Choking Explained?

I’m taking a graduate course at my public charter school in the Bronx, and we are reading a book by Caleb Gattegno titled In the Beginning There Were No Words:  The Universe of Babies.  Chapter 2 describes all the things a human baby must learn in the first few days after birth.

The following paragraph sent shivers down my spine.  It details the mechanics that a baby must teach itself in order to take in food:

The lips must learn to hold on to the nipple.  Then the muscles of the mouth must pump liquid with the lips, and while the liquid is in the mouth, the tongue must hold it so that the epiglottis closes the opening of the trachea (with the vocal cords) and the uvula closes the passage to the nose.  Then the tongue must bend to deliver the liquid to the esophagus.  All these new demands must be learned quickly and well, for the burning of reserves will create an imbalance requiring replenishment.

I read that paragraph in a stunned state of mind and practically clutched the front of my neck with my free hand.  I felt that this description details the specific, separate actions that must take place in the back of the mouth in order not to choke, and to let the solid food or liquid head down the happy rabbit hole known as the esophagus.

Babies teach themselves how to do this, how to coordinate these distinct actions, in the first day or so after they are born.  And while it might have been a conscious process with them at first (which my course book contends, although Wikipedia, the fount of all knowledge, says certain parts of the process are mere reflex), it soon becomes second nature, an autonomic procedure.

If any of these separate actions doesn’t occur, however, food and/or liquid might end up in the trachea or nasal passages.

Is this what happens with advanced Parkinson’s?  I recall the case of radio host Diane Rehm‘s husband, John Rehm, who had PD and willed himself to death by not eating or drinking anything, as he kept choking on his food.  His case was mentioned in a NY Times editorial that supported physician-assisted suicide, and his wife, Diane Rehm, wrote a follow-up letter after a NY Times reader argued that Parkinson’s is not a terminal disease.  Here’s her letter:

To the Editor:

In a March 23 letter about the desire of my husband, John Rehm, to end his life after years of suffering from Parkinson’s disease, the writer described Parkinson’s as a chronic and progressive but not terminal condition. In fact, after suffering two bouts of pneumonia, brought on by John’s loss of muscular ability to swallow correctly, his doctor determined that John had six months or less to live and prescribed hospice care.

This was not, as the letter writer put it, an example of an “exceptionally slippery slope.” It was, rather, an example of a courageous man who saw his disability as continuing to lead him to further degradation and loss of dignity. He chose to die on his own terms, without further loss of his basic abilities to function as a full human being.

DIANE REHM

Of course, John Rehm may have had additional problems with swallowing if the muscles in his esophagus were not working normally.  We have two kinds of muscles in our body, right?  The voluntary, striated muscles that we can control at will (e.g., the muscles in my fingers which are tap-tap-tapping at my keyboard right now) and the smooth involuntary muscles that, say, pump the heart or push digesting food through the intestines.  The muscles in the esophagus fall into this latter category.  Parkinson’s disease interferes with our ability to control the voluntary muscles, but does it also impact the involuntary ones?  Is this what leads Parkies to experience choking (and, as a side issue, constipation)?

I have so many questions now which I’ll carry with me going forward.

Final note on choking, from Wikipedia, the fount of all knowledge:

Obstruction of the airway can occur at the level of the pharynx or the trachea. Foods that can adapt their shape to that of the pharynx (such as bananas, marshmallows, or gelatinous candies) can be a danger not just for children but for persons of any age.
…
In adults, [choking] mostly occurs while the patient is eating. In one study, peanuts were the most common obstruction.

Oh, jeepers – now every time I toss a handful of peanuts in my mouth, I’m going to worry.

Final piece of trivia, again from Wikipedia:

The term muscle is derived from the Latin musculus meaning “little mouse” perhaps because of the shape of certain muscles or because contracting muscles look like mice moving under the skin.

Note:  I wrote this post from the position of lay person.
If a doctor or scientist who knows better 
wants to correct me, please do so!

Update!

Someone who read this post added these comments on one of the Facebook groups I’m in:

Nice post. I consider choking to be defined as an obstruction of the airway (i.e. the kind of thing that would be best addressed by the Heimlich :-)). I think the much bigger issue in Parkinson’s is particles from the mouth getting into the airway. That’s known as “aspiration” and can lead to more serious issue such as pneumonia. A number of folks with Parkinson’s tell me if they have issues with pills as well. This is somewhat separate issue but one that can cause a lot of frustration. My best advice is to take pills with a little bit of applesauce or chewed up banana or some of the purée HTH.

Another Update!

A different person on different Facebook page wrote the following:

Problems with swallowing (medical term: dysphagia) is common with Parkinson’s. There are both sensory and motor components that contribute to this problem. New research shows that people with Parkinson’s may not always feel when food/liquid enters the airway–they may not have the coughing that we typically experience. When food/liquid enters the airway it’s called aspiration. This can put one at risk for aspiration pneumonia, a leading cause of death. If you’re experiencing difficulty swallowing, discuss this with your doctor. A referral to a speech-language pathologist for imaging studies and therapy is the typical course of action.