By Jan Engoren
It’s one of those things you take for granted, until you lose it.
Eating and swallowing are second nature for most people, but if you’ve had a stroke or suffer from Parkinson’s disease or some other medical conditions, swallowing may have to be relearned.
Swallowing disorders, known as dysphagia, are not uncommon and can happen when the swallow reflex is absent, delayed or weakened.
This can result in excess saliva, drooling, coughing or choking during eating, or more serious conditions such as pneumonia. Some people will have difficulty speaking or will speak hoarsely.
“Take swallowing difficulties seriously,” says Shari Napier, a speech pathologist at Baptist Health City in Boynton Beach. “If food or liquid get into your lungs, infection or pneumonia can follow.”
She says that the same muscles used for talking are used for swallowing. “If you’re having problems with either, see a doctor and ask to see a speech pathologist. This is what we do.”
Swallowing occurs in three stages, starting in the mouth.
After it’s chewed (oral phase), food moves into the throat (pharyngeal phase), where the airway gets closed off to keep food and liquid out. When this doesn’t occur, one may cough or choke.
The third stage is the esophageal phase, where the esophagus opens and closes, sending food to the stomach. Many people suffer acid reflux, or indigestion, when stomach acid backs up into the esophagus.
While exact numbers are unknown, the National Foundation of Swallowing Disorders estimates that 22% of the population over 50 years of age may suffer from a swallowing disorder.
Victor Connor, 70, of Wellington, a financial adviser at Connor Wealth Management in Boynton Beach, is one of them, and he sought treatment from Napier.
He lost the ability to swallow and speak after he was diagnosed with Stage 4 throat cancer in 2015. He also had a spot of cancer removed from his lung.
A lifelong equestrian and an announcer at polo matches, Connor underwent 10 weeks of radiation and 10 weeks of chemotherapy and took another year to regain his strength.
On a feeding tube, Connor knew he had to regain his swallowing abilities to regain his quality of life. Although he says he no longer rides horses, he earned a pilot’s license and bought an RV to tour Florida with his wife.
Connor says he felt lucky to find Napier.
“Shari is a miracle worker,” Connor says. “She helped me regain my life.
“It doesn’t help to stick your head in the sand,” he says. “Find someone who knows what they’re doing and can help you.”
After administering a swallow test on Connor, Napier was able to diagnose his issues (one vocal cord was paralyzed) and created a treatment plan for him.
Among other techniques, Napier taught Connor to eat and swallow more mindfully, to blow into a straw to strengthen his vocal cords, to use a nebulizer to add moisture to his throat and to take smaller bites of food, swallow hard and swallow again.
He spends a few minutes each day on a balance board to strengthen his core muscles.
Connor had scar tissue in his throat from the radiation treatments and found help from Anita Parrondo, a physical therapist with Baptist Health South Florida. She loosened up the scar tissue with therapeutic massage.
Back at work, with two new grandchildren, a good prognosis and hope for the future, Connor says having a positive outlook helped him through his ordeal.
“Attitude is everything,” he says.
Pathologist at work
In the field for 32 years and a voice specialist, Napier has conducted more than 16,000 video swallow tests, where X-rays are used to pinpoint which area is affected and what can be done to ameliorate the condition through diet, exercise or behavior modification.
“We need eyes on the anatomy,” says Napier, who sang with Women of Note, a Sweet Adeline a cappella group, for 15 years. “We need to know what’s working and what’s not working before we can recommend a treatment plan.”
In addition to X-rays, she uses a fiberoptic endoscopic evaluation of swallowing, in which a diagnostic instrument goes into the nose to assess the swallow function.
Napier says once the problems are diagnosed, she helps clients strengthen the muscles and nerves involved in swallowing. She offers tips on how to help yourself. Those include keeping a food diary to see what triggers the condition.
For reflux, she recommends not eating two to three hours before bedtime and raising the head of the bed 4 to 6 inches.
“Have your ice cream after lunch, not after dinner,” she says.
Swallow twice with solid food and use a little liquid to help wash it down.
If you cough while eating, she recommends avoiding small crumbs and eating solids and liquids separately. For example, for chicken noodle soup, eat the chicken separately from the broth and remember to chew your food well.
Napier says therapies can be extremely successful but depend on the extent of the damage, such as from a stroke, or, if you have Parkinson’s disease, what stage you are in.
Most everyone, she says, can benefit from even one treatment. Exceptions may include patients with multiple sclerosis or ALS.
Napier has worked with singers from American Idol, America’s Got Talent and The Voice on their singing voices. “A lot can be done to help people with dysphagia. Don’t sit with difficulties swallowing or losing your voice,” she says.
“The more people know what speech language pathologists do and what we can do to help, the more we can assist them in leading a better quality of life.”
Jan Engoren writes about health and healthy living. Send column ideas to jengoren@hotmail.com.
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