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Almost 7 years ago, when I was brand new to the constantly changing, faceless group known as stroke survivors in the rehab facility, I was more absorbed with my lack of right-sided movement than with anything else. And I was on intravenous, plus a feeding tube for 5 weeks that injected “formula” directly into my gastrointestinal tract to keep me alive in name only. I had no appetite anyway because the noxious depression, accompanied by random seizures, kept on going, never stopping, even for mealtime.

After 5 weeks, I was subject to a swallowing test where, if I passed in the dimly lit room with an accompanying screen with video imaging to see if my throat muscles moved correctly, I could eat what is known as a mechanical soft diet, a collection of foods that disgusted me, just because: soft mashed potatoes smothered in gravy, jello, pudding, overcooked vegetables–those sorts of things, soft things. The first time, I failed the test. I wasn’t swallowing correctly and my tongue was going awry, but I didn’t even know. But a week later, I passed.

There was a separate section set up for all those who passed that test, the controlled feast as I called it, and across from each person sat a speech therapist taking notes on the progress while the people ate the mechanical soft stuff. It made me nervous and a little edgy, but I ate, albeit drooling with food occasionally falling out, little bits at a time to avoid choking, to keep the feeding tube removal on schedule.

So all tolled, 6 weeks, and then I could eat without the intent gaze of the speech therapist watching me, the feeding tube was out and, as I say in my book, the tuna sandwich, which I ordered first, never tasted so good.

You might take the act of swallowing for granted, but stroke survivors shouldn’t. Neither should anybody else. Swallowing, as I came to find out, is a complicated process where any one thing could go wrong. Swallowing food or liquid involves moving the substance from the mouth, down the back of the throat, through the esophagus, and into the stomach.

The condition is called dysphagia, when a food or drink substance that is swallowed enters the airways and/or lungs, sometimes resulting in pneumonia. In most people, aspiration (or the sucking of food or drink) would produce a ferocious cough, often expelling what is in there. In stroke patients, food or liquid could go down the wrong way, and they wouldn’t even be aware of it because of the paralysis. Thus, the test that was given to me.

    Suzanne Kowler, a speech and language pathologist at St. Mary’s Medical Center Acute Rehabilitation unit in San Francisco, says, “If all the muscles on one side are weak or paralyzed, it’s going to be difficult to chew. They’ll have something sticking on the right [or left] side of their mouth. Normally it takes about a second to swallow. Even a small disruption places that person at risk for aspiration into the lungs.”

    Through Kowler, I understood the test better. A diagnostic tool called a modified barium test, or videofluoroscopic swallowing study (VFSS), allows the therapist to watch a video in real time of a stroke patient consuming various liquids and foods.

    “We can see if the food is going into the airway or not. And we can see when the patient coughs if they’re effectively expelling food from the airway,” says Kowler. The test also demonstrates which muscles are not functioning.

      The National Institute for Health says aside from stroke, conditions like traumatic brain injury, cerebral palsy, Parkinson disease and other degenerative neurological disorders such as amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease), multiple sclerosis, progressive supranuclear palsy, Huntington disease, and myasthenia gravis could experience dysphagia.

      The overwhelming research says to eat slowly and don’t recline–or worse, lay flat on your back–when you eat. Eating shouldn’t be a hazard. But you already knew that, didn’t you?

      One more thing: I couldn’t drink water years after my stroke because it brought on a choking fit. The speech therapist said that water is “the thinnest liquid that there is–you have to drink a thicker substance.” After that explanation, instead of apple juice which was my only drink for the next year and high in calories, I switched to ginger ale. When I found out a few months later the ginger ale had high fructose corn syrup adding pounds, I diluted it with water. And then more water was added to the ginger ale.

      I went to a festival about a year after that, and all they had was water. I was so thirsty it left me no choice but to drink it, bracing myself for the coughing spell. And you know what? I didn’t cough, even one time. I’ve been drinking plain water for about a year now, and that diluted ginger ale was a blessing, the training, it turns out, to drink water again.

      Joyce Hoffman

      Joyce Hoffman

      Joyce Hoffman is one of the world's top 10 stroke bloggers according to the Medical News Today. You can find the original post and other blogs Joyce wrote in Tales of a Stroke Survivor. (https://talesofastrokesurvivor.blog)
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      8 thoughts on “Swallowing, a Simple Thing You Take for Granted

      1. I really appreciate you writing these blogs. They remind me of how far I have come. Two years ago I had a stroke and I woke up in a wheelchair being asked if my head hurt. I can't remember anything before that but I am thankful for that. I had to have a shunt put in my head to control the bleeding. I had no hair on my head and a drill hole in the front of my head. I remember not being able to hear my voice, but I was talking. This brings it all back so clearly. I had the feeding tube. The speech therapist and her aide would sit patiently by my side as I tried to eat the mush. I was so thankful when I finally graduated to the real food table. I still can't move my right arm or hand. But I will continue to try. I am back in physical therapy for the fourth time, but I will not give up. Thank you again.

      2. This just took me back to sitting in the wheelchair at the table two years ago with the speech therapist on one side of me and the aide on the other side, with me praying that I would get to move to the next table and be able to eat food and not mush. It took a few days but I finally graduated to the next table. Funny, I had Tuna too. I am so thankful that you write these. They remind me how far I have come.

      3. I did, Donna. All of it. I don't consider myself inspirational either. I'm just doing a needed job, albeit self-imposed, to get the word out. Thanks for your comments!

      4. Joyce, I had no idea you went through this. I have never had a stroke, but I do have Spina Bifida, and use a wheelchair, so I do know something about what you went through, having to be taken care of, watching what you ate and drink, and I can only imagine how difficult this must have been for you. Thank you so much for this article. It made me realize more just how hard it can be with someone who has had a stroke. I never knew anything about the swallowing issue. I'm not going to say, you're an, "inspiration", because I get that myself, and I personally don't think I am. I will say this; you are one strong woman. I admire your courage and strength. Take care, and God Bless.

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