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Swallowing problems


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#1 Beau's Mom

Beau's Mom

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Posted 29 May 2013 - 11:23 AM

I had my second swallow study yesterday after being reduced to pureed foods and crushing as many meds as could be crushed and taking them with applesauce. I was told that my difficulties are a combination of three things: slow esophageal motility, a weak tongue, and having, over time, changed how I place food in my mouth to make it easier to swallow. It was recommended that I literally suck my thumb periodically during the day to strengthen it and relearn how to push food to the back of my mouth. I was also told that throwing my head back to make swallowing easier is more likely to cause aspiration. Can you suggest any other exercises to relieve any of these symptoms? Thank you.

I am not a human being trying to have a spiritual experience; I am a spiritual being having a (sometimes difficult) human experience.

 

First symptoms: right-hand tremor, constipation and restless arms 1978 (age 25). Depression and anxiety (non-motor symptoms) began in 1989 and worsened through the years. Last inpatient episode June 2013.

Diagnosed December, 2010 by a regular neurologist (age 57). After negative reactions to Requip, Mirapex and selegiline began Sinemet 25/100 3x/day. First MDS visit in Houston in February of 2011 was inconclusive. Second MDS visit at Baylor Fort Worth in May/June 2011 diagnosis changed to Parkinsonism, Sinemet stopped. Third MDS visit in August 2011 in WA State: received a confirmed diagnosis of idiopathic PD which had started on the right side and had now crossed to the left side as well. Restarted on Sinemet 25/100 4x/day. A short trial of Amantadine caused audio hallucinations in September 2011.

 

Current medications at age 62: Sinemet 25/100 ODT every 2.5 hours while awake (7/day). One Sinemet 25/100 CR between midnight and 4 AM. Trazodone 200 mg at bedtime, Fluvoxamine 300 mg at bedtime. Clonazepam 0.5 mg morning and afternoon, 1 mg at bedtime. Vit D3 2x/day, Calcium Carbonate Susp. 5 cc daily, Baclofen 10 mg 3x/day, Flonase two sprays 2x/day, Calcitonin-Salmon nasal spray once daily (for osteoporosis). Gel eye drops as needed throughout the day, Restasis Eye drops 2x/day, Nighttime eye ointment at bedtime. 02 2L per nasal cannula while asleep. Walker, electric wheelchair, moist and soft or pureed foods and 115 caregiver hours/month keep me sane.

 

All of the above subject to change based on progression, stress level, and dyskinesia. Whew! I'm glad I finally wrote that all out.


#2 Dr. Mahler

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Posted 29 May 2013 - 06:34 PM

I'm glad that you had a swallow evaluation because it is important to understand the reasons for difficulty swallowing. Yes, I do have some suggestions for things that you might do to improve your situation. I am not familiar with thumb sucking technique to strengthen the tongue so can't comment on that. I am familiar with the work of JoAnne Robbins and her colleagues (2005; 2007) at the U of Wisconsin who have done considerable research investigating the benefits of tongue pressure resistance training; a workout for swallowing problems. Other researchers have also investigated tongue strengthening such as Cathy Lazarus and colleages (2003) and Youmans et al. (2009) so there is evidence that the method can be of benefit. The rationale behind using tongue-pressure resistance exercises is that the tongue is made up of muscle that can weaken with normal aging and that is made worse by PD. Robbins and her colleagues have demonstrated that healthy seniors can improve tongue strength with exercise. This is not a guarantee that these exercises can help improve your swallow but they may. The exercises are done with a device that measures pressure generated by the tongue. It is important that an accurate baseline strength be established and then it is recommended that patients exercise at 60-80% of their maximum capacity in an intensive manner to improve tongue strength that could result in a more efficient swallow. A speech-language pathologist (SLP) can help you with this. Talk to your movement disorders neurologist or ask at a PD support group for the names of SLPs who are experienced in treating people with PD. There is preliminary evidence that the intensive exercise of LSVT LOUD can also improve aspects of swallowing for people with PD.

I wish you the best.

Leslie Mahler
Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island

#3 Dr. Bassich

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Posted 30 May 2013 - 01:28 PM

Dear Beau's Mom, I agree with Dr. Mahler's advice but have a few other ideas.

It is hard for me to provide advice with such little information. But here are some thoughts. First, you mentioned that you were diagnosed with slow esophageal motility. I hope you are seeing a GI specialist, who can advise you about this problem. I like to think of this problem as “The clogged drain problem.” In other words, even if you have a strong tongue and can swallow efficiently, the food is getting backed up, much like a sink with a clogged drain.
There are some resistance exercises, that Dr. Mahler mentioned, that could possibly improve your tongue strength. But you must be under the care of a speech pathologist that specializes in swallowing. Your speech pathologist could design a program to hopefully improve tongue strength and to assist you to learn how to properly position your food after it’s chewed and avoid unsafe behaviors like kicking your head back while swallowing. There are various exercises such as “tongue push-ups” , effortful swallowing, and expiratory muscle strength training – but they must be taught and your performance should be monitored by a SLP.
Finally, try to eat your meals during the middle of your medication cycles versus at other times. This could possibly maximize your swallowing and you might find that at this time you have better oral control, particularly with your tongue.
I hope these ideas are helpful. Above all, I urge you to seek guidance from a GI specialist and a Speech Pathologist who specializes in swallowing problems.




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