John Syphrit of Knoxdale went to bed three hours earlier than usual on Jan. 10. His eye hurt while reading the newspaper. He woke with the worst headache he ever had, he said, and called for his wife, Liz Syphrit, to take him to DuBois Regional Medical Center. “I didn’t know what was happening,” John Syphrit said, “but I knew it was bad.”
Syphrit had suffered a stroke. From the Emergency Department, he was admitted to the Intensive Care Unit. Through evaluations, the damage from the stroke was not severe – he was weakened and had issues walking. However, there was one thing that noticeably changed – he couldn’t swallow. “Something I’ve been doing for 77 years, all of a sudden, I couldn’t,” he said.
Syphrit has dysphagia, pronounced dis-phase-ya. Dysphagia is a term to describe the condition of having difficulty swallowing or pain when swallowing. This makes eating and drinking difficult and can lead to aspiration, malnutrition or dehydration, Toni Mohney, speech-language pathologist at DRMC, said.
Swallowing is a complex process using 50 pairs of muscles and even more nerves to work food and drink into the stomach through three stages.
In the first stage, the tongue collects the food and moves it around in the mouth and chews. In the second, the tongue pushes the food to the back of the mouth. The voice box closes tightly and breathing stops to prevent anything from entering the airway and lungs. In the third, the food enters the esophagus, the tube that carries food to the stomach.
Dysphagia is a problem with any of the nerves and/or muscles that control any of that swallowing process. It could be weak tongue or cheek muscles that may make it hard to move food around in the mouth for chewing. It could be that the airway isn’t closing tight enough or that the esophagus isn’t pushing the food down to the stomach.
“Dysphagia has many possible causes and happens most frequently in older adults,” according to the National Institutes of Health. Other conditions that cause dysphagia include any neurologic disease, stroke, cerebral palsy or cognitive decline. Though considered rarer, children can be born with dysphagia problems, and infections or accidents can also cause changes in the muscles and nerves in all ages.
Dysphagia can cause people to become malnourished or dehydrated. Also, it causes people to choke easily since coughing or clearing the throat doesn’t work as well.
While in DRMC, Syphrit was first given nourishment through a tube in his nose connected to his stomach. “I remember that going in,” he said. “It was aggravating.” But the tube kept him hydrated and fed for a month. As he grew stronger, he was transferred to The Rehabilitation Center at DRMC for therapy – physical therapy for walking better, occupational therapy for improving abilities to perform daily activities and speech therapy because dysphagia can be treated.
At DRMC, speech-language pathologists work with patients who have swallowing problems from babies and children in The Feeding Clinic to the elderly and everyone in between.
The first step for treatment is to be evaluated to find the exact area that is weak. With an individualized exercise program, including simple exercises, such as repeating words and sounds, swallowing muscles can be built up. The speech-language pathologists also use a device called Vital-Stim that provides electrical stimulation to muscles through tiny, stick-on pads.
Syphrit was doing well, but he had one setback while in rehab. He got pneumonia and had to be transferred back to the ICU.
Syphrit recuperated and progressed. Back in Rehab, he had the nose tube removed and a different tube inserted into his side to provide nourishment directly into his stomach. He could start eating orally beginning with pureed foods, such as applesauce and mashed potatoes, with liquids thickened to a honey consistency. He then progressed to a mechanical-soft diet, such as steamed-vegetables and ground meat, and liquids thickened to nectar consistency.
On Feb. 17, John came home without any feeding tubes. Today, Julie Goff, DRMC speech-pathologist, visits Syphrit two to three times a week at home to continue to monitor his progress and continue his treatments using the Vital Stim. “I can tell the difference every week,” Syphrit said. Without the exercises, patients can backslide, Goff said. They are very important.
Syphrit also does his exercises on his own at least three times a day. He is on a soft diet and can eat some things more easily than others. Bread is hard to swallow because of its gumminess, but toast and grilled cheese are easier.
Chewing is still a lot of work and often his meals would get cold causing him to give up. But it is getting better. Last week was the first time he left the table without feeling hungry, he said. His goal is to be able to eat anything, again – especially a good steak.
For more information about dysphagia or if you have a sudden or gradual change in your ability to swallow, consult with your physician or call DRMC Speech Therapy at 375-3082. May is Better Speech and Hearing Month, a time to take steps to improve communication and quality of life related to the work speech pathologists can do.