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My girlfriend had brain surgery a few months ago. Afterwards she was unable to properly swallow for a few weeks. At first they thought it was from the intubati

My girlfriend had brain surgery a few months ago. Afterwards she was unable to properly swallow for a few weeks. At first they thought it was from the intubation but since it continued for several days they referred her to a speech therapist which is who handles this sort of thing. Her neurosurgeon gave her actively dangerous advice that both the nurses and speech therapist told her to ignore ("just chew the food more, then everything turns to oatmeal") It turns out swallowing is really complicated. After neurological damage you get mobility back much more quickly than sensation and since swallowing is very sensation-intensive there was the real possibility that it may never go back to normal. I'm not a doctor so I'm probably getting some details wrong but there's a semi-voluntary component that kicks off the process, then the involuntary actions kick in. The involuntary bit is a delicate ballet of neighbouring semicircles in your throat contracting simultaneously, then one after the other. In her case, some of those semicircles were not firing or were firing at the wrong time, but only on one side. That made food that breaks into particles or is too thin get pushed around instead of down, so it would get stuck in her throat. If you inhale food particles this way, particularly with a weakened immune system, you're at risk for pneumonia so they take it very seriously The food she could and couldn't have was pretty surprising. She could have shredded chicken, but not ground beef. She couldn't drink regular water, but could have jello (she could handle jello or augur both, though many people with dysphagia can't handle jello because it melts at body temperature and then runs down your throat). She had to have thickened water which I'd never heard of but was in every drug store I checked. She could have soups that were viscous enough, and vegetables that form fibrous strands when you chew them (like celery), as long as they didn't also form tiny leaves (like broccoli). She could have peanuts but not walnuts. A good friend saw the weird puzzle of which foods she could have as a fun challenge and flew across the country to stay with us for a couple of weeks and experiment. We went through dozens of dishes a day, mostly in small quantity and then scaling it up if she didn't have trouble with it. I've never washed so many dishes in my life She's fully recovered now but a challenge definitely helps you definitely learn to appreciate the little stuff :)

amelius 8y ago
Interesting that a speech therapist was involved, because swallowing is in some ways the opposite of vocalization. The larynx goes up and eustachian tube briefly opens. This is the opposite of what you want when speaking.
- BjoernKW 8y ago
  Speech therapists need to have an in-depth knowledge of how speech organs such as the larynx work mechanically. This includes not just their function as a speech production device but their other functions, too. Additionally, speech therapists are used to working with patients with neurological disorders.
- nepeckman 8y ago
  Speech therapists are actually the most qualified clinicians for swallowing interventions. Entire courses on swallowing are required for the degree. Source: my wife is finishing her masters in speech therapy, spent an entire semester doing swallowing studies at a psychiatric hostipatal.
- MattPearce 8y ago
  Here in NZ they are also the go-to for swallowing issues (they are called SLTs here - speech-language therapists). Our 10 month old daughter is fed 50/50 via bottle and nasogastric tube due to an as yet undiagnosed issue that causes her to stop drinking partway through a feed when she is still hungry. Among the many specialists involved in her case, the SLTs are responsible for observing the mechanics of how she drinks and checking that she is safely swallowing etc.
- towaway1138 8y ago
  As others have pointed out, speech therapists ("speech language pathologists", in the US) cover a broad area, most of which has nothing to do with tasks like correcting speed impediments. Many SLPs work in medical and rehabilitation settings, often with older patients. (And indeed, this work generally pays better than school settings.) Swallowing is a major topic, since not being able to do this competently can have fatal consequences. Beyond that, SLPs deal with a number of practical cognitive issues. Some of these are related to language specifically, others with related processes. If you've had a stroke, you might have severe problems generating spoken language, even though you can still generate written language without trouble. Or, you might have difficulty with basic planning tasks that we usually take for granted (e.g., what exactly do you need to do to mail a letter?).
mxuribe 8y ago
Thanks so much for sharing this; very informative! I certainly didn't go through anything that your girlfriend has undergone, but i have my own issues, and this has helped me with insight. Cheers, and glad to hear that your girlfriend has recovered!

amelius 8y ago

Interesting that a speech therapist was involved, because swallowing is in some ways the opposite of vocalization. The larynx goes up and eustachian tube briefly opens. This is the opposite of what you want when speaking.

BjoernKW 8y ago
Speech therapists need to have an in-depth knowledge of how speech organs such as the larynx work mechanically. This includes not just their function as a speech production device but their other functions, too. Additionally, speech therapists are used to working with patients with neurological disorders.
nepeckman 8y ago
Speech therapists are actually the most qualified clinicians for swallowing interventions. Entire courses on swallowing are required for the degree. Source: my wife is finishing her masters in speech therapy, spent an entire semester doing swallowing studies at a psychiatric hostipatal.
MattPearce 8y ago
Here in NZ they are also the go-to for swallowing issues (they are called SLTs here - speech-language therapists). Our 10 month old daughter is fed 50/50 via bottle and nasogastric tube due to an as yet undiagnosed issue that causes her to stop drinking partway through a feed when she is still hungry. Among the many specialists involved in her case, the SLTs are responsible for observing the mechanics of how she drinks and checking that she is safely swallowing etc.
towaway1138 8y ago
As others have pointed out, speech therapists ("speech language pathologists", in the US) cover a broad area, most of which has nothing to do with tasks like correcting speed impediments. Many SLPs work in medical and rehabilitation settings, often with older patients. (And indeed, this work generally pays better than school settings.) Swallowing is a major topic, since not being able to do this competently can have fatal consequences. Beyond that, SLPs deal with a number of practical cognitive issues. Some of these are related to language specifically, others with related processes. If you've had a stroke, you might have severe problems generating spoken language, even though you can still generate written language without trouble. Or, you might have difficulty with basic planning tasks that we usually take for granted (e.g., what exactly do you need to do to mail a letter?).

mxuribe 8y ago

Thanks so much for sharing this; very informative! I certainly didn't go through anything that your girlfriend has undergone, but i have my own issues, and this has helped me with insight. Cheers, and glad to hear that your girlfriend has recovered!