
Making Swallowing Safer for those who have trouble swallowing - sohkamyung
https://physics.aps.org/articles/v12/11
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ketralnis
My girlfriend had brain surgery a few months ago. Afterwards she was unable to
properly swallow for a few weeks.

At first they thought it was from the intubation but since it continued for
several days they referred her to a speech therapist which is who handles this
sort of thing. Her neurosurgeon gave her actively dangerous advice that both
the nurses and speech therapist told her to ignore ("just chew the food more,
then everything turns to oatmeal")

It turns out swallowing is really complicated. After neurological damage you
get mobility back much more quickly than sensation and since swallowing is
very sensation-intensive there was the real possibility that it may never go
back to normal. I'm not a doctor so I'm probably getting some details wrong
but there's a semi-voluntary component that kicks off the process, then the
involuntary actions kick in. The involuntary bit is a delicate ballet of
neighbouring semicircles in your throat contracting simultaneously, then one
after the other. In her case, some of those semicircles were not firing or
were firing at the wrong time, but only on one side. That made food that
breaks into particles or is too thin get pushed around instead of down, so it
would get stuck in her throat. If you inhale food particles this way,
particularly with a weakened immune system, you're at risk for pneumonia so
they take it very seriously

The food she could and couldn't have was pretty surprising. She could have
shredded chicken, but not ground beef. She couldn't drink regular water, but
could have jello (she could handle jello or augur both, though many people
with dysphagia can't handle jello because it melts at body temperature and
then runs down your throat). She had to have thickened water which I'd never
heard of but was in every drug store I checked. She could have soups that were
viscous enough, and vegetables that form fibrous strands when you chew them
(like celery), as long as they didn't also form tiny leaves (like broccoli).
She could have peanuts but not walnuts.

A good friend saw the weird puzzle of which foods she could have as a fun
challenge and flew across the country to stay with us for a couple of weeks
and experiment. We went through dozens of dishes a day, mostly in small
quantity and then scaling it up if she didn't have trouble with it. I've never
washed so many dishes in my life

She's fully recovered now but a challenge definitely helps you definitely
learn to appreciate the little stuff :)

~~~
amelius
Interesting that a speech therapist was involved, because swallowing is in
some ways the opposite of vocalization. The larynx goes up and eustachian tube
briefly opens. This is the opposite of what you want when speaking.

~~~
nepeckman
Speech therapists are actually the most qualified clinicians for swallowing
interventions. Entire courses on swallowing are required for the degree.
Source: my wife is finishing her masters in speech therapy, spent an entire
semester doing swallowing studies at a psychiatric hostipatal.

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freedomben
As someone who is young (mid 30s) but suffers from Dysphagia, this is
interesting to see. As instances of eosinophilic esophagitis continue to
increase, more and more people will experience this.

If you have trouble swallowing sometimes, or it feels like food or pills get
stuck, you may want to go see an allergist to get tested for food allergies.
Don't procrastinate it thinking it will go away or is just in your head. If
you do that, you'll get be at huge risk for Dysphagia, which is Hell. If you
distrust the medical establishment, want concrete results (medical tests have
false positives/negatives all the time) or would rather save the money, check
out the book "The Elimination Diet" by Tom Malterre and Alissa Segersten.

~~~
kevinmchugh
I have difficulty swallowing pills! I've been hospitalized for it twice and
just barely avoided a third. I had an unrelated allergy test after I thought I
developed a food allergy but didn't test positive on any of the food tests. Do
you have enough experience to know what that might be?

~~~
BadCookie
Are you, by chance, allergic to mold? Most people don't think of mold as a
food allergy—I certainly didn't used to. But many foods contain mold
(especially aged cheese). There seems to be some controversy around whether
mold-allergic people need to follow a special diet, but anecdotally, I find
that I must. Otherwise, I get chronic migraine headaches and a whole laundry
list of related problems that I won't list here. (I tested positive to mold
allergy on a skin prick test.) I was also having difficulty swallowing at one
point.

[https://www.webmd.com/allergies/mold-allergy-
basics](https://www.webmd.com/allergies/mold-allergy-basics) (Note: The list
of foods here is pretty good, but some of the foods only need to be avoided if
they've been dried/aged/preserved, such as meat, in my experience.)

~~~
kevinmchugh
I am indeed allergic to mold! But I've never noticed any symptoms. The
incident that caused me to get tested by an allergist was a slight itch in my
throat after eating some mac and cheese I made. But there wasn't any aged
cheese and aged cheese hasn't given my cause for concern before.

I later felt that same itch eating pre-cubed grocery store cheddar. They add
cellulose to those packages, which I'm guessing could be too blame.

~~~
BadCookie
Most cheeses contain mold: [https://www.bonappetit.com/story/is-moldy-cheese-
okay](https://www.bonappetit.com/story/is-moldy-cheese-okay)

Only fresh cheese don't, such as cream cheese, mozzarella, and queso fresco.

One last tip that might help you if mold is your problem: I find that I have
to scrub my faucets clean about once a week with an old toothbrush. I'm
sensitive enough that a bit of mold in my drinking water can cause a coughing
fit. (But I also live in a pretty humid place where mold grows easily.)

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fdavison
I don't normally have trouble swallowing but a couple of big pills I take
daily would give me trouble. A trick I learned recently was to turn my head to
the side as I swallowed them. This video on youtube also describes different
techniques besides turning your head:
[https://youtu.be/NUzRGKx79k4](https://youtu.be/NUzRGKx79k4)

~~~
12084182
I got into a habit of putting water in my mouth first, and then popping the
pill in to swallow. It's weird cause now I can't put the pill first and add
water, but it helps me with bigger pills, I find it easier when it's floating
in the liquid.

~~~
freedomben
I've successfully used a variation of this technique, essentially holding the
pills in my mouth until they are coated well with saliva. This has helped
immensely.

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pizza
Fantastic, dysphagia is a special kind of hell.

------
jamisteven
twss

