The saddest summary of a life contains three descriptions: could have, might have, and should have.” -Unknown. Everyone fears something and honestly speaking having fears are as normal as breathing unless it starts interrupting with your daily life activities. Just like many of you, I was suffering from the choking phobia since my childhood. But a few years back, my fear of choking came out as my biggest nightmare. The inability to swallow my food was a frightening experience and then my physician asked me to visit a renowned speech therapist in Rawalpindi. I was diagnosed with dysphagia (a medical term for difficulty in swallowing), where I initiated my journey of living with dysphagia.
What is dysphagia?
Dysphagia or swallowing difficulties resulting in putting more effort to consume any form of solid or liquid. The word ‘dysphagia’ is composed of two parts- ‘dys’ refers to the trouble and ‘phag’ means eating. The condition is usually associated with several physical, social and psychological impacts. While choking and danger of aspiration are closely related to dysphagia, it also increases the chances of malnutrition and hydration among the patients.
Causes of dysphagia
Some of the major causes behind dysphagia are;
- Acid reflux that is damaging for oesophagal tissues
- Neurological problems
- Diffuse spam
- Narrowing of oesophagal stricture
- Foreign bodies in the throat
- Zenker’s diverticulum (a pouch that collects food particles in the throat)
- Cancer and cancer treatment
- Other health issues (i.e. scleroderma, food allergies)
- Common symptoms of dysphagia
Common symptoms of dysphagia
Dysphagia is characterized by several signs and symptoms including;
- Inability to swallow
- Painful swallowing (odynophagia)
- Oral leaking
- Food captured in cheeks
- Compromised chewing ability
- Food stuck in throat or sternum
- Coughing while swallowing
How many types of dysphagia exist?
The grouping of dysphagia types depends upon the position of swallowing impairment. The four main types of dysphagia are;
1- Oropharyngeal dysphagia
2- Esophageal dysphagia
3- Esophagogastric dysphasia
4- Paraesophageal dysphagia
Risk factor for dysphagia
Several factors can increase the chances of developing dysphagia. Some of the common dysphagia risk factors are;
- Neurological damage
- Surgical treatments
- Cancer treatments
- Gastroesophageal reflux disease
- Premature birth
What is dysphagia diet?
One of the most commonly suggested solutions of dysphagia is dysphagia diet or the alteration of diet textures to make it easy to swallow. As food texture directly affects the intake of food, so modifying the texture can be theoretically a good option to treat dysphagia. But when studied in detail, these modifications were found to have unexpected consequences.
Consequences of the dysphagia diet
Unfortunately, the dysphagia diet was not the solution to the problem. Some of the problems associated with dietary modifications include;
One of the most common dietary modifications to combat dysphagia was the consumption of thick liquids. However, this practice increases the risk of dehydration among patients. Although thicker liquids are not dehydrating themselves, they were the root cause of the problems because
- It is hard to prepare the thickened liquids
- People don’t like their taste and texture which automatically reduced their consumption
- Thickened liquids tend to keep full for longer periods of time that also affect consumption.
2- Texture modification are challenging to attain at home
Most of the time, speech-language pathologists refer to bringing down the texture of your diet to minimize the risk of aspiration and choking. But texture modifications often come with a huge burden. One of the common practices to bring down the texture of food is the addition of fluid in it. However, it isn’t easy for the people who are depending upon non-commercial kitchens.
Moreover, it can significantly affect the nutritional value of the food by interfering with the densities of nutrients in food. However, the problem of nutrient management isn’t incurable, you can seek out help from a nutritionist or even your speech pathologist can give you some useful tips. While I was facing a similar issue, I went to attock hospital Rawalpindi and was fortunate to find the best physicians there.
3- Texture modifications and food intake
As already discussed, most of the speech therapists recommend diluting the food for texture improvement. But this also comes with significant impacts on the intake of food. As the addition of fluid reduces the nutrition density of food, similarly it interferes with the food flavour. Diluting food reduces its overall consumption due to its unappealing taste.
Dietary modifications are the most convenient solution to make dysphagia manageable. Despite the several unwanted outcomes of dysphagia diet, it is still one of the most favourable choices by patients as well as speech pathologists.