A Medical Look at Disphagia
By Valeri Thelen, Staff Writer

 

The Agency for Health Care Policy and Research estimates that more than 60,000 Americans die from complications associated with swallowing difficulties each yearómore than liver and kidney disease, as well as HIV/ AIDS combined.

Swallowing difficulties are a serious problem for many loved ones and a stress factor for caregivers nationwide. There are four main families of dysphagia, which have many of the same symptoms, but different causes and treatments.
First, preparatory dysphagia is the actual loss of smell or taste sensation and saliva. It also includes weak chewing muscles as well as painful gums and cheeks.
Second, oral dysphagia is caused when part of the tongue is missing and there is then impaired tongue control and sensory loss.

Esophageal dysphagia is the sensation of food sticking in the base of a loved oneís throat or chest. There are quite a few causes of this dysphagia, ranging from narrowing or weakening of the esophagus muscles to food or other objects causing obstruction.

Oropharyngeal dysphagia relates to nerves and weakened throat muscles, making it difficult to move food from the mouth to the throat and esophagus. This is mainly caused by neurological disorders or cancer, causing choking, gagging or coughing when a loved one attempts to swallow.

Regardless of the type, dysphagia can be debilitating to a loved oneís daily life, but is also treatable. Each diagnosis and treatment is as unique as the person suffering from the swallowing disorder.

SYMPTOMS

The signs and symptoms that a caregiver should be aware of if suspecting dysphagia include:

  • Pain while swallowing
  • Inability to swallow
  • Sensation of food getting stuck in the throat or chest, or behind breastbone
  • Increased drooling
  • Hoarseness
  • Bringing food back up (regurgitation)
  • Frequent heartburn
  • Food or stomach acid backing up into a loved oneís throat
  • Unexpected weight loss
  • Coughing or gagging when swallowing

Itís important to seek immediate help if obstructions are interfering with breathing or swallowing. If occasional swallowing difficulty becomes ongoing, or is accompanied by weight loss, regurgitation or vomiting, a caregiver should seek medical treatment for a loved one.

If left untreated, dysphagia can lead to serious issues such as malnutrition, dehydration and respiratory problems. When preparing for the initial doctorís appointment to discuss swallowing issues, a caregiver can help make the most of the short time with the professional by preparing information.

First, make sure that there are no pre-appointment conditions such as diet restrictions, then prepare a list of a loved oneís symptoms (including their severity and frequency), as well as lists of current medications and questions for the practitioner.

Some things to discuss with a health care provider are cause, treatments, longevity of issue, side effects from treatment, alternatives, existing health conditions, resources, etc.

THERAPIES

Swallowing disorders affect each person differently and a specialist will look at those particulars to come up with a specific treatment plan. Itís not a ďone size fits allĒ way of addressing the issue, and a loved oneís plan will be tailored to their needs.

The goals of treatment, however, are standard:

  • To be at a place where swallowing is done as safely as possible, and minimizes the risk of choking or aspiration, and
  • Ensure the correct amount of nutrition and hydration is able to be provided for a loved one.

An important thing for a caregiver to realize is that treatment for dysphagia involves a loved oneís family and other support systems. Swallowing can be improved by addressing the overall condition, including strength, stamina, motivation and emotional state.

First, a loved one and caregiver will need to understand what is wrong with the swallowing. A basic understanding will help them connect with the therapies the specialist recommends.

For oropharyngeal dysphagia, a speech or swallowing therapist may be recommended by the doctor. Common therapy includes exercise and learning swallowing techniques.

With a diagnosis of esophageal dysphagia, treatment may be more aggressive, including esophageal dilation, surgery or medications.

If a medical professional recommends medications, professionals suggest a loved one help a person sit upright, stay calm and take one pill at a time during administration. Use plenty of liquid and applesauce to help with the swallowing of pills. They should be taken early in the day, and a loved one remains upright for 30 minutes after swallowing.

Treatment for a swallowing disorder most likely will include a diet modification. A caregiver should make sure their loved one is avoiding foods that may have caused problems in the past, such as tough meats, crusty breads, raw vegetables, whole nuts, some fruits, and sticky foods like peanut butter or frosted treats.

Another thing to monitor is food with mixed consistency, meaning both liquid and solid elements. An example is cereal with milk. The milk can get to the throat sooner and cause swallowing issues. Mushy cereal may be a good fix.

Salad is another big no-no for those with swallowing concerns. Lettuce is very difficult to make manageable. The dressing is the other concern, as with the milk and cereal scenario. It can get to the throat sooner and be swallowed before the person is ready.

Fruit is many times a mixed consistency food, with skin and juices blending, as may be ice cream and gelatins that start out as solids and melt to a thin liquid in the mouth.

While lifestyle changes are likely, many people with swallowing issues find ways to manage the concern and live full, social lives. A caregiver can help with the embarrassment factor, especially in public settings, by planning ahead, whether itís calling the restaurant or talking to the party host.

ONGOING TREATMENT & EVALUATION

Even if treatment is going well, caregivers must not let themselves or a loved one feel that the dysphagia has been completely overcome and get comfortable. Itís still a very dangerous, life-threatening condition if not monitored properly and regularly.

Here are some tips for living with chronic dysphagia:

  • Watch for respiratory difficulties such as coughing, rapid breathing, wheezing, chest pain or changes in voice.
  • Continue with the therapist-approved swallowing exercises that involve breathing, coughing and chewing.
  • Continue to work on overall fitness, muscle strength, balance and posture.
  • Keep the mind and body active with reading, games and word puzzles, etc.
  • At bedtime, keep a loved oneís head elevated to 30 degrees to minimize aspiration and reflux.

Part of a caregiverís challenge is to help a loved one find support. A counselor, therapist and even support group can help those involved find encouragement, support, and even information on the latest treatments.

Prevention of dysphagia is not usually possible. While some of the symptoms cannot completely be erased, especially if neurological, early detection and treatment can help minimize the lasting effects. Eating and chewing slowly is an important technique for those already diagnosed, and a lesson in patience for loved ones, albeit a lesson well worth the time.

Treatment of swallowing problems is ongoing, and a caregiver and loved one must understand that the initial plan is likely not the final one. The swallowing specialist will cater the treatment to a personís progress and also changes in health if necessary. A caregiver must always keep a health care provider in the loop of a loved oneís advance directives, and changes in condition, in case the treatment is no longer necessary or pertinent.

 

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