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Treatment for Difficulty Swallowing

difficulty swallowing thickeners dysphasia

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#1 daddysgirl

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Posted 05 September 2013 - 01:28 AM

Hi, my 89-year-old father has Parkinson's disease. Two of my main concerns right now are that his blood pressure keeps dropping after meals, and he is drooling excessively due to the build-up of saliva in his mouth. Based on my research, I know that his excess saliva is due to a decrease in his ability to swallow. Currently, we are using a host of non-medical strategies to reduce his drooling and stimulate swallowing such as having him suck on sugarless candy and drink frequent sips of water throughout the day, and making sure he eats with his head tilted forward. We also use a suction machine to help him get rid of excess saliva, but clearly something more needs to be done to prevent aspiration, because he currently has pneumonia for the second time in two months. Unfortunately, Botox is not an option, because we live on a small island and the ENT here has never used Botox for this purpose. Additionally, there are only two speech therapists on island and neither of them has experience working with Parkinson's patients. His doctor prescribed glycopyrrolate to help dry out his mouth, but we agreed that this medication should be a last resort due to the side effects. I just told my mom to start thickening his liquids with Thick-It, but I am concerned that using a thickener will affect the absorbency of his medications, what do you think? He is currently on Sinemet, Aricept and Clonazepam. Also, should we thicken his water too? I read a NIH study which stated that using thickeners can affect the absorbency of certain medications, and they can lead to weight loss and dehydration, because thickened liquids can make someone feel full. My dad cannot afford to lose any more weight. I would appreciate any advice you can give me.

#2 Dr. Mahler

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Posted 09 September 2013 - 07:59 AM

Dear Concerned Daughter,
It sounds like your father is facing several challenges. I will address those that I can as a speech-language pathologist. For other concerns you should also consult with a physician. I cannot comment on blood pressure but I do have experience with drooling issues associated with PD. I agree with your impressions from the research that excessive salive is mostly attributable to decreased swallow ability. The primary strategy that I use for my patients with this problem is an intensive exercise based approach. Chin down posture helps some individuals but without seeing your father in person it is not possible to comment about whether it would help him. If your father has pneumonia for the second time in in two months then this is a serious issue. You should ask the neurologist prescribing the medications whether the thickening agent interferes with the absorbency of PD medications specifically. If liquids need to be thickened for safety of the swallow then ALL liquids need to be thickened. Water can be one of the most challenging consistencies because it can go "down the wrong way" before the person with PD begins to control the bolus. Even if the speech therapists on island don't know PD, they may know swallowing. It is important to have a swallowing evaluation that includes a modified barium swallow study to determine swallow safety and prevent your father from losing any more weight.

Sincerely,

Leslie
Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island

#3 daddysgirl

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Posted 09 September 2013 - 03:01 PM

Hi, thank you for responding to my inquiry. My dad is doing much better now. He was congested and coughing for two and a half weeks. His doctor gave him some antibiotics to ward off pneumonia early on, since he had pneumonia in July, but his x-ray and CT scan shows that he doesn't have pneumonia after all. He took his x-rays 13 days after treatment, so we may have caught it early. However, he is still drooling and spitting up a lot, and he has a lot of mucus in his throat which is obviously distressing him. He told me the excess saliva make him tired. I am going to take him to get a swallowing evaluation on Sept. 16, so I hope we can get some additional tips that would help him with that problem. If not, I will reluctantly do a trial of glycopyrrolate to see if that will help. I have also been giving him pineapple juice and papaya juice sometimes which does help, but they only offer temporary relief.

#4 daddysgirl

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Posted 24 September 2013 - 01:14 AM

Hi, I took my father to do the swallowing evaluation like you suggested, but unfortunately it was a waste of time.  She did not do a barium study. All she had him do was drink water and eat some apple sauce, and almost everything she told me contradicted everything I have ever read about how to treat dysphasia which was extremely disconcerting. She said that there was nothing we could do to prevent aspiration. She was not in favor of using thickeners, and she told us he should eat with his head up.  Now I am going to have a difficult time convincing my family why they should not listen to her.  I wanted to ask you one more question.  I bought a soft, cervical collar for my dad, because I read that this can help him keep his head up and help with his drooling and maybe even his breathing. Do you think the cervical collar will actually help him?



#5 Dr. Mahler

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Posted 03 October 2013 - 03:13 PM

I'm sorry you did not get the information you were seeking or that the results were not explained in a way that was understandable.  This might be a case where you need a second opinion from someone who works with people who have Parkinson disease regularly.  Without seeing your father in person, I cannot comment on the benefits of a cervical collar.  My experience is that patients need to do more to actively control the swallow to swallow safely.  The specific swallow recommendations that are appropriate for your father are as unique to each individual so I can't tell you what they should be without evaluating him myself.  While I can't give you specific swallowing recommendations, I can tell you that frequent oral care is essential.  This will cut down on the bacterial levels in the mouth and can reduce the risk of an infection developing if material is being aspirated.  Frequent means mornings, evenings, and before and after each meal.  Other general safe swallow strategies include:

-Sitting upright with the hips flexed at 90 degrees for all meals and when taking medications

-Remain sitting for 30-45 minutes after a meal to allow gravity to aid in digestion

-Eat more frequent smaller meals so as not to tax the swallowing muscles by eating after they are tired

-Swallow twice for each food or liquid presentation and swallow HARD/WITH EFFORT

 

I wish you the best in getting your questions answered.

 

Sincerely,

 

Leslie Mahler


Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island




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