Why should I care about dysphagia?

“Hello, my name is Michelle and I’m from speech therapy. I’ve come to check your…”

“Speech therapy? I talk just fine. I don’t need you, I need to walk!”

“You do talk great! I’m here to check to see how you are swallowing. The doctor told me you are having some trouble.”

“I’m not having any trouble with that.  I can’t walk!”

“So you’re not coughing a lot when you try to eat or drink?”

“Well, only because I feel a little tickle in my throat when I swallow, but that doesn’t mean I’m having trouble.”

When I worked in skilled nursing, this was how the conversation usually went. And in the beginning of my career, I wondered why I had to sell my services so hard. I quickly realized after talking to patients, families, nurses, and even some doctors, that most people don’t know what “having trouble swallowing” means.

Trouble, or difficulty, swallowing is called “dysphagia.” Many elderly experience dysphagia for a variety of reasons, yet most people do not know or understand the monetary and quality of life implications it has. Yes, walking is important, but you can live with out being able to walk. When you have dysphagia, your risk for death increases exponentially, and that’s why more people need to know and understand it.

First let’s talk about the symptoms.  The first question, I usually ask is:  “Do you get choked or strangled when you eat or drink?”  That’s the non-technical term for aspiration.  Frequent coughing when you eat or drink is probably the most obvious sign of dysphagia.  We all “choke on our own spit;” I do it most often when I try to chew gum and talk to someone.  It’s when it happens regularly or consistently with a specific type of food or drink that it is a cause for concern.  Other signs may include, but are not limited to:  wet/gurgly voice when eating (frog stuck in your throat), feelings of food stuck in your throat, feeling of food stuck or fullness in your chest, feeling a tickle in your throat when you swallow, drooling, food falling from your mouth when trying to chew, holding food in your cheeks, recurrent pneumonia or upper respiratory infections, difficulty finishing your meals because you’re too short of breath, significant, unexpected weight loss, and/or loss of appetite.  

Next, let’s discuss the quality of life issues.  First off, having recurring pneumonia, is not a fun way to spend time; it’s hard to breathe, you feel tired all the time, and you just want to lie around in the bed.  That is not what us humans are meant to do with our lives!  For many elderly folks, pneumonia can lead to death. 

Then there’s the weight loss, which means your body isn’t getting enough nutrition.  Even though you may not feel hungry, your body requires a certain amount of food & liquid consumption each day to keep functioning.  The more weight you lose, the less energy you have, the less you do, the less you feel hungry, the sicker you get, the worse you feel, the more weight you lose.  It’s truly a negative cycle.

And then, there’s the dreaded altered-diets & thickened liquids that people get put on.  I’ll go into this more later, but I can tell you,  the vast majority of people I’ve talked to, would rather dehydrate than have to drink thickened liquids or starve to death before they’ll eat only pureed foods.  Meal time is such an important part of our social routine, to not be able to eat at all, or even to not be able to eat the same food as your family, is devastating for some people.  (*Just remember, altered diets and thickened liquids ARE NOT suppose to be a long term solution; more on that in a few paragraphs!)

And the monetary implications of dysphagia are nothing to take lightly.  According to “Impact of oropharyngeal dysphagia on
healthcare cost and length of stay in hospital: a systematic review ” by Stacie Attrill et. al., published in the BMC Health Services Research in 2018, a person with oropharyngeal dysphagia will stay in the hospital between 2-8 days longer, regardless of their initial admission diagnosis, than a person without dysphagia.  Additionally, persons diagnosed with “oropharyngeal dysphagia incurred 40.36% greater costs than those without dysphagia.”  The article goes on to say, “The finding that presence of oropharyngeal dysphagia resulted in increased expenditure regardless of diagnosis highlights the often under-recognized magnitude of this patient-related factor on healthcare systems and resources.” (Attrill, et. al., 2018) 

All of those quotes to show, regardless of any other underlying diagnosis, the diagnosis of oropharyngeal dysphagia increases the length of stay in hospitals, by an average of 4 days, increases the cost of the stay by 40%, and causes serious quality of life issues. (Attrill, et. al., 2018)

I don’t want that for you or anyone!

A speech language pathologist (SLP) has special knowledge of the anatomy and physiology of your mouth and throat.  Humans use those structures and muscles for speaking AND SWALLOWING!  Therefore, your local SLP, specializing in dysphagia, (in other words, ME!) can help you if you are experiencing any of the symptoms of dysphagia.  This is how:

1- Use an instrumental evaluation, so I can actually see the specific swallow deficits.  Any evaluation that does not use instrumentation is a guess;  a well educated guess, but still a guess.  There is an abundance of literature, from SLP research, that shows evidence that without an instrumental evaluation, SLP’s often over diagnose aspiration events and put patients on altered diets when they really didn’t need it.  OR we miss aspiration all together and don’t provide enough treatment.  Your instrumental evaluation will also show the exact deficits, which provides the information needed for an efficient, individualized therapy plan.

2-  That individualized treatment plan is driven from the information gathered from the interview, medical history, and the instrumental evaluation. It is patient specific.  Remember, every BODY is different, every BRAIN is different, and every NERVE network is different.

Sometimes the issue is strength and I provide exercises that target specific muscles to improve your swallow.  Sometimes the issue is timing, and I provide you with specific strategies to alter the timing of the swallow, so that it lessens the risk of aspiration.  Sometimes a swallow can be altered by medication, and so I may need to talk to your doctor about the medication you are taking. Sometimes, I may have to change your diet WHILE we work on improving your swallow function. The plan is to temporarily change the diet to make you safe while you are working hard, so we can get you back to eating what you want to eat. Thickened liquids and altered diets are not meant to be long term prescriptions for dysphagia!!  That is not how I treat dysphagia in my practice.

Sometimes, however, when a disease process is involved, particularly a degenerative disease, like COPD, Alzheimer’s, Parkinson’s, or Multiple Sclerosis, the therapy plan becomes more compensatory, rather than restorative. Which means altered diets and thickened liquids may be the only choice to reduce risk of pneumonia and all the other bad things associated with dysphagia.  However, I will try every treatment technique and strategy for you before I recommend a permanent diet or liquid change.

When you come to me for help, you can rest assured that I will gather all the information about you & your swallowing abilities, so that I can begin addressing your specific needs. I want you to get better and I’ll work as quickly or slowly as you need.  I am here to serve you!

If you have any topic suggestions or burning questions related to speech therapy, please feel free to comment below or email me: Michelle@resurgenceneurorehab.com