My Visit to the Speech Therapist - A discussion of swallowing problems.

I want to share what transpired at my first visit with the speech therapist in hopes that it might help others who are experiencing swallowing problems or difficulties with speech. She wanted to focus on my swallowing problems first and offer some recommendations on how to compensate. I told her that sometimes, after I had taken a drink, I would choke and spray it all over. I also told that I find myself actually thinking about swallowing, which had been all involuntary before. She said this wasn't too uncommon. Evidentially, because of HD slowing down my response times to almost everything, my epiglottis is no exception. This is the little flap that covers the larynx during eating or drinking so that everything you swallow goes down your esophagus.

I'm actually having to swallow several times because it doesn't feel like everything has gone down okay, or that it's delayed. She stated the correct way to swallow when I'm having problems is to take a small bite, or drink, and then tilt my head forward until my chin rests on my chest. I tried this a few times and I was surprised how easily everything went down. She said this was because, in bending my head forward, I caused my epiglottis to partially close over my larynx using gravity. With it already partially closed, when my brain gave it the signal to start closing because a swallow was coming up, it was already over half-way there to begin with, thus compensating for the slow response to the signal it was getting.

She also recommended drinking all liquids through a flexible straw in order to keep my head level or tilted forward, instead of thrown back like when you take a normal drink of something. Some of her recommendations were common sense, but none-the-less, needed reinforcement, like cutting everything I eat into small pieces. She told me I needed to keep all distractions to a minimum while eating to avoid choking. I told her she's never been to my house- it would be easier to count the number of times a day when there weren't any distractions, rather than when there were, especially with six kids still home and a granddaughter next door who's always playing here! She stated that as the swallowing gets harder, it would be easier to eat alone, without any distraction such as the TV, etc. I told her that that would be hard.

She then recommended that if I wanted to continue eating with the family, that either I start before they sit down to eat so that I would be almost finished, or come in to eat when they're almost finished so that I can still feel like I'm a part of them! I liked that idea! Although my swallowing problems are still intermittent, it's been real scary when I've tried to swallow and haven't been able to. She said that if this happens again then she would suspect that the muscles in my esophagus weren't synchronized any more because of the HD. She said that I could request an esophagram to verify this, once it starts getting worse.

I told her that I had already had a modified barium swallow test done a while back that didn't show anything wrong, at least at that particular time. Two separate things she said. The modified barium swallow test shows how well you are swallowing and the esophagram measures how well the esophagus is expanding and contracting in rhythm to move liquid or food down. I recalled hearing weird bubbly sounds in the back of my mouth at times for the last couple of years. I could never figure out what it was. She said that it was a sign, once again, of the epiglottis not closing during normal swallowing and some of the liquid making a "bubbling" or almost "hissing" sound around the opening of the larynx. I was glad to finally find out what was causing that weird sound. All-in-all the visit was very informative.

This Tuesday we work on some more swallowing strategies and will hopefully move on to my intermittent slurring stuttering and choppy pronunciation problems. All of these are exasperated while under stress but normally, they're pretty good. If anyone has any questions please ask.

Provided by Phillip J. Hardt, E-mail: phardt1@HOME.COM

Eating and swallowing difficulties (includes Heimlich Maneuver)

Published by the Huntington's Disease Association, London.

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Eating and Swallowing

Published by the Kansas University Medical Center.

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