July 16, 2014

"Difficulty Swallowing Can Be Fatal For People with Parkinson's"

Yesterday, I discovered that -- for people like me with Parkinson's -- swallowing difficulties can be fatal. I immediately searched for more information and found a good source on the National Parkinson's Foundation (NPF) website.

Difficulty swallowing, chewing, speaking and pushing food through the digestive system can all result from Parkinson's, since these functions depend on muscles that may be weakened due to changes in the brain.

Many people with Parkinson’s (PWPs) -- especially those in the later stages of the disease -- experience difficulty swallowing, or "dysphagia." The condition compromises quality of life, and cause life-threatening complications like aspiration pneumonia, malnutrition, and dehydration, according to Leslie Mahler, Ph.D., an assistant professor in the Department of Communicative Disorders at the University of Rhode Island. “The complication to be most concerned about is whether food is going down the right way,” she said.

According to the National Institutes of Health, the leading cause of death for PWPs is aspiration pneumonia, which occurs when food or liquids end up in the lungs -- not the stomach. That misdirection can inflame or infect the lungs and the passageways leading to them. PWPs are also at risk for asphyxiation and choking to death.

It is important to know the warning signs of a swallowing disorder, because some people may appear to be eating and drinking normally, but they are not, said Dr. Mahler. Early intervention and proper management of swallowing abnormalities are key to preventing major complications, she said.

Drooling and Coughing
One warning sign of dysphagia is drooling. The normal swallowing pattern slows, and -- as a consequence -- PWPs tend to drool as saliva accummulates in the mouth. The drooling is embarrassing and can cause a buildup of phlegm in the throat.

Anticholinergic drugs -- which inhibit the action of the neurostransmitter acetylcholine and are typically used to treat chronic obstructive pulmonary disease (COPD) -- can reduce drooling by restricting saliva production. But research shows these medications cause dry mouth and can have serious side effects like memory impairment, constipation, confusion and hallucinations... especially in the elderly. 

Researchers also found that severe drooling can be treated with botulinum toxin (Botox) injections into the salivary glands, but that effect lasts only a few months. I haven't experienced the drooling (as far as I know). But I've recently been hacking up phlegm.

Coughing or choking during or after meals indicates that food is either stuck in the throat or has gone down the trachea -- windpipe -- into the lungs instead of the esophagus.

Doctors think coughing is a good sign, because it's a reflex that occurs when food goes down the wrong way or is trapped in the throat. Coughing helps keep airways clear, and prevents food from going into the lungs. However, sometimes food enters the windpipe without any sign of coughing or choking, causing silent aspiration.

So... perhaps my coughing up phlegm, not drooling, is a good sign, says John, the eternal optimist.

More Red Flags for Dysphagia
The NPF identifies other warning signs of dysphagia: 
  • gurgly voice
  • sensation that something is stuck in the throat
  • difficulty keeping food or liquid in the mouth
  • difficulty swallowing medication
  • unintended weight loss
  • chest discomfort
  • heartburn
  • sore throat
  • slowness in eating
In severe cases, patients may need a feeding tube to maintain hydration and nutrition. “It is possible for someone to eat and drink what they can and get the rest through tube feedings,” said Dr. Mahler.

Mahler advises people who think they have a swallowing problem to see a speech-language pathologist with experience treating PWPs. “People with Parkinson’s who have difficulty swallowing often have voice problems, because speech and swallowing share common anatomy,” she said. “It has been estimated that as many as 89 percent of people with PD have a speech disorder that can impact their quality of life."

According to Mahler, speech therapy can help people improve swallowing and increase vocal loudness by teaching them muscle strengthening exercises. An intensive speech exercise program -- the Lee Silverman Voice Treatment (LSVT LOUD) -- has proven effective in treating PWPs with speech problems, she said. At least one study has shown its effectiveness in improving swallowing.

A Few Well-Timed Obscenities
I've been doing my own version of LVST LOUD by shouting out the counts while doing the LSVT BIG exercises. I also belt out obscenities at my computer when it acts up... and "good job!" to myself. :-)

But it's clearly time for me to seek professional help. 

A newer therapy -- Expiratory Muscle Strength Training -- can improve swallowing. Developed by experts at the University of Florida Center for Movement Disorders and Neurorestoration, it teaches patients how to strengthen the muscles involved in swallowing and breathing.

The NPF and Parkinson Disease Foundation also recommend these tips to help alleviate swallowing and drooling problems:
  • Take frequent sips of water or suck on ice chips during the day and before meals to help increase swallowing and to thin phlegm.
  • Reduce sugar intake, because sugar increases saliva.
  • Suck on sugarless candy or chew sugarless gum for temporary relief from drooling.
  • Take smaller bites of food, chew food thoroughly, and eat slowly.
  • Sit upright for at least 15 minutes after eating.
  • Take small sips of water or beverage when eating.
  • Sit upright with head slightly forward when eating, drinking, and taking pills. Tilting head backwards can increase the risk of food or liquids going into the lungs.
  • If a glass is half empty, refill it. 
  • Maintain an upright posture and keep chin up, because a flexed neck or stooped posture exacerbates drooling.
  • Rinse mouth after meals.
  • Eat softer foods, pureed if necessary. 
  • Drink tea with lemon or carbonated beverages to help thin phlegm. 
  • Avoid dairy products, which can make phlegm worse. 
  • Drink thicker liquids, as they may be easier to swallow because they do not go down as fast.
  • Moisten dry foods to make them easier to swallow.
  • Sleep with head raised up to prevent choking.

1 comment:

emergency button for elderly said...

Thanks for helping me better understand this disease. I think this disease affects more Americans than I realized. I think giving good senior care to these people is the most important thing we can do for them.

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