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 :)
Thanks so much for sharing this; very informative! I certainly didn't go through anything that your girlfriend has undergone, but i have my own issues, and this has helped me with insight. Cheers, and glad to hear that your girlfriend has recovered!
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.
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.
As others have pointed out, speech therapists ("speech language pathologists", in the US) cover a broad area, most of which has nothing to do with tasks like correcting speed impediments.
Many SLPs work in medical and rehabilitation settings, often with older patients. (And indeed, this work generally pays better than school settings.) Swallowing is a major topic, since not being able to do this competently can have fatal consequences.
Beyond that, SLPs deal with a number of practical cognitive issues. Some of these are related to language specifically, others with related processes. If you've had a stroke, you might have severe problems generating spoken language, even though you can still generate written language without trouble. Or, you might have difficulty with basic planning tasks that we usually take for granted (e.g., what exactly do you need to do to mail a letter?).
Here in NZ they are also the go-to for swallowing issues (they are called SLTs here - speech-language therapists). Our 10 month old daughter is fed 50/50 via bottle and nasogastric tube due to an as yet undiagnosed issue that causes her to stop drinking partway through a feed when she is still hungry. Among the many specialists involved in her case, the SLTs are responsible for observing the mechanics of how she drinks and checking that she is safely swallowing etc.
Speech therapists need to have an in-depth knowledge of how speech organs such as the larynx work mechanically. This includes not just their function as a speech production device but their other functions, too.
Additionally, speech therapists are used to working with patients with neurological disorders.
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.
Whoa. In the last few years I’ve maybe once a month been eating and felt something get stuck in my throat. It’s unconfortable and I drink water to get it down, but it hurts going down. In the last few months, I’ve noticed if I slam back my pills it feels like they’re getting smashed into the tissue where my tonsils would be if they hadn’t been removed.
Now that I think about it, I did Keto for about a year and don’t remember it ever happening during that time. My sleep apnea also cleared up.
I got tested for allergies and nothing came up, then the doctor told me to stop the low carb diet and start taking Prilosec. Really stupid, I haven’t seen a doctor since. I’m kinda worried now though, thanks for sharing this.
I was having trouble swallowing after eating meat for a few months. I gave up meat but then it happened when eating a bagel. When I got into see the doctor he said it was a stricture forming in my esophagus due to acid reflux. Taking a proton pump inhibitor (Prilosec is a PPI) made all the swallowing symptoms go away.
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?
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
(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.)
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.
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.)
Wow, thanks for sharing. Didn't even think about mold as a food allergy! I have tested positive for allergies to molds, so this could be one of the sneaky things causing me issues!
Depending on the food, you may have a false negative on your allergy test (this happened to me with dairy). You will also want to make sure you get tested for both IgG and IgE (tho there is a debate out there regarding whether that is necessary).
Unfortunately the Elimination Diet is the only way to prove it if the test isn't working. If you have a food you suspect, you can try cutting it out for a couple of weeks and then abruptly adding it back in and see how you feel.
If you are willing to spend the money, an endoscopy can provide some valuable clues. They can take a biopsy of any inflammation and can analyze it to look for clues about what is causing the problem.
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
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.
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.
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 :)