I have posted often in the may threads on swallowing issues and PEG tubes about something that everyone seems to ignore in the equation when it comes to dysphagia, or swallowing difficulties at the end of treatment. That is radiation exposure to the muscles and nerves that control it all.

While this is pretty well understood, a German oncology journal published an article this month stating that there was a direct correlation between the amount of radiation that these sensitive structures get and long-term swallowing issues.

Posters in past threads often talking about losing the "swallowing memory" after becoming dependent on a PEG, but that does not account for the many people that have had no dysphagia after being on PEGs for protracted periods of time. Indeed people both with and without PEGs end up with swallowing issues and the constancy of who has problems and who does not, cannot be tied to getting a PEG alone. It has everything to do with radiation exposure, angles of exposure, and where the primary is located, which yields a greater or lesser level of radiation to these sensitive areas.

http://oralcancernews.org/wp/dysphagia-after-definitive-radiotherapy-for-head-and-neck-cancer/

Thanks for the information!

Thanks for this Brian. I got into a "discussion" with two SLP's about dysphagia, and touched on long term effects of radiaiton, something that I don't believe they thought of before that discussion. That was actually right before a presentation done at the WA Speech Language/Hearing Associations state convention, where myself and JenSLP have been asked back to do a longer presentation this year. Great material to include!

Brian,
I agree with you. I have no swallowing function. On Tuesday they will go in with the endoscope. The last barium swallow test revealed the fluid stopping at the beginning of the esophagus. Nothing goes down. If I try to swallow too much water it will aspirate. The PA that saw me suspects scar tissue. My tumor was rather large and at the base of the tongue so I believe the upper part of the esophagus is likely compromised. I'll see on Tuesday. I want this PEG tube out! Been totally dependent on it for 4 months.

I read a lot this weekend and I too believe the focus and the intensity of the radiation has everything to do with impaired swallowing. The speech therapist did say that atrophy sets in....I asked her how come a new born baby can swallow for the first time right out of the womb? I believe its the radiation but will do whatever the gastroenterologist tells me.

Mr Mike

Mike, Sorry you are struggling with swallowing. Did you continue to swallow all through your radiation treatments?
In the scheme of things 4 months is'nt really that long to have a PEG. It's certainly a small price to pay to avoid the aspiration pneumonia.
I hope your team can assist you to regain your swallow.
By the way, babies in utero ( in the womb ) constantly swallow the amniotic fluid. They pee too.
Tammy

I am 11 years out from start of treatment and the UW docs are sending me to swallowing boot camp in February to work on swallowing issues. Consists of two weeks of one hour daily sessions on learning new techniques to work that food down the throat. Issues might keep showing up as side effects from treatment but I am still very happy to be around to enjoy them!! Wonder how many pounds I'll gain??? - Kris

Brian

Interesting abstract. I agree that swallowing difficult is primary radiation based, but just as dysphagia cannot be tied to a PEG alone, this study of 50 people with 50 or 60 GY does not appear to have segregated those with a PEG and those without. It certainly does not refute the PEG dependency/ swallowing memory loss/atrophy theories/concerns that RO's like mine and many others have when they encourage their patients to go without a PEG if they can.
Of course I'm biased since I still think it significant that after my first 72 GY in a field that also encompassed the constrictor muscles, I bounced right back with no dysphagia.
We disagreed on this issue when I first joined OCF, and until and unless there are some relevant studies on dysphagia with and without a PEG tube with similar radiation fields, I think we continue to do so.
That said, there is no doubt at all that my second round of radiation bringing me up to 97 GY did mean the constrictor damage was permanent and had nothing at all to do with my PEG. The first thing my SLP said to me when I went for swallowing therapy was "why are you here with that much radiation and especially where you had it?" she focused on speech. I had to go back to my CCC to find another SLP who did VitalStim who was willing to try but she also felt that it was a very long shot.
Both SLP's made the same point as the journal and your post. It's the radiation that is the primary culprit.
Charm

I agree that the radiation is the culprit to having a peg tube. I recemently had a neck dysection and they also cut the sphinxter muscle in my throat so that i can eat. Excuse the spelling. When they did the neck they cut so many muscles and took out alot of what controlled my eating. I have had vita stim befor the surgery and it personally did not work for me. But I could swallow and they said it was all asperation because of the spinxter bar in my throat. If they would have cut that muscle sooner I would not have a peg. Well with this second muscle cut in the troat and neck area I again have to strengthen my tounge and jaw muscles to swallow again. I am doing new therapies and I project to be eating in about 6 months. It does take alot of discipline to do the excercieses, but I want to eat. I see a speech pathologist twice a week for one hour. I might have to have another operation once I start eating due to acid reflux, but will cross that bridge when I get to it. Keep on trying!!!