BACKGROUND:
I am the main caregiver for my husband. He had radiation for cancerous tumor on left tonsil 6/05--8/05 and neck dissection 10/10/05. In December 2005 a swallowing study indicated severe dysphagia. He started therapy and was allowed to swallow small bites of thickeend liquids. Cancer metastasized and he had five chemo treatments, last one on 5/18. His 6/12/06 PET scan showed that the cancer was in remission.
UNSURE WHO OR WHAT TO BELIEVE
GI DOCTOR IS SAYING ONE THING AND SPEECH THERAPIST SOMETHING ELSE.
A 6/27/06 swallow study given by a speech therapist indicated severe to profound dysphagia and nothing orally per therapist.
Don had a EGD on 7/3 and initially the GI doctor was not optimistic that Don would be able to swallow since a spur was pushing against his throat. However, after a swallow study with the radiologist he was much more hopeful. Per GI doctor, the spur was not interfering with my husband's swallowing and not interfering with esophagus. While he was not able to swallow the barium pill, he was able to swallow three cups of barium. Per the GI doctor, my husband's esophagus is OK. He saw no problems. He said my husband should start drinking liquids. This differs from what the speech theapist is telling us. The GI doctor wants to dialate my husband's esophagus. He feels that once it is dialated he should be able to swallow more thicker foods than liquid. Aside from my husband's brief swallowing in January he has depended on his feeding tube for all of his nutrition.

Does anyone care to express an enlightened opinion?

Eileen

Was your husband prescribed any swallowing strengthening exercises by the therapist? Having the swallowing exam is just the first step -- so that problem areas can be identified and a series of specific exercises given to address these issues. The typical exam consists of swallowing (or attempting to swallow) a thin liquid, a thick liquid, a puree and a cracker with a barium paste. You may also be asked to make certain sounds, all while being filmed with a fluoroscope. The doctor examines the latter and IDs areas of malfunction.

The act of swallowing is quite complex and many muscles and tendons are involved. Plus the epiglottis, which closes off the trachea during swallowing, is a dependent organ -- its correct function relies in great part on the functioning of the adjacent muscle bundles. If they are weak or damaged it may not close completely and you may end up aspirating food, with the consequent risk of pneumonia. Which happened to my husband despite his eating throughout treatment.

My husband was prescribed a series of exercises including suction, "hard" swallows, certain sounds, etc. to do 3x a day -- he started these in mid-November and still does them, although not as often. For a while they were quite hard, now they are very easy and done mostly to prevent any "creep up" of problems which can occur.

Perhaps ask your speech therapist to explain exactly where he/she saw your husband's swallowing problems and if any exercises can be done to address these. My husband's ENT monitors a number of HNC patients who have been treated elsewhere and some of these have had complete dysphagia (unable to swallow their own saliva, the ENT told us) and after several months of therapy are starting to show progress. It can be very slow and apparently, not very effective for some time as the muscles/nerves are being retrained. Like if you had a severe leg injury and had to have months of therapy, patience and persistence are part of the solution.

Sound to me as if you need a bit more information from the therapist and the Dr.. It is certainly possible that problems in the throat/epiglottal area and the esophagus both exist. I recall several people on this forum saying they had espohageal strictures ID'd late (after months of dysphagia) so both problems may have to be addressed in the months ahead.

However the good news is that the cancer seems to have been beaten -- now is the time to look forward with optimism...

Best,
Gail