For stroke patients, dysphagia is hard to swallow

Dysphagia is a condition that affects approximately 45 percent of stroke patients. It is characterized by the difficulty or inability to swallow due to the weakness or lack of coordination in the mouth and throat muscles.

And while dysphagia is relatively common – affecting as much as 13 percent of the general population, according to a 1991 study – it is often underdiagnosed. On average, only two percent of dysphagic patients in long-term care are identified.

This raises a host of problems. Undiagnosed dysphagic patients suffer from impaired nutrition. According to Dr. Reynaldo Rey-Matias, a physical and rehabilitation specialist from St. Luke’s Medical Center, "systemic complications brought about by dysphagia include dehydration, malnutrition and weight loss, and chronic respiratory insufficiency."

In addition, dysphagia also puts patients at a high risk of aspiration pneumonia, a condition resulting from the entry of foreign material, usually food particles, into the lungs instead of the esophagus.

To a stroke patient with dysphagia, the reduced voluntary movements and slowing down of reflex activities such as those in the pharynx are likely to have impaired the normal ways of expelling food such as coughing and gagging. This inability may lead to what Rey-Matias calls "silent aspiration."

"Some of the subtle signs of silent aspiration are choking and a gurgly voice," he said. Left unchecked, aspiration pneumonia can be fatal.

Dysphagia can be managed by a team approach, employing the active cooperation of a neurologist, an ENT (ear-nose-throat) specialist, a physiatrist or rehabilitation medicine physician, a nutritionist, a speech and occupational therapist, and a caregiver.

The neurologist diagnoses the patient’s condition and then leaves the ENT specialist to analyze the ability of the patient to swallow food.

The physiatrist trains the patient to learn how to swallow again through exercises that stimulate the tongue and the mouth. The nutritionist analyzes the patient’s feeding needs, while the speech therapist helps the patient regain his ability to speak. The caregiver becomes the implementer of the medical team’s recommendations.

Perhaps, one of the key duties of the caregiver is feeding a stroke or dysphagic patient. Often, food is pureed in order to solve the chewing problem, if any. However, pureed food can appear formless and unappetizing.

In addition, water and food pulp may separate, producing a mixture of consistencies and increasing the risk of aspiration. Patients find it hard to control food with a mixed consistency. With a limited range of foods suitable to conventional pureeing, patients are at risk of malnutrition, and perhaps, dehydration.

To address the patient’s swallowing problems, Fresenius Kabi, the leader of infusion therapy and clinical nutrition in Europe, has introduced Thick & Easy in the Philippines.

Thick & Easy is a starch-based thickener that, when added to food and drinks, results in a dense, cohesive consistency, suitable for patients to swallow.

The product, Rey-Matias believes, is far better at controlling the consistency of food than proxy thickeners like gelatin or honey.

In addition, Thick & Easy releases 98 percent of the available fluids in food, helping to prevent dehydration. It creates varied, appealing and appetizing meals and minimizes the risk of aspiration pneumonia. It can also be used with a wide range of hot or cold food and drinks.

Thick & Easy blends quickly and smoothly and can be frozen and reheated. Food can be prepared in bulk and can be used in standardized menus. In addition, Thick & Easy has a shelf life of three years.

Thick & Easy is available at selected Mercury Drugstores. For inquiries, call 889-6492 local 123.