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Many Parkinson's disease patients come to struggle to swallow as their condition progresses, something known as dysphagia. What can you do to make it easier?

When you're first diagnosed with Parkinson's disease you'll know that muscle rigidity comes with the territory. The fact that it also often impacts your esophagus, pharynx, palate, and tongue — all the parts you need to eat and swallow — may come as a surprise, however. As Parkinson's progresses, many patients start suffering from dysphagia, a medical term for difficulty swallowing. This can make it hard to ingest solid foods, but also medication, water and other drinks, and even your own spit. A symptom that can severely impact your quality of life, dysphagia can easily induce panic, anxiety, and even depression.

Just like the other symptoms of Parkinson's disease, dysphagia slowly creeps in over time — it starts with subtle things you may miss at first, like coughing while eating or a slight pain in your throat as you try to swallow. Over time, however, it can develop into choking, being unable to swallow your medication, and drooling. When left untreated, dysphagia can easily lead to malnutrition and dehydration as swallowing becomes so hard you'd rather avoid it, as well as cause chest infections and even asphyxiation. 

What do you need to know about dysphagia, and how can you make life easier if you suffer from it?

1. Learn what to look out for — and seek help on time

Recognizing the warning signs of dysphagia early on means that you have time to seek medical help for the problem before it gets really bad. The relatives and loved ones of a person with Parkinson's can also keep an eye out, as they may recognize the symptoms before the patient does. 

You may have dysphagia if:

  • You find yourself coughing while eating or drinking
  • You've noticed that swallowing has become painful or you have a kind of pressure in your chest while eating
  • You have a "gurgly" voice
  • You've noticed that it's harder and harder to swallow your meds
  • You choke on food, drinks, or your saliva quite frequently
  • You're drooling because it's hard to swallow your saliva
  • You're experiencing spontaneous weight loss
  • Food "sticks" in the throat or on the palate
  • Heartburn is becoming a more frequent occurrence
  • You often have a sore throat

2. Talk to your doctor!

Once you've recognized the problem, it's time to talk to your neurologist. They'll be able to refer you to a speech-language pathologist, who will be able to evaluate your condition and make things slightly easier for you. A gastrointestinal specialist may also get involved, as many people who have dysphagia suffer from reflux.

As they assess you, your speech-language pathologist may order the following tests:

  • Videofluoroscopy (a kind of X-ray) — you'll be asked to eat and drink something during this exam so your doctor can get a good look at the mechanisms that are preventing you from swallowing well. 
  • Fibreoptic endoscopic examination of swallowing (FEES) with a camera — a tube is inserted to see how you swallow.

These exams will help your medical team understand exactly what's going wrong, so they can recommend exercises and other treatments to make it easier for you to swallow.

3. Exercises to help you swallow

Just like physical and occupational therapists can help you with motor symptoms of Parkinson's like gait problems, stiffness, and balance, a speech-language pathologist can do exercises with you that will help you swallow more easily. They are likely to use the Lee Silverman Voice Technique, which has been backed up by research as a way to improve dysphagia in people with Parkinson's. 

4. Expiratory Muscle Strength Training (EMST)

Expiratory Muscle Strength Training (EMST) is a therapy during which you breathe into a valve to help strengthen the muscles that help you speak, breathe, and swallow. The therapy can help Parkinson's patients who struggle with speech, as well as those who find chewing and swallowing difficult. 

5. Dietary changes

Many patients benefit from moister, softer foods, or smaller chunks, which may be easier to swallow. Soups, eggs, oatmeal, bananas, and rice are some examples of foods that may go down more easily, while you want to avoid tough chewy things like steak or dry crackers. Some patients have the opposite problem — when the aspiration of liquids is the issue, these can be thickened. Your doctor will be able to advise you on dietary changes that will help in your specific situation. 

6. Change your meal schedule

Many Parkinson's patients find that their symptoms are at their least invasive shortly after taking their medication, especially levodopa. If this is the case for you, you'll want to eat soon after you have taken your meds to minimize the swallowing difficulties you encounter. 

7. Change your posture while eating

Your posture can make it easier or harder to swallow, and to make sure that yours doesn't get in the way of eating, try:

  • To sit straight — pay attention to your spine. If this is hard to achieve on your own, pillows or a comfortable chair can help you.
  • To bend your head forward a little bit. 
  • To let your meal "sink  in" by staying seated for about 15 minutes after you're done eating.

8. Conscious eating

Mindful, conscious eating, in which you may attention to your every move without too many distractions, can help you swallow more easily. If relevant, cut your food into small, easy to swallow, pieces beforehand. Chew well and slowly, and don't talk while you're eating. Don't put too much food into your mouth at any one time, and be patient — it make take a few goes to swallow everything that was in your mouth. Should food get stuck in your throat, cough and clear your throat before you try to swallow again. 

9. A little help from your specialized equipment

Specialized adaptive cups and utensils can make life easier — and your speech-language pathologist will be ale to tell you all about them. Examples of equipment that may benefit patients with dysphagia include:

  • Straws
  • Cups
  • Cutlery
  • Plate guards

These aren't garden-variety items — they're specially designed to help you swallow more easily and to prevent you from choking.

10. Feeding tubes

For Parkinson's patients with severe dysphagia, a feeding tube may be the right answer. A feeding tube may seem like a big step, but it may allow you to have a better quality of life in which you no longer have to struggle during mealtime in a bid to get the nutrition you need. You can still eat for enjoyment and taste, but don't rely on it to meet all your nutritional needs anymore, and neither will you need to worry about dehydration. Some Parkinson's patients use a feeding tube only while their medication kicks in. Keep in mind that some forms of levodopa can also be administered through a feeding tube, which helps ensure you get the treatment you need without having to swallow it. 

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