Swallowing problems?

Ed1937

For about the last week or so, often when my wife is eating a meal, she will begin choking as if she has food stuck in her throat. I'm not sure if this is the start of swallowing problems or not. Is this how they typically start? Is it time for a swallowing test? If so, how is that done, and is it traumatic for the PWD? Thanks for any enlightenment.

M1

Ed as tests go, it's pretty easy; they will have a speech pathologist work with her to swallow various textures, and they will also give her some thickened barium to drink and watch it go down with a fluoroscope (completely painless).  The difficulty might come with her following instructions, but with her nursing background she might be okay.  Do you have a GI doc you work with?  that's who usually would order, tbough your PCP might could order it too.

Hope it's not the start of anything ominous, but it could be I suppose.

Jo C.

Hello Ed; it is hard to tell just what is happening when those dynamics begin.  My LO did begin her swallow difficulties with coughing while eating and it became persistent.  This was the point at which aspiration became an overt concern.

If this has been continuing, it is best to ask the doctor to order a swallow test for her.  It is absolutely simple, it is not invasive, and nothing touches the patient during the test.  My LOs primary MD ordered the test.

The testing is usually done at an outpatient radiology center and most often the person performing the test will be a Licensed Speech Therapist that works with such challenges.  The patient sits comfortably on a guerney with the backrest up.  There is a fluroscopy machine near the patient, but it does not touch the patient. 

In our case, I was permitted to sit inside the room off to the side.  My LO was given a bit of pudding to swallow, a bit of applesauce, a bit of cracker and a small amount of water.  The fluoroscopy machine visuals were fascinating.  One could see inside the mouth with the tongue and how the chewing and beginning of the swallowing was being processed; then one could watch the food as it was swallowed down all the way down . . .

The Therapist could then identify if there was a true problem and if so, at what point in the feeding the problem was at.  She was then able to prescribe the best way to provide the food and also if necessary can prescribe a thickener for liquids and sometimes, not always, the diet may need to be adjusted to soft foods and for some people, a pureed diet.

At that point, my LO was prescribed a soft diet, thickener for full liquids she was drinking, and even had some exercises prescribed with an explanation sheet for doing so to assist in strengthening her ability to use her swallow "muscles" better.

That was all it was.  It did not take long at all, and as said, nothing was invasive and my LO who was usually a highly irritable and at times agitated person, did great with no issues.  Most of the time following directions were problematic at home, but she had no problem with the test and did just fine.  All she needed to do was eat a bit of this and that which seemed to not be a problem for her to do which surprised me.

So hope all will be well.  If this is a recurring problem, it is best to get it addressed asap to avoid preventable problem issues which I am sure you would be doing anyway; you are always on top of things.

J.

Lills

My DH had a swallowing test about 4 years ago.  As has already been noted here, it was painless; in fact, my DH found it very enjoyable!  I was in the room, but not in sight.  The therapist put different foods out on a plate and explained to him what she was going to do.  (He has FTD and ALS) so the words went right over his head.  She handed him a cookie.  He ate it in one gulp.  She laughed and needed to keep giving him more because he was eating too fast.  I think he ate 3 cupcakes, cookies, crackers, juice, etc. during that session!  He was thrilled

He passed the test with flying colors!

jfkoc

I had a swallow  test some years ago. It was easy but then I did not have any health issues.

Getting there, understanding etc. Could be difficult.

Is the problem with all foods including something like applesauce  or is it with things like meat.? If meat things it could be a chewing problem.

Ed1937

Thanks so much for the replies. Now I have a good idea about the testing. I'm not sure what kinds of foods is causing the problem. I'll have to watch more closely.

nancyj194

My DH has swallow issues. He also had the test mentioned above with me in the room and it went well.  

We followed up with an endoscopy. There was some narrowing of the esophagus, so the doctor stretched the esophagus, which did help.  The doctor also suggested my husband drink water as he ate to help wash the food down. It worked so very well, but now DH refuses to drink any water during the meal.  I don't say anything unless he starts coughing and hacking.  Then he will have a drink to help the food go down. That does not happen often. 

There are so many good suggestions on here with starting with a swallow test. 

Pam BH

Ed, my DH and your DW have a lot of similar problems including getting choked.  DH's started with a stroke several years ago and happened sporadically. After VaD/AZ diagnosis it's increased significantly where it occurs now with every meal, sometimes requiring me to do the Heimlich. Type of food or drink doesn't seem to matter in his case. He also chokes on his own saliva when not eating. He's had numerous swallow tests and endoscopies with no findings. He's receiving Home Health visits now for leg weakness and supposed to have a speech therapist come also for the swallowing/choking problem. Thickeners haven't helped in his case. Would love to know how to prevent it.  On a different subject, I think your wife asks where your dog that passed away is and I was wondering how you handle answering her.

Ed1937

Thanks again for the replies.

Pam, she always thinks we have more than one dog. Sometimes two dogs and a cat, or maybe three dogs. I just tell her we only have one dog because if I tell her something other than that, she'll want to see the other one(s). This happens almost every single day. Other family members tell her the same thing. She'll tell us we're wrong. She knows better.

Pam BH

Thanks, Ed.  I have the same response when DH asks where the female dog is. I just tell him we have one dog, Moose, and he's enough.  He just shakes his head like he can't believe I don't realize we have another dog but doesn't say anything.  I wish you the best of luck with the choking issue.

Ed1937

Thank you!