Dysphagia Awareness

Dysphagia

June is Dysphagia Awareness Month.  A month dedicated to a disorder that most have never heard of but comprises 80% of my work.  It’s not even in my title, so what the heck is dysphagia?

What is Dysphagia?

If you Google dysphagia, you get this:

dys·pha·gia
ˌdisˈfāj(ē)ə/
noun

MEDICINE
  1. difficulty or discomfort in swallowing, as a symptom of disease.
    “progressive dysphagia”

What does a Speech Language Pathologist (SLP) do?

I have worked in a number of different settings as a full-time employee, part-time employee and PRN (as needed).  I have worked in Skilled Nursing Facilities (SNF otherwise known as a nursing home), home health, outpatient (where people come to see me), schools and in the hospital.   Some people research the swallowing process, techniques we use and interventions while teaching people to become and SLP at the college level.

Now, you need to get your head out of the gutter!  When I say I’m working with swallowing, I’m talking about the ability to swallow, saliva, food, drink and pills.  You know, that thing that we do 600-1200 times per day without a second thought!  It’s after a person or a loved one actually starts having a problem that people realize swallowing can “go wrong.”

I have worked with patients with such a variety of diseases.  Thyroid issues, CVA (stroke), Parkinson’s, ALS, MS, Rhett Syndrome, Mitochrondial Myopathy, Shaken Baby Syndrome, dementia, just to name a few.

Typical Day?

So what does a typical day look like for me?  Well, there is no typical day.  I never know what I’m walking into!  In the SNF setting, I walk in the door and hope for the best!  I work with Occupational and Physical Therapy to provide the best care for each elder that I possibly can.  For some that involves working on their cognition (memory, problem solving, executive functions), some work on their speech because they may have difficulty with word-finding (aphasia) but most have some type of swallowing problem.

In the hospital is where my day varies the most.  At the hospital is where I also get to work in x-ray to actually see how the swallow is affected.   I get the chance to mix barium with food and watch, using fluoroscopy, a live feed of the swallow.  Barium is used because it is dense and shows up as a dark substance on the swallow study (Modified Barium Swallow Study or MBSS).  I watch to make sure the muscles do what they’re supposed to do (close the airway, squeeze the pharynx, block off the nose, move the food/drink (bolus) back in the mouth and open the esophagus) and that the food/drink goes where it’s supposed to go, into the esophagus and not into the airway (aspiration) or remains in the pharynx/throat (residue).  I also am called in to assess patients in their rooms and determine the safest diet consistency for them.

Is Swallowing a Problem for You?

Most of the time, I’m told “I don’t need speech, I can talk just fine.” Sometimes, I’m told “I don’t have any problems with my swallowing” as the person takes a drink of water and coughs relentlessly.  I’ve also been told that “It’s just sugar that gets me” as the person drinks water and coughs relentlessly.  If you haven’t figured it out, that relentless coughing often clues me in that the person may be having difficulty with swallowing and that water may actually be going down into their lungs.  So what are some signs of swallowing problems?  Well, here’s a list that may indicate a problem:

  • Coughing/choking with food or liquid.
  • Feeling that food is “stuck” in the throat.
  • Difficulty chewing, losing the food/drink from the front of the mouth (through the lips) or not able to move the food to the back of the mouth to swallow.
  • Avoidance of certain foods.
  • Feeling that food “balls up” in the mouth as the person chews.
  • Frequent pneumonia.
  • Weight loss.

These are just a few things that may indicate dysphagia.  If you or a loved one experiences any of these, go to your doctor who can then refer you for Speech Language Pathology (Swallowing) services.

Rehabilitation

So now, you may wonder what a Speech Language Pathologist (SLP) can do for you.  A Speech Language Pathologist will determine the cause of the dysphagia or swallowing problem and create a treatment plan to rehabilitate the swallow.  Swallowing is mediated by 55 muscles and cranial nerves.  These muscles can be exercised to improve their function.  Now, we can’t necessarily set you up on a treadmill or a weight machine and let you go to town, sometimes these exercises are a little creative and may seem a little silly at first, but your SLP should describe the exercises to you and explain why each exercise is needed.

Sometimes, the SLP will recommend a different consistency of food for you to eat.  It may be recommended that you eat a mechanical soft diet with your meat ground (no crunchy, hard foods) or you may be advised to eat only pureed foods (mashed potato consistency).  It may be recommended that your liquids be thickened using a commercially available thickening agent.  You may be advised to use a compensatory strategy to increase the safety of your swallow such as turning your head to one side or the other or looking down at your lap as you swallow.  Some people have a better swallow if they eat a bite of lemon ice before their food or if they take a drink of water after each bite of food.  Some people even have difficulty with pills and need help in how they take their pills.

Why an SLP?

You may wonder, what makes me, an SLP, the person to help you or your loved one because all of this sounds extremely complicated!  It is very complicated!!  There is no cookbook approach to swallowing disorders and each person has to be treated and evaluated individually.  The SLP holds a Master’s degree.  Why yes, that may mean SIX years of college.  I’m also responsible, after all that school to continue my education through courses taught be other SLPs or professionals.  This is called Continuing Education.  I am required by the state of Indiana to have at least 36 hours of continuing education every 2 years.  I go well above and beyond that because there is always so much to learn!!  I also read research about swallowing.  A lot of research.

Some of us even go a bit beyond that and obtain Board Certified Specialty in Swallowing and Swallowing Disorders (BCS-S).  The SLP will then sign all their paperwork with that BCS-S to demonstrate this specialty.  Holding the BCS-S means that I have participated in 72 hours or more of continuing education specifically in the area of dysphagia, I have demonstrated competency through a test in dysphagia and have demonstrated more advanced work such as educating the public in the area of dysphagia.

My “Job”

My job is not a fleeting/passing moment with people.  I work with people in a variety of settings with something that is very important to them.  Eating/drinking is our staple for social interactions.  We often go out for drinks or go out to eat.  The most rewarding part of my job is when my patient reaches their goal and eats/drinks that item that they have been longing for, but was not deemed safe for them.  It is that time that the patient no longer experiences discomfort or difficulty with one of life’s main functions.  We need nutrition, right?  I work closely with these patients and we develop a connection.  It’s absolutely the best part of my job!  I don’t aim for perfection with my patients, I aim for functional!

Some other cool things about my job?  I get to write this blog!!  I love writing my thoughts out and sharing them with the world.  I never in a million years dreamed that people would actually read what I write!  I have collaborated with other professionals and app developers to create apps for Apple regarding dysphagia.  I have had the opportunity to teach webinars and to travel and teach classes about dysphagia.

National Dysphagia Awareness Month

Our field has, in recent years, lost 2 people integral to the world of dysphagia.  Dr. Jeri Logemann passed away on June 19, 2014.  She was the mother of the field of dysphagia.  I owe her so much for delving into this world of swallowing, assessing and treating that I love so much!  Dr. Steven Leder recently passed away.  He was a major researcher in our profession who brought passion to our field and made us all use our brains!  We will forever be grateful for the work that both of these influential souls have given us and leave to us!

Let’s “celebrate” National Dysphagia Month by spreading awareness!   May all your swallows be functional swallows!

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