Patient information Swallowing problems Name: Date: Speech and Language Therapist: Golden Jubilee National Hospital Agamemnon Street Clydebank, G81 4DY (: 0141 951 5000 www.nhsgoldenjubilee.co.uk Reviewed: May 2016 Next review: June 2017 Version 1
About this booklet This booklet contains information about swallowing difficulties. The medical name for a swallowing difficulty is dysphagia. We hope this booklet will help you understand dysphagia and offer some advice on ways to help. Normal swallowing 1. To be able to swallow normally and safely it is important to have good control of food and drink in the mouth (so that it doesn t spill out of the mouth at the front, or slip back into the throat causing coughing and choking). You need to have good movement of your lips and tongue so that you can chew hard or tough foods, and so that you can push all the food backwards into the throat (See figure 1). 2. Once the swallow has been started, automatically the entrance to your lungs closes over like a valve to stop anything going down the wrong way (See figure 2). The muscles in your throat push the food or drink into the gullet. (See figure 3) Once the swallow has started it takes one to two seconds to complete for a healthy individual. Figure 1 Figure 2 Figure 3 2
The role of the Speech and Language Therapist in swallowing Speech and language therapists can help you with swallowing problems because of their knowledge of the structure, muscles and nerves used in swallowing. Speech and language therapists assess the safety and efficiency of your swallow and give advice on how to manage your swallowing problem. Common signs of swallowing problems can be mild or severe, last for a short time or persist long term. Some swallowing problems may also change over time. The common signs are: Food sticking in, or falling from the mouth. Taking a long time to eat and drink. Difficulty getting food over. Food or drink sticking in the throat. Your voice may sound wet or gurgly when eating and drinking. Coughing or choking. Choking on a lump of food may interfere with breathing and may require emergency help. Food or drink going down the wrong way into the lungs instead of the gullet. The medical term for this is aspiration. This may happen in tiny quantities without causing coughing and may be the way that bacteria and viruses get into the lungs to cause a chest infection (sometimes known as aspiration pneumonia). Your speech and language therapist will advise you on how to reduce the risk of aspiration. Normal swallow Food or fluid flow safely down into the gullet. Swallowing difficulty Food or fluid flow the wrong way into the airway and into the lungs. 3
What can happen as a result of swallowing problems? You many find yourself avoiding certain foods. You may become embarrassed to eat and drink in public. You may find that it takes a long time to eat a meal. You may start to lose weight and, or become dehydrated. You may be more likely to cough and choke. You may develop a chest infection or breathing difficulties. Who experiences swallowing problems? Lots of people experience swallowing difficulties. Certain medical conditions can cause these, although often there is no known cause. Listed below are some of the medical conditions associated with swallowing problems: stroke head Injury; progressive neurological conditions e.g. Parkinson s Disease, Motor Neurone Disease, Multiple Sclerosis, Dementia, Huntington s Disease; cancer in the brain or central nervous system; respiratory conditions e.g. Chronic Obstructive Pulmonary Disease (COPD); and head and neck cancer. Swallowing strategies Here is some general advice which you may find useful. Please note not all of the items will necessarily apply to you. 4
Please concentrate on the ones which your speech and language therapist has ticked specifically for you. Sit in an upright position. Take your time. Try to eat in a quiet place, with few distractions. Soft, moist foods may be easier. It may help if you choose foods that require little or no chewing. Chew food well and make sure that your mouth is empty before taking another mouthful. Only heat up small portions of food at a time so that food does not get cold. Smaller, more frequent meals may be less tiring. Keep your chin tucked down towards your chest when swallowing. Swallow several times after each mouthful. Take regular alternate sips of fluid when eating to help clear any residue that may be in your mouth or throat. Clear your throat regularly when eating and drinking, then swallow again. Cough after swallowing. Consult your GP or pharmacist about taking medication in syrup or soluble form. Do not crush tablets or open up capsules without checking with your pharmacist that it is safe to do this. 5
High risk foods Below is a list of high risk foods. These are the foods that are most likely to make you cough and choke and therefore you should avoid them. Stringy fibrous textures e.g. pineapple, runner beans, celery. Vegetable and fruit skins including peas, grapes, baked beans, soya beans, and black eyed beans. Mixed consistencies e.g. cereals which do not blend with milk (e.g. Muesli), mince and thin gravy, soup with lumps. Crunchy foods e.g. toast, dry biscuits, crisps. Crumbly items e.g. bread crusts, pie crusts, dry biscuits. Things to avoid The high risk foods mentioned above. Foods that you find difficult (for many people these will be hard, dry or stringy foods). Taking very large mouthfuls. Tipping your head back. Eating and drinking when you feel short of breath. Talking while eating and drinking. Straws unless specifically recommended by your speech and language therapist. Please refer to any additional information sheets your speech and language therapist has given you. Your speech and language therapist also recommends the following advice specifically for your needs: 6
Further information There may be other health professionals who can help you with your swallowing problem: Dietitian You may be referred to a dietitian who will consider whether you need any advice or supplements to help you meet your nutritional requirements. Physiotherapist You may be referred for chest physiotherapy to help clear secretions (e.g. mucus) from your lungs if you are unable to cough these up. Please contact the Speech and Language Therapy department if: You or your relatives have any worries or questions about your swallowing problem. Your swallow deteriorates. You develop new swallowing difficulties. Your Speech and Language Therapy department phone number is: 7
(: 0141 951 5513 Please call the above number if you require this publication in an alternative format This leaflet was originally devised by SLT and reproduced for the Golden Jubilee National Hospital with kind permission from Greater Glasgow and Clyde. Golden Jubilee National Hospital Charity Number: SC045146 D07