When swallowing is a painful truth

Manila Bulletin

By OWEN BAUTISTA-ALCARAZ

She sits motionless on a wheelchair inside the hospital clinic, patiently waiting for her physical therapist to return with her food for the day. Despite her condition, her mind is in deep thought of how she can ingest any solid or liquid without much difficulty. After suffering a stroke last month, this has been her everyday struggle – swallowing food, that is.


Stroke patients aren’t the only ones affected with this condition called Dysphagia, a clinical term used for swallowing difficulties. People with diseases of the nervous system, such as cerebral palsy or Parkinson’s disease, often have problems swallowing. A head injury may affect the coordination of the swallowing muscles. An infection or irritation can cause narrowing of the esophagus. People born with abnormalities of the swallowing mechanism may not be able to swallow normally. Infants who are born with a hole in the roof of the mouth (cleft palate) are unable to suck properly, which complicates nursing and drinking from a regular baby bottle. These are only some of the most likely candidates for dysphagia.

Although it is relatively common – affecting as much as 13 percent of the general population, according to the 1991 study – it is often under diagnosed. On average, only two percent of dysphagic patients in long-term care are identified.

"This raises a host of problems because undiagnosed dysphagic patients suffer from impaired nutrition," relates Dr. Reynaldo Rey-Matias, a physical and rehabilitation specialist from St. Luke’s Medical Center. "Systematic complications brought about by dysphagia include dehydration, malnutrition and weight loss, and chronic respiratory insufficiency."


POSSIBLE FATAL CONDITION


Characterized by the difficulty or inability to swallow due to weakness or lack of coordination in the mouth and throat muscles, Dysphagia and its complications are better understood with a closer look at the complex process of swallowing.

Swallowing is a reflex that involves a sequence of involuntary muscle movements. Normally, when food leaves the mouth and enters the pharynx, the body, through nerve endings, determines if it is air being inhaled or solid that needs to be swallowed. Solid food creates a sensation of pressure that relaxes and closes the epiglogius and the vocal chords. The food is then safely swallowed down the esophagus.

However, for those with dysphagia or any swallowing difficulty, this sequence of muscle movements for any number of reasons such as stroke or accidents becomes impaired. To make swallowing easier, the food must be pureed. But when many foods are pureed, the liquid often separates from the pulp. Thinly pureed foods lack the bulk and consistency to adequately trigger the swallowing reflex. Food moves so quickly that dysfunctional muscles cannot control it. The pressure of the swallow forces the separated liquid down the back of the throat and into the lungs – a process called aspiration.

"Some of the subtle signs of silent aspiration are choking and gurgly voice. Left unchecked, aspiration can be fatal," tells Dr. Rey-Matias.


FINDING A SOLUTION


Dysphagia can be managed by a team approach, employing the active cooperation of a neurologist, an ENT (ear-nose-throat) specialists, a physiatrist or rehabilitation medicine physician, a nutritionist, a speech and occupational therapist, and a caregiver. Or, to address the patient’s swallowing problems, use a food thickener.

"Thick and Easy, the leading food thickener from Fresenius Kabi is especially processed to thicken pureed foods and liquid to promote safe swallowing for people with dysphagia. It thickens without altering the taste of the food or liquid," tells senior product manager Lulu Que. "Thick and Easy is a modified starch made from non-genetically modified ingredients. The modification simply enlarges the particle size which then stores the liquid and thickens the product," she further relates.

During the swallowing sequence, 98 percent of the liquid is released; thus, preventing dehydration and reducing the risk of aspiration. Since Thick and Easy doesn’t contain any vitamins or minerals, there is no limit to the amount that may be used throughout the day. However a healthcare professional should always advise the required consistency.

Liquid needs to be thickened to prevent aspiration in the dysphagic person. Thin liquids like water can be difficult to control especially during the swallowing sequence. By using Thick and Easy, one can modify this consistency to varying viscosities. The appropriate quantity of Think and Easy to use should be determined by a healthcare professional as it varies depending on individual requirements. Again, recommendations can be found at the back of the tin.

Lastly, Que relates, "Using a thickener such as Thick and Easy can be very helpful in the treatment of the patient with dysphagia. The foods that can be prepared for the dysphagic patient are endless. You can easily serve nutritional and appetizing meals to those who have difficulty swallowing. And patients with dysphagia still have dignity while enjoying their food. With a little time and imagination, meal times can remain an enjoyable experience for everyone."