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Dysphagia – A Diagnosis That’s Hard to Swallow
Dysphagia, or trouble swallowing, is a condition that can come on suddenly from any one of a number of causes and finding the right treatment is often tricky. I’m just beginning to understand how complicated the swallowing process is and how easily it can become disrupted.
Regardless of cause, the resulting inability to enjoy a meal is in itself devastating to the person afflicted. Food is one of life’s great joys. It comforts and nourishes us. Families come together around the table to celebrate individual milestones and to mourn the passing of loved ones. Every culture has its favorite dishes lovingly passed down from generation to generation.
Until now, I’ve never had reason to wonder how swallowing works and I never knew that it takes over 40 pairs of muscles working in coordination to take a bite of food from my mouth into my digestive tract.
There are three stages of swallowing. The first one is where we take food or drink into the mouth, chew it and push it into the throat. It’s here that what one doctor called a design flaw kicks in. We have to breathe and swallow through the same tube.
There are specific muscles that are supposed to briefly keep us from breathing, push the food away from the breathing tube that goes to our lungs and send it into the esophagus and finally down into the stomach. When they don’t work properly we aspirate food and drink into the lungs.
Like many people with dyspagia, Dad has the most trouble swallowing liquids. He even has trouble swallowing his saliva. It pools at the base of this throat and he sounds as if he’s talking under water. Small amounts of food get stuck as well, causing him to cough, choke, and sometimes turn bright red. He aspirates without being aware of it and is at high risk for aspiration pneumonia.
He’s undergone both a modified barium swallow where he was given foods of various consistencies that had been mixed with barium and a video was made, showing how the food moved into his throat. He’s also had two video endoscopic swallowing studies where a fiber optic scope was inserted in his nose allowing the doctor to examine his esophagus. Both tests clearly show puddling at the base of his throat. A small portion of every spoonful of food gets stuck part way down. He must swallow two to three times after each half teaspoon of food to clear the way for the next bite.
In older persons, dysphagia can be caused by a stroke, Parkinson’s disease and some dementias. Dad has dementia and Parkinson’s disease either one of which could have caused his swallowing difficulties. However, since it first manifested after he had a heart valve replacement and bypass surgery in 2001 and it has worsened after undergoing more surgery in November, I believe his case was initially brought on by nerve damage from intubation during surgery and is worsening with age and the onset of his exacerbating illnesses. No one is to blame. It just is and we have to work around it.
The hardest part for Dad is relearning how to eat. He loves food and his habit was always to take in as much as possible as fast as possible. He was always the first one to clean his plate regardless of what was served.
“I don’t say I don’t like this or that, he’d say. I eat anything.”
Now he’s restricted to pureed food and honey thickened liquids. Neither one of which look very appetizing nor do they satisfy the urge to chew. I cringe at the thought of forever giving up the salty crunchy treats I enjoy now and then. Or life with no ice cream which is banned because it melts into a liquid in the mouth. Pureed broccoli has little eye appeal and one can eat only so many meals with mashed potato and gravy on the menu before even that gets old.
“I need real food,” he tells his doctor. If I don’t get a sandwich soon I’m a gonner.”
I tried to show him that the mushy stuff he insists isn’t food is the same stuff he’s been eating only in a different form. I asked him to mash the potatoes and add the butter and cream. He helped me prepare the vegetables and put them in the food processor and then put it on his plate and carry it to the table.
“This is real food, he finally admitted. “But it’s not as good. I need the real, real food.”
I know how he feels. I’d love to serve him a meal of roasted chicken and stuffing with a baked potato and fresh green beans on the side. I’d give him a big slice of apple pie with ice cream for dessert and watch as he opened the top button on his pants and sighed contentedly. He should be able to eat anything he wants. But he can’t. The danger is too great. A bout of pneumonia could kill him.
And so I try to be creative in what I prepare and every now and then I give him a small bite of something I know he loves just to see if he can handle it. Some days he can. Other days he can’t, but he’s always glad to have tried.
I’ve pureed cupcakes and put a bit of whipped cream and cherry juice on top of them to satisfy his sweet tooth and I’ve made chicken stew with all the standard ingredients and pureed it for him. The peas turned the stew green so it looked a bit odd but it tasted good. I use a lot of gravy to soften things and he can have that baked potato as long as it has lots of butter on it. I thicken nutritional drinks with bananas and peanut butter and a bit of baby cereal to make milk shakes that don’t melt in his mouth and he enjoys those. He likes ricotta cheese and that goes down easy and he loves puddings, which I know make daily.
I’m always looking for new tastes and flavors I can give him, new recipes for those with trouble swallowing. If you are caring for a loved one with this problem and have some ideas to share, please post them here or contact me directly at bcarducci@comcast.net I’d love to hear from you.
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