Joey Wahler (Host): We're discussing swallowing disorders, also called dysphagia. Our guests from MA Medical Center, Alexandra Soyer, director of Rehabilitation and Speech Language Pathology, as well as Dr. Luis Helme. He is Consulting Director of Rehabilitation and Speech Language Pathology. This is MIMO MED Talk. Thanks for joining us. I am Joey Wahler.

Hi there, doctor Alexandra. Doctor, can I call you Luis?

Dr Luis Riquelme: Yes, of course. No problem.

Joey Wahler (Host): Excellent. Great to have you both aboard. So first, let's start with you, Alexandra. How common is dysphasia? What are the primary causes?

Alexandra Soyfer: hello to everyone. dysphagia is a very common disorder, That is associated with a lot of different medical problems. it could be, started at birth for little babies who are born prematurely or. Who are having difficulty, just starting their, feeding journey. And then all the way up until later stages in life could be due to, either dementia or some neurological disorders like, stroke, Parkinson's disease, as well as head and neck cancer and other numerous problems.

Joey Wahler (Host): So obviously a wide array of reasons this can occur both from right after birth to perhaps shortly before end-of-life. So that being said, Luis, can you explain the different types of swallowing disorders in a nutshell And what some of the symptoms there are that may indicate someone has it?

Dr Luis Riquelme: Oh, sure. so we typically think about, swallowing disorders that might happen in the mouth or the oral cavity or in the throat, or the pharynx or in the esophagus, which is the tube that connects the throat to the stomach. and, in terms of, Types of swallowing disorders. It really depends on what the problem is.

If it's in the mouth, if it's in the throat. And so in the throat area or in the pharynx and larynx, we're usually concerned about, aspiration or food or liquid entering the airway and making its way to the lungs and eventually turning into bacteria And the resulting in a pneumonia.

But we also, are concerned about efficiency. So, once the chewing is done And we move the food to the back of the mouth to swallow or the liquid, are the throat muscles, efficiently squeezing, that food or liquid down, into the esophagus, which then. Takes it over to the stomach.

So there are over 32 pairs of muscles involved, in these actions. that also involve, taste. So that influences how we swallow, the texture of the food influences, how we swallow the amount of food or liquid we put in our mouth. And the temperature. So all that influences, how we swallow.

and as we get older, this changes, right? And some changes are, are natural, just like the muscles in our arms and legs change. So do the muscles in our mouth and throat. And so we need to pay attention to those minor changes. Often the first signs, to follow, up with your question are things like, throat clearing.

sometimes feeling like you have to swallow an additional one or two times, when you are eating. so typically, let's say if you. are eating food and usually you manage it in one or two swallows per bite, and now it's three or four. That means you're feeling something left over And so you feel you have to clear it up.

We don't see a lot of pain on swallowing, although That is seen, for example, in head and neck or during radiation treatments, et cetera. But that might be sign of other problems. And so it's important that, persons, seek help for these difficulties.

Joey Wahler (Host): Gotcha. And so that being said, Alexandra, what are the main ways in which this condition can affect a person's overall health and of course, nutrition.

Alexandra Soyfer: we take things like eating for granted, right? We don't think about when we swallow, how we swallow, and when, people are having difficulty swallowing that affects every aspect of their life. we're social creatures. And so, everything around revolves around us getting together with our friends and family and eating together and drinking together.

And so when people are having difficulty, that really affects them emotionally as well as physically. in terms of. Some of the effects of, swallowing difficulty. People who are having difficulty, either drinking or eating, a lot of the times will start losing weight. Their nutrition gets worse. their overall health gets worse.

Just like Luis mentioned earlier. difficulty swallowing can, result in pneumonia. As well as, getting really, sicker and not being able to move around. So basically all aspects of our life, is affected by difficulty swallowing.

Joey Wahler (Host): And you make a great point there, Alexandra, about the fact that swallowing certainly one of those things that most of us take for granted until it's not working the way it's supposed to. Right. Correct. So Luis, how do you two and yours go about diagnosing swallowing disorders? As in, does someone have one?

