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

Voice Exercises Will Help Parkinson's Disease Symptoms

Choking Is No Laughing Matter

If you have trouble swallowing, being heard when you speak, breathing, seem to have excess saliva or drooling, if you are concerned about choking, you need help. There is no magic pill that can help with all of these problems if your PD has progressed to the point where you have these problems frequently. What there is for you is exercise. Repeated exercises several times a week. Sometimes we need the encouragement of friends and family to keep up the routine. For many of us we need to see or hear the exercise with a leader.

We've written several articles about these breathing, swallowing, enunciation aids, throat relaxation and in all have suggested that a friend or caregiver could read them aloud to you. We were considering taking this further when we had a note from Mary Spremulli, MA, CCC/SLP Speech Pathologist telling us that she had a DVD, VOICE AEROBICS incorporating Voice Therapy and Voice Physiology which she was offering for sale at her website. We went to her website and really appreciated what she had to say.

We viewed the tape with my sister, who has years and years of theater experience. And although we were watching to review the presentation, we found ourselves joining the class.

Here's what we really liked about the video:
1) The combination of vocal and physical exercise 99.9% of which is done seated.
2) The progression of the exercises through 3 stages with an actual break between each. (You'll want to pause the play.)
3) The advantage of seeing and hearing the instructions. Don't forget you can always pause, reverse and play again.
4) Seeing that those in her class are not those toned models but real patients who have the same goals as all PWPs
5) She uses some vocal exercises which don't translate easily to print
6) She stresses vocal support, that all important breath support
7) She creates a comforting environment and encourages your participation.
8) Whatta deal! While what she takes her class through may look easy to some, there is true professional leading this class. Brava Mary!!!
9) Almost forget - physical exercise accompanies all of the vocal/breath support exercises.

Sure there are a few sound glitches on the recording but somehow that makes it all the more real - it's not slick, it's just Mary leading a class with calming music and simple scenery out the window. And Mary sets a reasonable pace in a calm voice. As the tape progresses, she just gets better and better.

We suggest that you couldn't spend a better $20.00 (plus $3.60 shipping and handling) for a potential life saver. Mary even donates 10% of the proceeds to the National Parkinson's Foundation and to the Lee Silverberg Voice Treatment Foundation. And she offers shipping discounts in case your support group would like to take advantage of this excellent product. Mary has over 25 years of experience as a medical speech language pathologist in addition to being a licensed nurse and a national lecturer.

The run time is 59 minutes - you may want to watch it first and join in when ready. You can do 20 minute segments at a time if the hour seems too long. Use the program in a way that adjusts to your schedule and keeps you in your comfort zone to return again and again.

This is direct link to the order form

Voice Aerobics is not just for Parkinson's disease, it is very important for stroke victims, for anyone with a breathing issue, swallowing problem, or even a healthy person, caregiver perhaps, who wishes to develop a better speaking voice.