Sometimes It's Hard To Swallow

Dysphagia is a condition I provide therapy for. It means your swallow is not effective and you are at risk for aspiration or choking. This condition can send an elderly person to the hospital in respiratory distress within an hour after eating. When a patient comes to the hospital following a stroke or the the skilled nursing facility because they can no longer care for themselves, I evaluate their ability to swallow. The way it works is……..; you get hungry…….this gives you an "appetite" All of your senses are involved. (e.g., smell, sight, sound, taste, touch). These sensory messages cause stomach contractions and thus begins the search of food. What can go wrong?

1. brain damage decreases senses therefore decreasing appetite
2. pharmacologic interference (too many drugs on board) or those that can cause swallowing problems.
3. febrile states (a significant increase in body temperature accompanied by increased pulse and respiration rates, anorexia, constipation, insomnia, headache, pains, and irritability.)
4. G.I. disorders
5. vitamin deficiencies

The result is often ((pneumonia)) most commonly bacterial….caused by aspiration ((the result of an infection in the alveoli (the little sacks in your lungs….they fill up with fluids and there's no room for oxygen….this is very bad:(

The symptoms of pneumonia are;

1. shaking chills
2. fever (101-105)
3. weakness/malaise
4. difficulty breathing
5. increased coughing

Now for the causes…..There are many things that can go wrong and it goes something like this;

1. impaired respiration/swallow coordination
2. silent aspiration (this is pretty common) patients are experiencing foreign material entering their lungs and there are no outward symptoms.
3. impaired vocal folds. They either don't open and close at the right time or not at all
4. impaired epiglottis (the little flap that covers your airway as the food slides down)
5. liquid pools in the valeccula and/or the pyriform sinuses. (little pockets on either side of your airway that can hold liquid. This can spillover into your airway when you're not ready to swallow and your airway is not protected.
6. decreased ability to cough due to weakness, (congestive heart failure)
7. the whole timing thing could be off…..
8. impaired function of the soft palate( causing food and fluid to go up your nose
9. damage to the nerves can decrease sensation of the oral articulators (lips, cheeks, jaw, tongue, pharynx)
10. muscles responsible for chewing are too weak
11. no teeth at all for chewing
12. decreased saliva
13. dizziness/difficulty balancing body in space
14. damage to the Vagus nerve resulting in impaired (respiration, phonation, resonation, heart, G.I. tract)
15. neck injuries decreasing the ability to tilt the head
16. decreased alertness and/or arousal
17. decreased ability to feed self
18. decreased cognitive awareness (as in Alzheimer's)

It is usually a combination of these factors that impair someone's swallowing ability. This gives you an idea of what my primary responsibility is within acute care and the SNF's