And if so, which of those types that you covered?

Dr Luis Riquelme: Right. So Alexandra and I are, both speech language pathologists, who often, lead teams, regarding swallowing, but we do work within a multidisciplinary environment. And so we work, very collaboratively with ENT or, otolaryngology, with gastroenterology, with our colleagues in nutrition. in neurology, other medical specialties, certainly oncology and occupational therapy as well.

So, typically, we start off with what we call a, a clinical exam, which would be the office exam or the bedside exam if the patient is in the hospital, where, as speech pathologists, we review the history, we interview the patient, we. Try to ask questions to figure out what's happening.

And then we do a cranial nerve exam, to see how the structures are working, how the nerves are working. we also check voice, we check respiration. we check the patient's cognitive status. Are they understanding? Can they express themselves, et cetera. All that ties in, right? Because the muscles we use for swallowing are also the muscles we use for talking.

And so, once we're done with the clinical exam, we then decide if the patient is ready And we need to further evaluate what's happening. usually during that clinical exam, we also do a few trials with liquids and a few different, textures, to see how the patient's responding. But if we need more information than that, then We would, conduct an instrumental exam, is what we call it.

It could be a video fluoroscopy or modified Merriam swallow, which is, an x-ray for swallowing that the patient is seated. We give them different liquids and foods that are coded with. Barium so we can see it on the movie that's created right with the x-ray, and really determine where the problem may be.

or we might do an endoscopic exam, where a. a thin tube with a camera is passed through the nose, looking down then into the throat, as, the patient drinks or eats to try to figure out what's happening. And then after that, we can determine, what's happening. we think of dysphagia as a symptom of something.

And then that's where the coordination starts, right? What's the plan of care? What can the patient manage right now that's safe and efficient? And then. Do we need to start doing some direct neuromuscular therapy or take some other approaches, to improve those muscles and improve that swallow response? Also, might the patient need to go see their neurologist for some medication adjustment?

Do we need to, have the patient see gastroenterology or ear, nose and throat to further evaluate? so the puzzle starts. Um, kind of coming together.

Joey Wahler (Host): Gotcha. And so when you talk about plan of care, which you mentioned Luis Alexandra, how about treatment options available for swallowing disorders And the role. Essentially that speech pathologists like the two of you play in that process?

Alexandra Soyfer: the role that the speech pathology plays is, starting, like Luis mentioned with the evaluation And then continuing with management and treatment. And so, it's important for. People who are having difficulty swallowing to continue following up with a speech pathologist. So, we can provide them with, exercises that might be beneficial to improve their swallowing.

we also provide support to the families to make sure that the patient's are able to continue to consume safe and efficient diet. and, the least restrictive diet that we can possibly provide for the patient's. We, continue to reassess constantly and see if the patient's are eating the diet that they, can be eating or if we're able to give them a little bit less restrictive foods and liquids.

And so we here at Maimonide have, outpatient centers where we provide, Speech pathology services for pediatrics And for adult patient's, with all kind of, difficulty swallowing as well as speech and language deficits.

Joey Wahler (Host): And you mentioned family there, Luis, what about the importance of family members or other caregivers offering support, dealing with this condition? How can they be of help during this whole process?

Dr Luis Riquelme: Oh, totally essential. and honestly in our field, there's more and more literature on the important role of caregivers And also making sure we pay attention to, our caregivers from the point of the premature baby that's in the NICU and is being cared for by the medical team. That includes speech pathology and occupational therapy, and working with the parents and helping the parents work through some of their fears as the baby gets better.

All the way to geriatrics where we have, loved ones parents, family members, spouses, that are at-risk for malnutrition and dehydration because of their swallowing disorder. the role the family plays is just. Essential in maintaining, better health. and as Alexandra mentioned a bit earlier, also the psychological impact, right? So how do families stay together and still celebrate with food and, liquids, that everyone can enjoy?

