Dysphagia is a broad term for a collection of about 100 conditions that result in difficulty swallowing. The causes of dysphagia range from vitamin B-12 deficiency to neurological disorders to autoimmune disease to stroke to side effects of prescription medication and surgery. Problems with swallowing can also stem from gastroesophageal reflux disease (GERD) and yeast infections.
Signs that the problem is located in the throat (pharynx) include:
- Changes in food preferences.
- Changes in speech or voice (wet voice).
- Coughing or choking with swallowing.
- Difficulty initiating a swallow, without trouble with the second swallow.
- Food sticking to the lining of the throat.
- Nasal regurgitation.
- Repeated bouts of pneumonia.
- Sialorrhea (excessive saliva production).
- Unexplained weight loss.
Signs that the problem is in the esophagus include:
- Symptoms of gastroesophageal reflux disease, such as burning in the throat, hoarseness, and heartburn, and
- Sensation of food sticking in the chest.
Dysphagia is also a complication of many other diseases, including:
- Nephropathic cystinosis.
- Neuromuscular disease.
- Recent injection of Botox (which is sometimes used to treat spasms of the throat).
- Recent stroke.
- Thyroid disease.
- Traumatic brain injury (TBI).
The medical treatment of dysphagia is complicated, but there are common-sense, holistic interventions that work in nearly all cases, including changes in eating habits. At least at first, it's helpful to eat soft or pureed foods. Small bites are key, and it helps to take a sip of water between each bite of food. Liquids can be as problematic as solids; if there's a problem with water or thin, runny liquids, use a thickener to make the liquid easier to swallow. Typically, nutritionists will recommend a progressive scale of food choices something like this:
- Thin liquids, for example, fruit juice, coffee, and/or tea.
- Nectar-thick liquids, for example, cream soup, and/or tomato juice.
- Honey-thick liquids, that is, liquids that are thickened to a honey-like consistency.
- Pudding-thick liquids/foods, including, of course, puddings, and mashed bananas and cooked cereals.
- Mechanically softened foods such as casseroles and meat loaf.
- Chewy foods, such as bagels and pizza.
- Foods that fall apart, such as rice and muffins.
- Finally, mixed textures.
Master one level of texture before you proceed to the next. If you are bothered by symptoms, then go back to the level that works best for you. It's extremely important to avoid malnutrition, because if you get food into your lungs and develop aspiration pneumonia, then you need all the reserves you can to find the disease.
Hydration, getting enough water, is just as important as nutrition. It's easy to become dehydrated without even noticing. Dry skin, skin that you can pinch, dry mouth and nasal passages, and a generally gray color are warning signs that more water is needed.
When the underlying problem is autoimmune, often there is reduced salivation. That's when oral care becomes especially important. Lemon-flavored glycerin swabs can keep the lips, tongue, and mouth moist so they don't crack and form entry ways for bacterial infection. It's even more important than usual to brush the teeth after meals. Keeping the mouth moist can even reduce the risk of pneumonia by reducing the number of bacteria in the mouth.
Exercises can help with the tone of the muscles surrounding the throat and make swallowing easier. Simply lying down and lifting your head up off the pillow so you can see your toes, or at least your stomach, and holding it position for a few seconds several times a day can improve your ability to swallow. Any of the exercises in Carole Maggio's Facercise can help you not only look better but swallow food and drink more easily.
Your doctor may be able to show you how to do deep pharyngeal neuromuscular stimulation (DPNS) with flavored mouth swabs that stimulate pleasure (with a sweet taste) or aversion (with a bitter taste) and improve muscle tone in the process. You can also learn how to do tactile-thermal stimulation (TTS) with a cold probe to contract muscles in your face that help you control swallowing and gag reflexes.
Some people get better results when they eat or drink with their chin down, or if they tilt their heads to one side, or if they do a superglottic swallow, which requires holding your breath while swallowing. Your doctor should be able to show you how to do any of these exercises that can make swallowing a lot easier.
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