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Bloody drool & swallowing issue


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#1 Pennypims

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Posted 14 July 2011 - 10:45 AM

Hello,

I have Multiple systems atrophy and recently started having trouble swallowing pills. One night, after a real battle with the meds I woke up with blood stains on my pillow. My PD doctor ordered a barium swallow, which showed thin liquids slipping into my esophagus. The Speech & swallow doc said "My God, you are only 46. I just can't see thickening your fluids"
I have an appointment at Hopkins with my PD+ doctor next week and will do as he instructs me. In the meantime, I don't want to wind up with Pneumonia.

Any advice?

Penny

#2 Dr. Mahler

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Posted 14 July 2011 - 02:25 PM

Penny,

I am so sorry to hear of your difficulty swallowing pills. It sounds like you had a terrible night that preceded waking up with blood stains on your pillow. Safe swallowing is a critical issue. It is good that you went to your doctor about this and had a modified barium swallow study. If the "speech and swallow doc" was a speech-language pathologist then I hope they said much more to you than just the reply you quoted. The purpose of a modified barium swallow is to identify treatment strategies as well as determining whether liquids and food go down the wrong way into the esophagus.

Swallowing is very complex. It is not possible for me to make specific recommendations about what you need to do to have a safe and efficient swallow for maintaining hydration and nutrition without getting pneumonia without seeing you in person.

My advice is to get more information from the speech-language pathologist about your modified barium swallow study results. Request a copy of the written report. There may be more information available in the report than you remember from what the person told you at the end of the study. You could also contact them directly and ask the following based on what they saw in the modified barium swallow study:

Are there any postures that are appropriate for you to use to minimize the risk of aspiration?
Sometimes a posture such as putting your chin down to drink liquids can help reduce the risk of aspiration (swallowing liquids into the esophagus)
Is there an exercise program that is recommended to improve swallow function?
Joanne Robbins and her team at the U of Wisconsin have published about tongue strengthening exercises and there is an article by ElSharkawi et al., providing preliminary evidence of a benefit to swallowing after completing LSVT LOUD

People with a diagnosis of multiple system atrophy typically experience speech and swallowing issues sooner than those diagnosed with idiopathic Parkinson disease so I hope you will follow up on this quickly. You could try taking your pills with a pudding consistency instead of water to see if that might help. For example, you could put the pills in applesauce or yogurt. It is possible you might need to thicken your liquids to have a safe swallow. You need more information than I can give you in the Forum from someone who has examined you directly.

Keep in close contact with your doctor about this and definitely follow up. You are right to be concerned about pneumonia.

Sincerely,

Leslie Mahler, PhD, CCC-SLP
Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island




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