Monday, July 6, 2009

Swallowing Problems in Parkinson's Disease

Having PD Can Be Tough to Swallow

One of the common stereotypes of Parkinson's disease is the image of an old man drooling. But that image doesn't do justice to the issue because the not being able to swallow can occur at any stage of PD as the muscles simply do not respond to swallowing the 1 to 2 quarts of saliva which the body produces every day.

For long-term health we believe that a PWP should think in terms of exercise to alleviate the problem rather than go the medication route. Exercise requires more of your energy and time but may save more of you in the long run because it is safer than medication and speaks directly to the all of the related problems.

While you are waiting for the positive results of exercise you can try sucking on hard candy or chewing gum? If you have trouble swallowing these might force you to swallow. Or not. Might be worth a try. Usually it is suggested for dry mouth but since it requires a more conscious effort, it might have some value.

The first suggestion of things to do before consulting your doctor is to read the Parkinson's Disease Society article about the problem. This is an excellent article with practical suggestions. You can print it and take it to your doctor who may not be as familiar with the problem as you are.

Swallowing issues are a very serious problem in PWPs and you may need additional assistance from a Speech Therapist to assist you with exercises. You can ask your doctor for a referral. You can contact the American Speech-Language-Hearing Association for a referral in your area or contact the professional organization in your state. and of course you can contact the nearby universities with medical colleges.

According to many sources, including the Mayo Clinic, "Anticholinergic medications, such as transdermal scopolamine, can be used to decrease saliva" BUT these are not without side effects. One of these side effects is that you can develop "dry mouth" which is bad enough but it can lead to dental problems. Another significant concern is that anticholinergics are usually contra-indicated if you are taking the standard levadopa meds for PD. You can also develop some urinary issues beyond the standard PD problems. Do be advised that before you begin a symptomatic treatment such as an anticholinergic, you need a baseline cognition test because loss of cognitive skills is another side effect.

A treatment you might have read is to use atropine (eye drops) one drop on or under the tongue once or twice daily. This may avoid the adverse effects of stronger medications and still be effective. You should certainly consult your physician first about the efficacy in doing this before trying it.

If you actually treat the developing muscle rigidity, you may find that with professional therapy and/or continued exercise at home, you will not only swallow without choking but also speak more easily and audibly. You will decrease your risk of aspiration pneumonia and increase your ability to continue breathing properly.

While waiting for the day of you appointment with your internist or neurologist you can warm up with Breathing Exercises for PD: Yoga and Buteyko and Voice Exercise Will Help Parkinson's Disease, an article about an excellent DVD available from Mary Spremulli, an experienced Florida-based Speech Pathologist. Steve uses Mary Spremulli's DVD and the exercises provided at Parkinson's Focus Today with good success.

One of the experts in the field is Roxann Diez Gross, PhD, director of the UPMC Swallowing Disorders Center and assistant professor of otolaryngology at the University of Pittsburgh School of Medicine. Her contact information is provided on the chance that you live in that area.

The swallowing issues won't get better, the speaking voice will not improve, breathing and choking can become progressively worse. These problems will not go away without attention; exercise might just slow the progression and improve quality of life.

Resources:
Common Antichloringerics Speed Cognitive Decline
A study by Dr Diez Gross about similar work with COPD patients

5 comments:

  1. This is wonderfully written! For many PWP patients this is an ongoing issue...I agree that if one suffers with these issues, even if they seem to be minute, jumping on it early one can benefit in the long run tremendously!

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  2. I've noticed that among YOPDers sometimes one of the very early symptoms can be voice issues.

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  3. The information on sleep apnea cures should be known to everyone. The problem with Sleep apnea is that most of them are unaware of the condition. It can be only recognized by the close watch of the bed partner or the family member sleeping near you. So if you possess tired or sleepy and having snoring inform your partner or your family member to perform a close watch on your sleep and take proper treatment as prescribed by the doctor.

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  4. While we are not familiar with the Sleep Apnea Center, this is very good advice.

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  5. Great Blog I am sure will be helpful for many and solving problem of snoring for others. Keep up a good work for Sleep Apnea Cures.

    ReplyDelete

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