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Beginning to spit up a lot

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My wife was diganosed with PD 4 months ago and a couple things seem to be advancing quickly. She is taking up to 10 tabs of Sinemet 25/100 a day.


The symptoms that concerns me most has been difficulty swallowing pills and thick saliva coming up. Sometimes after taking a pill with water the pill will come back up and often thick spital comes up and she has to spit it out. This seems to be increasing. Yesterday we went out to dinner. She did not eat much, it seems her appetite is decreasing, and towards the end of dinner she suddenly had this thick clear saliva coming up into her mouth and had to spit it out. No food or drink coming up. Just clear saliva. This continued for about 15 or 20 minutes. I've never seen it that bad. Generally she has no problem with meals. But almost always with taking pills. Even if taking with yogurt.


She returns to her SLP in a few weeks but I am very concerned by these symptoms. Any advice on what is happening is appreciated.

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Difficulty with swallowing is called "dysphagia" and it is really important that you wrote about this.  The reason it is important is because swallowing problems can potentially be linked to health risks such as not being well nourished or hydrated, not being able to take medications, and having food or liquid go down the wrong way.  So this is something that should be looked into soon.  It also sounds like this situation is very distressing for you wife. 


There are a number of reasons why swallowing can be "difficult" for a person with PD.  The reason your wife needs to get a referral for an evaluation with a speech- language pathologist (SLP) is so that they can identify the unique causes of the swallowing difficulty and thick saliva for her as an 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 that is more difficult to observe directly. When the evaluation is done the SLP should be able to describe your swallowing problems, the underlying physiology causing the problems, your risk for aspiration, and treatment strategies that appropriately address the cause of the problems.


Your email makes it seem that the swallowing changes have happened over a relatively short period of time and that is not typical for idiopathic Parkinson disease so it is another reason for following up soon.  Although people with PD share a common etiology, there is great variety within the population regarding the cause of swallowing problems.  Appropriate treatment techniques to address swallowing disorders in people with PD need to address the motor and sensory components unique to each individual.  Common treatment approaches for may include:

  • Modifying bolus flow with postures
  • Maneuvers to improve airway protection or airway clearance
  • Alterations in diet consistency
  • Swallowing exercises
  • Alterations in feeding patterns - (such as more frequent smaller meals)

I hope that your wife will find the expertise she needs.  Please write again if you have any further questions about this important topic.




Leslie Mahler



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Thank you very much Doctor. She did have a swallow evaluation done a couple months ago. And yes this has been a sudden change. She will return to the same SLP so hopefully the baseline from 2 months ago will be helpful.

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