Swallowing

**********

Swallowing

This week I was talking with the principal at our 2^nd charter school, and I mentioned that one item at the top of my “to do” list is to see a speech therapist.  When I tried to explain why, I was at a loss for the right words – and no, that’s not the reason for seeking speech therapy.  Improper swallowing is a problem for people with advanced Parkinson’s disease, and I want to be ready for what’s coming down the pipe…I mean, coming down the pike.  I also want to explain it coherently.

So, here goes.

Wikipedia, the font of all knowledge, has nice opening sentences if you go to the entry for “Swallowing”:

**********

Swallowing … is the process in the human or animal body that allows for a substance to pass from the mouth, to the pharynx, and into the esophagus, while shutting the epiglottis. Swallowing is an important part of eating and drinking. If the process fails and the material (such as food, drink, or medicine) goes through the trachea, then choking or pulmonary aspiration can occur. In the human body the automatic temporary closing of the epiglottis is controlled by the swallowing reflex.

**********

If you’re not sure of the other terms, here are Wikipedia’s opening lines for the entry “Pharynx”:

**********

The pharynx … is the part of the throat behind the mouth and nasal cavity, and above the esophagus and trachea (the tubes going down to the stomach and the lungs)… The pharynx carries food and air to the esophagus and larynx respectively. The flap of cartilage called the epiglottis stops food from entering the larynx.

**********

“Larynx” = “Opening to the Trachea or Windpipe,” which you can see in the drawings above and below.  It also houses the vocal cords.

When most people breathe and eat, they have no problems in their throats.  When they breathe, air flows freely through the nose and mouth and heads unimpeded into the lungs, gliding down the rabbit hole known as the trachea.  When they eat or drink, the epiglottis covers the opening of the trachea, redirecting the food to the esophagus, the tube that transports your morning oatmeal and cold-brewed coffee down to the stomach.

Both processes occur for most people with nary a thought about what’s going on.  It’s amazing that people eat, drink, breathe and talk during a meal.  However, with advanced Parkinson’s disease, the swallowing reflex becomes rusty, and food and liquids may end up in the trachea, leading to choking, pulmonary aspiration, and pneumonia.

I’ve written about this before, when I blogged about the husband of radio host Diane Rehm:

**********

I can’t deny that a scary end-of-life scenario doesn’t happen for some people with Parkinson’s.  Recently the New York Times published an editorial promoting physician-assisted suicide, in which it highlighted the case of John Rehm, husband of radio host Diane Rehm.  “Severely crippled by Parkinson’s disease,” the Times notes, “his only option for ending the suffering was to stop eating and drinking.”  His wife writes in a subsequent letter that “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.”  His agonizing death from self-imposed starvation was, Diane Rehm says, “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.”

**********

I’m writing about this now because I’ve choked when drinking liquids a few times recently, and it’s utterly horrifying. First it seems like you’re being strangled, then it feels like a grenade going off in your throat.  I ended up coughing and spewing out whatever liquid I was drinking, splattering it far and wide.

Case in point: I was in a Zoom meeting last week and my iPhone alarm went off, reminding me to take my pills – three pills, each about the size of watermelon seed, although rounded.  I popped the three in my mouth, then took a moderate sip of water. I guess my epiglottis wasn’t doing its job, because I when I swallowed, I started choking seriously, and then coughed loudly, the pills and the water flying out of my mouth and all over my desk.  I was both shocked and petrified.

So now I’m in the market for a speech therapist who can help me surmount this problem, and I’m hoping for an appointment this week.  The therapist I contacted lives nearby but does his appointments over Zoom.

To read more about this issue, click here for a 50-page booklet called Speech and Swallowing:  A Body Guide to Parkinson’s Disease.  It’s published by the Parkinson’s Foundation.

*********