinks her coffee with a straw) Considering the environmental impact of making straws from paper isn’t well understood, and disposal of the now wet and possibly non-compostable waste means they may just end up in landfills anyway creating more pollution, I’m not convinced these are the best alternative — they may be the lesser of two evils.
    Paper Straws
  • Metal straws – I give metal straws a C. Sure, they work pretty well for cold liquids but they are not recommended for hot liquids as they conduct heat. Plus they are difficult to clean and transport. The bend in them is useful but they tend to be too long to use comfortably and don’t fit all cups well. While unlikely, I think they are an eye-poke hazard, and I’m not sure how to dispose of them. Finally, I think they add an odd taste to some liquids. The good news is that they could last forever — wait, is that good news?
    Metal Straws
  • Silicone straws – I give silicone straws an F. On the surface, silicone appears to be the best material as it’s flexible, inert, easily trimmed to an appropriate length and colorful, but it has one major flaw in being difficult to clean. I should have expected that issue when the straws I bought came with long metal (and plastic!) straw suitable pipe-cleaners. I’ve pretty much ignore these cleaners and just assumed that rinsing the straws out is sufficient. The problem is that you can’t see what’s growing inside your straw, because they are colorfully opaque, until it starts growing out of the straw. Something didn’t taste right so I got out the straw cleaner thingies and set out to clean the straws and boy, was I grossed out. Everyone of the straws needed to be scrubbed out which isn’t easy to do since the silicone likes to hold onto the cleaner. Maybe if manufacturers could produce clear silicone straws, their grade would improve to an A.
    Silicone Straws

So Now What?

At this time, we don’t have a solution we’re happy with and we continue to work on J’s swallow capability so that she might be able to avoid straws altogether. Plastic flexible straws are still being sold around here so we’ve stocked up on a solid supply expecting that they will be our mainstay at home for the near future. We’ll minimize our use as best we can and try to dispose of them responsibly and not create more pollution until better alternatives appear. What are your straw stories?

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.