Coping with Dysphagia
Having Chronic Dysphagia and being on a Nasal feeding tube in hospital for 4 weeks at the diagnosis of Dermatomyositis was not the best of experiences but coming off of the feed tube and having to sample the delights of puree food was another experience all on its own.
To say “Hospital Puree food” is an experience is an understatement, it is Bland, Tasteless, full of un-identifiable produce, and cold. anyway after a week in hospital on that I was glad to get home into my own environment. but now it was time to assess the situation, living on my own I was responsible for my own catering, this was in May 2011.
I started my meal regime by using soft food for breakfast ie soft cereal with plenty of milk like “Porridge” and “Wheatabix” always having a large glass of water handy to help with the swallowing, the main meals for lunch and supper were purchased from a catering company and delivered frozen on a weekly basis ready to cook straight from the freezer. Although these were better than the hospital meals they were (1) not that appetizing and (2) Expensive, so I decided that I would invest in a hand blender and puree my own food, that way I could choose what I wanted to eat, and also I would know exactly what I was eating.
Well this is where you adapt to the “Situation” I found that I was experimenting with various food item using fresh food and ready meals, I steamed all my fresh vegetables and pureed them down, also Chicken and Pork pureed down quite well, as did fish and Pasta, I discovered that I was, with the exception of “red meat” basically eating the food that I was eating before only pureed to a consistency that was easy to swallow.
going down this route gave me the nutrition that I needed and apart from the fact that things like bread, red meat,s, cake was a “no go” the only inconvenience was the amount of extra washing up, as I progressed throughout the year so I was able with the swallowing exercises from the Speech Therapist and advice from the dietician able to improve the swallowing to a point in November 2011 ( 6 months after coming out of hospital) that I was advanced onto a “soft lumps diet” which I am still on, my swallowing has improved 100% and although I still cannot swallow “red meat” I can now eat most things including Bread and Cake. I still need to have a glass of water with me at mealtimes and always have to take small bites and chew well but am improving all the time.
This time last year I was on a feeding tube, 5 months ago I was on a puree diet, now I am on a soft lumps diet, In 6 months time I hope to be able to eat and swallow a KFC.
One of the many extra complications involved with Myositis and many other neuro muscular disorders is Dysphagia.
Dysphagia is the medical term for the symptom of difficulty in swallowing. Although classified under “symptoms and signs” in ICD-10, the term is sometimes used as a condition in its own right. Sufferers are sometimes unaware of their dysphagia.
It derives from the Greek root dys meaning difficulty or disordered, and phagia meaning “to eat”. It is a sensation that suggests difficulty in the passage of solids or liquids from the mouth to the stomach. Dysphagia is distinguished from other symptoms including odynophagia, which is defined as painful swallowing, and globus, which is the sensation of a lump in the throat. A psychogenic dysphagia is known as phagophobia.
It is also worthwhile to refer to the physiology of swallowing in understanding dysphagia.
Swallowing involves three stages. These three stages are controlled by nerves that connect the digestive tract to the brain.
- Oral preparation stage
Food is chewed and moved around the mouth by the tongue while being moistened by saliva. The tongue pushes food and liquids to the back of the mouth towards the throat. Where the swallowing action starts.
- Pharyngeal stage
Food enters the pharynx (throat). A flap called the epiglottis closes off the passage to the windpipe so food cannot get into the lungs. The muscles in the throat relax. Food and liquid are quickly passed down the pharynx (throat) into the esophagus. The epiglottis opens again so we can breathe. (This phase starts under voluntary control, but then becomes an involuntary phase that we cannot consciously control.) It is at this stage that aspiration (breathing in of food particles) often takes place. Aspiration can lead to, choking, dehydration, malnutrition, and pneumonia. In fact, aspiration pneumonia is the fifth leading cause of death in people over 60 years of age and the third leading cause of death in people over 80.
- Esophageal stage
Liquids pass through the esophagus into the stomach by gravity normally in two to three seconds. Muscles in the esophagus push food toward the stomach in wave-like movements known as peristalsis. A muscular band between the end of the esophagus and the upper portion of the esophagus, known as the lower esophageal sphincter, relaxes involuntarily in response to swallowing, allowing food and liquids to enter the stomach.
Coffee and other caffeinated drinks
Oranges and other citrus foods
If the problem persists SEE YOUR DOCTOR
- Dysphagia Therapy and iDevices (swoslpnetwork.wordpress.com)
- UHN and TIMS DICOM Dysphagia Interest Group (swoslpnetwork.wordpress.com)
EXERCISES TO HELP WITH DYSPHAGIA
Exercising your swallowing muscles is the best way to improve your ability to swallow. Here, some different exercises developed by dysphagia rehabilitation experts.
Lie flat on your back and raise your head as though you were trying to fixate your gaze on your toes. While you do this, make sure not to raise your shoulders. This simple exercise improves swallowing ability if it is performed three to six times per day for at least six weeks. If you get good at it, increase the duration of each head lift and the number of repetitions.
Hyoid Lift Maneuver
This is a rather simple exercise, although it may sound more like a task performed in one of those reality TV shows. Place a few small pieces of paper (about 1 inch in diameter) over a blanket or a towel. Then place a straw in your mouth and suck one of the pieces of paper to its tip. Keep sucking on the straw to keep the paper attached, bring it over a cup or a similar container and stop sucking. This will release the paper into the container. Your goal is to place about 5 to 10 pieces of paper into the container.
This simple exercise is very effective at improving the swallowing reflex. It involves swallowing your own saliva. Normally, as the saliva enters the area just behind your mouth during swallowing, your “Adam’s apple” (the hard area about halfway down the front of your neck) moves up and then back down. To do this exercise, keep the Adam’s apple elevated for about 2 to 5 seconds each time. You can help it stay there with your fingers at first, in order to better understand the movement you are about to do. But the exercise will only help you once you can make it stay up without assistance. Repeat this exercise several times per day.
The purpose of this exercise is to improve the contact among the different muscles used during the act of swallowing. In essence, the exercise consists of swallowing. But as you do it, you must try to squeeze all of the muscles of swallowing as hard as you can. You do not need to swallow food during the exercise. Just a dry swallow will do. Perform this exercise 5 to 10 times, 3 times per day.
You should try this exercise without food first. As you get good at it, you can try it with actual food in your mouth. This exercise consists of 3 simple steps. First, take a deep breath. Hold it as you swallow, then cough to clear any residues of saliva or food which might have gone down past your vocal cords.
Super Supraglottic Swallow Maneuver
This exercise is just like the supraglottic maneuver described above, but with an extra twist. After you take that deep breath, bear down while swallowing. The pressure generated helps with swallowing and increases the strength of your swallowing muscles.