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Thread: Dysphagia: Can't swallow food

  1. #1

    Dysphagia: Can't swallow food

    Hey

    I've been experiencing this issue for the last 2+ weeks. I am frustrated and concerned.
    In my 12 yrs as a quad (c5-c6) I have never had an issue with swallowing, except initially when I had my trach removed.

    This began early november as a one-off occurrence. My swallow reflex failed to trigger halfway through eating a bowl of soup.
    It panicked me, though I didn't choke. I was eventually able to swallow and the rest of the soup was fine.

    10 days later it happened again, and more frequently. To a point where I couldn't trust that my swallow would engage when I work the food to the back of my throat. I have not eaten in two weeks.
    It feels as if I've forgotten how to swallow and properly maneuver food in my mouth.

    The first week liquids had become a problem, too. Even saliva in my mouth I felt I could not swallow and was forced to spit out. I think fear has played a big part now.

    I went to ER twice, had neck/chest x-ray, saw 2 speech pathologists who could not determine anything visually, had barium swallow test (with thick liquid only, and was 'okay'), saw a gastro doc who requested head CT scan (came back negative).

    I have another barium swallow test on tues (this time with food), and an MRI on friday.

    As I said I am very concerned as it has not gotten better, and I still have no answers.

    Gastro doc says a scope may be necessary, though I'm trying to exhaust all options before that.


    Anyone experience this or something similar?

  2. #2
    Did the speech pathologists give you any techniques for swallowing? One of them worked with me when I was in the process of having trach removed and they were concerned about my swallowing. I do remember something about how one can hold their head while swallowing in order to keep the trachea out of the way of the food passing to the esophagus.
    Once I had an endoscopy (?) done to look at my stomach for possible ulcers. At the same time the doctor asked if I wanted him to "stretch" my esophagus. It did not sound like a good idea so I declined. He pushed the idea, then the nurse stated 'she said no, doctor'. I'm not sure of his point, perhaps it was to improve swallowing, but I was not having a problem at that time.

    Hope you can get this resolved soon.

  3. #3
    Often people with new injuries in the cervical area have problems with swallowing, both due to paralysis of some of the muscles involved in the pharnygeal phase of the swallow, and due to side effects or complications from spinal hardware/stabilization surgery, especially anterior fusion/plating. It is unusual to develop swallowing problems years after injury. I would be concerned that the following be ruled out during your testing:


    • Movement or infection of the hardware in any spinal stabilization surgery you had when first injured.
    • Development of an ascending syrinx in your spinal cord.
    • An undiagnosed stroke or brain tumor.
    • An esophageal tumor


    Have you seen a neurologist in addition to the GI physician?

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  4. #4
    Thank you both for your responses.

    I never had surgery or hardware placed in my neck. I was diagnosed with complete c5/c6 and graced with a halo for many months.
    I've had neck pain since my injury.

    As for syrinx, stroke, brain tumor, and esophageal tumor, would an MRI indicate if any of those are present? I have an MRI this friday.
    As I mentioned my head CT scan came back negative. Would a stroke have clearly showed up in a CT scan?

    I have not seen a neurologist about this issue yet. Last time I saw one was 5+ years ago because of my neck pain. I declined surgery because there was no guarantees on outcome.


    Thank you both, again.

  5. #5
    Quote Originally Posted by eskay View Post
    I never had surgery or hardware placed in my neck. I was diagnosed with complete c5/c6 and graced with a halo for many months. I've had neck pain since my injury.
    A Charcot joint of your cervical spine should also be ruled out.

    Quote Originally Posted by eskay View Post
    As for syrinx, stroke, brain tumor, and esophageal tumor, would an MRI indicate if any of those are present? I have an MRI this friday. As I mentioned my head CT scan came back negative. Would a stroke have clearly showed up in a CT scan?
    Depends upon what is being MRI'd. A small stroke may not show up on a CT scan of the head, especially if old.

    Quote Originally Posted by eskay View Post
    I have not seen a neurologist about this issue yet. Last time I saw one was 5+ years ago because of my neck pain. I declined surgery because there was no guarantees on outcome.
    Recommend you see one specifically for your dysphagia to see if a neurologic cause can be identified.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  6. #6
    Thanks for your knowledge, SCI-Nurse.
    I will try to see a neurologist asap. I need to find an answer for this.

  7. #7
    Senior Member smokey's Avatar
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    Eskay, The same thing happened to me a couple of years ago. I was starving and I tried to eat a cheeseburger for lunch in about four bites.. I did not choke but it got stuck in my esophagus. I couldn't really swallow anything for the rest of the day whether it was food or liquid, nothing would go down into my stomach. Anyway after a battery of Gastro intestinal tests it was discovered my lower esophageal sphincter (LES) did not work properly and made swallowing very difficult. My G.I. doctor put me on 5 mg of Reglan to be taken 30 to 45 minutes before each meal. It seems to help quite a bit. Nevertheless, I still cut my food into smaller pieces, thoroughly chew everything and drink plenty of water with each meal. I haven't had a problem since I started doing this. By the way, I am a C67 quadriplegic about 40 years post.

  8. #8
    Quote Originally Posted by smokey View Post
    Eskay, The same thing happened to me a couple of years ago. I was starving and I tried to eat a cheeseburger for lunch in about four bites.. I did not choke but it got stuck in my esophagus. I couldn't really swallow anything for the rest of the day whether it was food or liquid, nothing would go down into my stomach. Anyway after a battery of Gastro intestinal tests it was discovered my lower esophageal sphincter (LES) did not work properly and made swallowing very difficult. My G.I. doctor put me on 5 mg of Reglan to be taken 30 to 45 minutes before each meal. It seems to help quite a bit. Nevertheless, I still cut my food into smaller pieces, thoroughly chew everything and drink plenty of water with each meal. I haven't had a problem since I started doing this. By the way, I am a C67 quadriplegic about 40 years post.

    That's interesting, GI problems are common in my family and I suspected it was that initially. I take a reflux med daily (tecta 40mg) for heartburn. I am not looking forward to GI tests, but I would if needed.

    I had my modified barium swallow test today, where you see an xray video of yourself swallowing with various textures of food.

    The speech therapists/pathologists present weren't at all concerned with my swallow, which was comforting.
    My issue though, is prior to and initiating the swallow. Once it triggers it works well and clears all food present. But it is in the end of the oral phase, and the beginning of the swallow that the issue lies.

    The speech therapist pointed out an osteophyte (bone spur) on the anterior spine, and in her opinion did not look overly concerning or impeding (though she admitted a doctor would have to properly confirm that).


    I have my MRI this friday which should paint a better picture of this osteophyte, and anything else that may be going on.

  9. #9
    Have you started any new medications? If yes, check side effects.
    Tom

    "Blessed are the pessimists, for they hath made backups." Exasperated 20:12

  10. #10
    I got choked on a Twinkie about 25 years ago (two years post injury) and was hardly able to eat for 3 months. Even after I got over the worst of it, I still have difficulty with swallowing certain foods. I had a few tests but nothing was found to be a cause so I guess mine is all psychological. Good luck...

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