Why? we need to make sure that the person with dysphagia isn't kind of set aside And so can't partake in some of those events. the goal is that they can continue to socialize And that we can provide the appropriate diagnosis and help, which is why the team effort is so important.

Joey Wahler (Host): Absolutely. Couple of other things for the two of you. First, Alexandra, I would imagine you both have many of these, but is there one particular recent success story you can share with us about someone that needed this type of help and wound up getting it and, basically the job that was intended was well done.

Alexandra Soyfer: well, I definitely have a lot of stories that I can share. but, I can tell you about one patient that, actually, one of my specialties is working with patient's who have had head and neck cancer. and some of these patient's end up with a surgery That is called ectomy, where their larynx is, fully removed and, As we know, our vocal folds are in the larynx, so they're not able to communicate and vocalize after this kind of surgery.

however, there is a prosthesis That is placed, into those patient's that provide them opportunities to, fate and communicate. And so I personally work with these patient's. Who after going through this kind of, treatment And this, very extensive surgery, actually are able to get their voice back. So, I've had several success stories with these patient's where they are able to, fully continue to lead independent life and continue to communicate and even go back to work.

Joey Wahler (Host): That's awesome. And Luis, for you in summary here. How about the potential risks if this condition is left untreated, and what's your best advice for anyone joining us that may think they possibly have this issue but they're not sure and they've been hesitant to seek treatment for whatever.

Dr Luis Riquelme: So first I'll share with you that dysphagia is one of those, you know, the hidden problem, right? and although we know from some of the literature in geriatric medicine that it's one of the more common complaints, the patient might mention, oh, I'm kind of clearing my throat with liquids a little more often than usual.

It's usually, oh, okay, then, you know, just do this or do that. sometimes they're even advised to start thickening things, which, um. Is inappropriate because we really need to find out what's really causing that little throat clearing. and I think in terms of, thinking about risks, the major risk here of that, if the swallowing problem isn't evaluated and treated properly, the person might end up, with a recommendation for a feeding tube.

and again, there are people that might need those. however, can they continue to eat some things safely, and efficiently, by mouth to continue to enjoy not only food, but also produce saliva. We know saliva cleans our mouth. We know that also helps us with, what's called pulmonary toileting, which is keeping then our respiratory system in better shape.

all this ties in. I would say that, if someone is feeling like, I said, there's greater effort or greater need to swallow more often, during a meal, or through. Stroke clearing or voice changes, during the meal or even right after. checking with, their general physician and getting a referral for a swallowing evaluation is not a bad idea.

at Maimonides we have our rehabilitation. Centers. And we can be reached at 7 1 8 2 8 3 8 9 6 1, for an appointment. if, the, referring physician is more comfortable, they can certainly refer the patient to ENT or to gastroenterology. we work very closely with those two services, here at Maimonides and actually have a monthly, multidisciplinary team meeting.

Where we discuss cases that we have shared, throughout the month. So there's a lot of back and forth, between the other specialties as well, And that includes neurology and radiology and a few other's. So, Right now, I feel that in the United States, no one should be, walking around with complaints of a swallowing problem that hasn't been taken care of.

a good evaluation and figuring out what the options are for improvement for treatment, are readily available. they're supported by signs and they're supported by our healthcare systems. So important to do that.

Joey Wahler (Host): Valuable information. Indeed. Folks, we trust you are now more familiar with swallowing disorders. Alexandra Luis, keep up all your great work and thanks so much again. Thank you. Thank you. Absolutely. And for more information, please visit MIM o.org or follow on social media at MIMO Health to make an appointment.

As Luis mentioned, a reminder, you can call 7 1 8 2 8 3 8 9 6 1 or use the patient app. MIMO Care. If you found this podcast helpful, please do share it on your social media. To listen to additional episodes, please visit MIM o.org. I'm Joey Wahler, and thanks again for being part of MIMO Med Talk.