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Swallowing Problems (Dysphagia): Causes Symptoms and Treatment
Huntington's can affect the muscles in the throat which not only make it difficult to talk but can make it difficult to keep food and liquids in the mouth and to adequately prepare the food for swallowing.
Questions to ask yourself about swallowing
- Is it taking much longer to eat now?
- Do I have to take smaller bites?
- Have I lost more than 3-5 pounds recently without trying?
- Do I dread mealtime because I have chewing fatigue,respiratory fatigue or choke?
- Do I have too much saliva at all times?
- Do I have too try several times before I can actually swallow?
- Does liquid come up to the nose when drinking?
- Do you feel like food is stuck in the throat?
- Do I cough after drinking liquids?
- Is my voice "gargly" after drinking?
If you answered yes to one or more of these questions, you are likely having increased involvement of the muscles which prepare and transport solid foods, liquids and your saliva to the stomach.
Immediately let your doctor know about the problems you notice.
Why should I identify swallowing problems early?
The danger is that food may be coughed out, but go into the lungs, which can cause pneumonia. Especially thin liquids (like water) can be poorly moved through the throat and may go "down the wrong pipe". It may be so difficult to eat that you will not get enough of the calories or nutritional needs you must have for energy and body weight.
Swallowing problems or DYSPHAGIA may first be detected by the patient, a family member, doctor, nurse, or caregiver.
Symptoms of dysphagia may include:
- Coughing
- Wet sounding or gurgly voice
- Throat clearing
- Slow eating
- Weight loss
- Multiple swallows per bite
- Drooling
- Food left in mouth
- Fever
- Pneumonia
- Congested lungs
- Food sticking in throat
If a swallowing problem is suspected, you should contact your doctor and a SPEECH PATHOLOGIST. Speech pathologists specialize in swallowing disorders, are state licensed, nationally certified, and hold a Masters degree.
Swallowing disorders are assessed by a speech pathologist in two ways:
- A Bedside Swallowing Evaluation involves observing the patient eating and drinking, and is completed in the patients room.
- A Videofluoroscopic Swallowing Study is performed in the radiology department. Swallowing is observed via a moving x-ray. Videofluoroscopy provides definite results and will determine if and why a patient is aspirating. Aspiration is when food or liquid enters the patient's airway/lungs.
Management
Management of swallowing problems may involve
- Swallowing therapy
- Altering the food or liquid consistency.
Swallowing therapy may include utilizing techniques to directly improve the swallow and/or compensate for the problem.
Foods may be changed to puree, ground, chopped, or soft consistencies, and liquids may be thickened to make swallowing easier and safer.
One of the most common changes in diet consistency involves the liquids. Thin liquids such as water, juice, jello, ice cream, coffee, etc., are difficult to manage because they may easily and quickly spill into the airway. If a liquid is thickened, it is easier to control and it is less likely to enter the airway.
Thickening Liquids
Liquids may be thickened to three different consistencies: nectar (like tomato juice, eggnog, creamed soups) honey, and pudding.
Several thickening products are available: ThickIt, Menu Magic, Thicken Up, Thicken Right, and Nutrathick. These products can be purchased at your local pharmacy.
Many pharmacies do not have all thickeners in stock and must order them in advance. If this occurs, your speech pathologist or dietician can help you with a temporary supply.
Thickening Tips
- Best tasting with juices, milk, and soda.
- The longer it stands, the thicker it gets.
- May make drinks lumpy if temperature is very hot or very cold.
- Thickeners have a 2 year shelf life.
- Cost is approximately $5-6 per can.
Remember
Following the recommended diet consistency is the safest decision one can make; the chances of aspiration pneumonia, malnutrition, and dehydration are significantly reduced. Although it is tempting to allow yourself or your loved ones to eat/drink their favorite foods or forget to use recommended strategies, it places the person with a swallowing problem at a significant risk for pneumonia and other serious medical complications.
Swallowing problems can be serious, though they may not always be permanent. The Speech Pathology Department at MacNeal Hospital is dedicated to patients with swallowing problems and their families so that the simple pleasure of eating is restored to the best of the patients abilities.
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