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Aspirating water when swallowing and then wheezing


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#1 coacht

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Posted 25 June 2013 - 02:47 PM

Hello,
My DW has had two instances where she has aspirated water when drinking. She has laryngeal spasms and wheezes. The first time my daughter said she was choking and she could say it was water and I had her try to slow down her breathing, "breath in through the nose and slowly out the mouth. It worked and did the same thing the second time. She just utterly panics and can't do it on her own. What suggestions do you have? I said she needs to say something to the neurologist.

#2 Dr. Mahler

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Posted 26 June 2013 - 08:46 AM

Dear Coacht,
Thank you for writing with this very important question about swallowing. Swallowing problems can potentially be linked to health risks such as malnutrition and dehydration, not being able to take medications, and having food or liquid go down the wrong way that can lead to pneumonia. So the situation you describe with aspirating water that triggers laryngeal spasms needs to be addressed as soon as possible.

There are a number of reasons why swallowing can be "difficult" for a person with PD so an evaluation with a speech-language pathologist (SLP) is essential to determine the specific causes for a given individual. The evaluation usually consists of an examination of the muscles for chewing and swallowing and then possibly a modified barium swallow study if the SLP suspects a problem in the pharyngeal stage of the swallow which is more difficult to observe directly than the oral phase. When the evaluation is done the SLP should be able to describe the swallowing problems, the underlying physiology causing the problems, the risk for aspiration, and treatment strategies that appropriately address the cause of the problems. How do you know that aspiration is occuring?? Have the person already had a swallowing evaluation. If the evaluation was some time ago it may be time for a re-evaluation.

I completely agree that you should consult with your physician and seek an evaluation with an SLP who has expretise in PD. Although people with PD share a common etiology there may still be heterogeneity within the population regarding the cause of swallow problems. Appropriate treatment techniques to address swallowing disorders in PD need to address the motor and sensory components. Common treatment approaches for swallowing deficits in PD include:
  • Modifying bolus flow with postures
  • Maneuvers to improve airway protection or airway clearance
  • Alterations in diet consistency
  • Sensory stimulation
  • Swallowing exercises
  • Alterations in feeding environment
The evaluation will determine which strategy is appropriate for your family member.

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

Associate Professor

University of Rhode Island

#3 coacht

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Posted 27 June 2013 - 08:48 AM

Thank you,

I have noticed changes in her swallowing, but she doesn't except when this happened. She is 48, so we will see where this goes. Thank you for the quick reply.
Coach T

#4 Dr. Mahler

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Posted 27 June 2013 - 09:35 AM

Coach T,
The sooner she starts a swallow exercise program and using safe swallow strategies, the greater the potential benefit. Particularly for someone so young. Stay in touch about how it goes.

Sincerely,

Leslie Mahler
Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island

#5 Beachdog

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Posted 07 July 2013 - 08:19 AM

Timely advice! (for me at least and I suspect many others). Thanks.




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