Hi to all,
I'm new here ( have an introduction post/ story in the introduce yourself forum) so I don't know if this is the right place to post this question but I was wondering if anyone could elaborate on the swallowing tests they do post-surgery to determine if you are eligible to have your feeding tube removed? My husband is going in on Monday and wanted to know what to expect and if there is anything he can do now to increase his chances of having the tube removed.
Thanks in advance for any advice/insight/words of wisdom.
Many happy thoughts to all
Jingle Bell

Sounds like your husband is scheduled for a Modified Barium Swallow Study (MBSS) This test is generally completed by a Speech Pathologist (SLP) with a Radiologist or other MD present. The test is painless - begins with the Patient sitting in a chair or on a stool in the radiology suite. The SLP will give the Patient different consistencies of food and fluid with barium mixed in so that it can be seen as it's swallowed. It's really pretty cool! Completely non-invasive - no pain, no needles, just a video recording of the movement of your swallow as you actually swallow.
The test is to determine primarily if the food/fluid goes in the stomach or if trace amounts enter the airway - called aspiration. This is not a "pass/fail" test - if your husband does aspirate, the SLP will try different consistencies - thicker liquids/ softer foods to see if any specific consistency is more safe than another (meaning less risk of aspiration) If there is still aspiration no matter what kind of food or fluid is tried than the SLP will ask the Patient to complete "compensatory strategies" ie) chin tuck, cough after the swallow and see if that reduces the risk.
So, it's usually up to the SLP to discuss with you the degree of risk - if there is a high risk of aspiration then it may be that food and fluid isn't recommended until the swallow strengthens with specific exercises for a few weeks and then the MBSS may be repeated. If there's mild to moderate risk, the SLP will work with your specific situation to come up with a treatment plan that walks the line of minimizing risk (so not eliminating the risk altogether) and still moving forward on the path to improve swallowing and resume eating orally.

Keep in mind, returning to eating again can be tough - food tastes like crud, feels wierd and can even be a bit scary and overwhelming if the food doesn't move in the mouth the way it should - making one feel like they might choke. The best advice is to work with your SLP, move slowly, keep at it even when it's discouraging, do your oral motor exercies (at least 3x's per day!!!) and if all goes well - he'll be eating in a few weeks!

Another thing or 2 - the tube itself generally isn't removed until the Patient can "prove" they can eat/drink enough - this is usually by working up to not using it for a period of a few days to a couple weeks (excpet for the necessary water flushes)

Last thing, there is a small chance that the swallow may be permanently damaged and that the tube is a permanent thing. BUT, even if your husband does horribly on the MBSS that does not necessarily mean that he'll never eat again! When a swallow looks really bad it usually takes up to 2 years of work with the SLP, allowing for treatment and improvement over time before you'll have to/ should accept the remote possibility that he can't return to eating. Early intervention is key - glad to hear the MBSS is scheduled - that's the first step in the right direction!
Take care!

Hey there again - I just read your introductory post. I apologize, in my first response I assumed your husband was all done with treatment. It sounds like he may be needing chemo/radiation in the near future. All in all, most everything in my initial post still applies. Given that your husband is on an NG (nasogastric) tube - it may be that the MBS will reveal that he's swallowing well enough now to have it removed sooner rather than later - the NG tube can be pretty uncomfortable so they tend to remove that faster than the feeding tubes that are inserted into the stomach through the abdomen.
The process to return to eating, IF a feeding tube is necessary during chemo/radiation, can be tough because the muscles weaken quickly when not in normal use, the mouth can get very sore from the radiation and the sense of taste is impaired by radiation - so these issues may be ahead of him to one degree or another.

Looking at taking one step at a time - do the MBSS, let's hope he can get back to eating/drinking well before he starts treatment and keep doing so throughout treatment.
If not, he may need the more long-term feeding tube that is inserted into the stomach to get him through treatment and then have another MBSS later and work on getting the swallow back then.

Hope some of this info helps - in the mean time practicing swallowing by swallowing saliva and doing the oral motor exercises is key to keeping things moving!

Thank you Jennifer,
This information is extremely helpful. We still have a long road of recovery before us. Hopefully, it will be an uneventful journey.
Thank again,
Jingle Bell

what are the oral motor exercises? I was never given any to do and my surgery was 5 years ago in the States though now I live in the UK.

I can drop a link onto the site for you deb. If you'd like...

If you have a good link to the exercises, I would really like to see it.

Here's a link to the pamphlet put out by my hospital...



http://www.uhn.ca/Patients_&_Vi...ts/Swallowing_Exercise_HeadNeckCa_RT.pdf

Thanks Cheryl this is great.

Anyone have more??

Alex is 12 months out with liquids still his only oral intake. Anything to strengthen his swallow would be appreciated. He complains about a sort of "ledge" where food just stops and sits, giving him the feeling of either choking or something stuck in his craw (which it literally is). He has had 2 barium swallows which also show some functional damage. RO commented on this last week as a risk to oral health with infections coming from the material that just sits there.

Sorry Jingle Bell for the hijack but this might be relevant to your husband once the tube comes out if it isn't out already.

Your going to think I'm crazy - yawning helps!

Wow those links are really helpful. Thanks for sharing.

No problem!!

I love the link you posted Cheryl!
Here are some pharyngeal strengthening exercises - very good for improving the strength of the swallow itself:

Shaker Exercise (pronounced shu-keer)
Lie flat on your back and raise your head as though you were trying to fixate your gaze on your toes. While you do this, make sure not to raise your shoulders. This simple exercise improves swallowing ability if it is performed three to six times per day for at least six weeks. If you get good at it, increase the duration of each head lift and the number of repetitions.

Hyoid Lift Maneuver
This is a rather simple exercise. Place a few small pieces of paper (about 1 inch in diameter) over a blanket or a towel. Then place a straw in your mouth and suck one of the pieces of paper to its tip. Keep sucking on the straw to keep the paper attached, bring it over a cup or a similar container and stop sucking. This will release the paper into the container. Your goal is to place about 5 to 10 pieces of paper into the container.

Mendelsohn Maneuver
This simple exercise is very effective at improving the swallowing reflex. It involves swallowing your own saliva. Normally, as the saliva enters the area just behind your mouth during swallowing, your "Adam's apple" (the hard area about halfway down the front of your neck) moves up and then back down. To do this exercise, keep the Adam's apple elevated for about 2 to 5 seconds each time. You can help it stay there with your fingers at first, in order to better understand the movement you are about to do. But the exercise will only help you once you can make it stay up without assistance. Repeat this exercise several times per day.

Effortful Swallow
The purpose of this exercise is to improve the contact among the different muscles used during the act of swallowing. In essence, the exercise consists of swallowing. But as you do it, you must try to squeeze all of the muscles of swallowing as hard as you can. You do not need to swallow food during the exercise. Just a dry swallow will do. Perform this exercise 5 to 10 times, 3 times per day.

Supraglottic swallow
You should try this exercise without food first. As you get good at it, you can try it with actual food in your mouth. This exercise consists of 3 simple steps. First, take a deep breath. Hold it as you swallow, then cough to clear any residues of saliva or food which might have gone down past your vocal cords.

Super Supraglottic Swallow Maneuver
This exercise is just like the supraglottic maneuver described above, but with an extra twist. After you take that deep breath, bear down while swallowing. The pressure generated helps with swallowing and increases the strength of your swallowing muscles.