aspirations

[Sequoia]

Hello Forum Family! I need to hear how those of you who first started to aspirate experienced this. I have been coughing when I eat...it is a dry hacking non-productive cough..like an automatic reflex. It doesn't happen every time. Is this the beginning of the wind pipe relaxing, loosing its control? The odd thing is, I can drink any liquids and no cough, no problem...but when I eat I cough! I thought that aspirations came first with thin liquids, which I have absolutely no problem with.I have heard that post nasal drip can cause this, and so can the beginning of GERD.
Thanks for your feedback!:mrgreen:

 

[Sequoia]

It's getting kind of lonely here...did i post in the wrong place?

 

[susanf]

Hi Sequoia,
Have you had a barium study yet?

 

[michael0314]

I have never had that I have as you described trouble with liquids. Occasionally it feels like something doesn't clear the airway in my throat. That however feels like choking, not coughing. Sorry I'm no help

 

[HelenL]

Hi Sequoia, I just saw this today, but am afraid I can't help either... haven't gone through that yet luckily. I think Barry would be able to help you if you pm him?

 

[Sequoia]

thanks friends for responding. I have asked for a barium swallowing test and waiting for the doc to respond. I hope that will give me the answers I need.

 

[Sequoia]

Anybody else ever aspirate on food first, but not on liquids?

 

[notme]

Hi

Is the problem occurring as you are eating or right after? One of the first signs of difficulty swallowing is coughing while trying to eat.

While you wait for answers, you can try some gerd meds OTC and see if they help (with doc ok) but normally in ALS, I believe it is liquids that aspirate and cause choking early on.

It sounds like you are on the right track with asking for the swallow study. It could be totally unrelated to the ALS.

 

[rose]

Sequoia,

If you've not heard back from your doctor about having the test done, IMO you should contact the clinic you are seen at, and have them get the ball rolling.

Insist on having the modified swallow done. If nothing turns up, at least your doctors will have a base line for comparison.

I had aspiration pneumonia twice, and the first time it was not like there was just some single event that I could look back and and know when it was that I swallowed "wrong", it came on over a period of several weeks, I found myself coughing more and more, and when I finally ran a high fever, and actually went to the doctor about it, a culture revealed it was an infection due to aspiration.

Its not something to fool around with.

 

[Sequoia]

Thanks Notme and Rose for your input. Yes, I am coughing when I eat, but not everytime I eat, and have no trouble with liquids. Iwill get the modified swallow test soon, and keep tract of my temperature to be sure it is not pneumonia. Thanks so much!

 

[Sequoia]

Rose, am I getting this right? If you are coughing when eating it is a sign of possible small aspirations, which can lead to pneumonia? Thanks for clarification!

 

[rose]

Yes, if you are coughing when eating, it can be a sign of food or drink going to where it shouldn't go. Not necessarily aspiration. There are various levels of penetration. And they have specific terminology to rank this.

Food (in your case) might just be going in far enough to irritate and trigger the cough reflex, but not far enough to actually penetrate.

I think, generally speaking anyway, that thin liquid trouble is more an indicator of the epiglottis and/or vocal cords not closing tightly enough, and food problems seen more with a weak larynx and the swallow function of moving food down.

When you are seen by the speech language pathologist (who will conduct the test along with a radiologist) you will have a preliminary exam first, and he/she will observe how well your larynx elevates when you swallow, etc.

The actual test will include swallowing various thickness of barium laced food. You'll eat a cookie with some barium pudding on it, maybe have to swallow a pill, and also liquid from thick to very thin. Its not a hard test at all to go through. For the first time, they may want to take a couple of shots of your entire upper g.i. if that is the case, maybe no food after midnight before the test, otherwise, no prep at all.

 

[rcharlton]

Sequoia

Your coughing may be due to aspiration caused by a small amount of saliva trickling down your airway.

I have no problem chugging back liquids and eating most foods but will often choke on my saliva.

I like to think of it this way. When I am in eating mode I am focused on swallowing and protecting my airway. When I am not eating I am not concentrating as much on swallowing and clearing away what is in my mouth. Problem is that with PALS the epiglottis/larynx and muscles protecting the airway are weakened so that when we are not actually in the process of and/or focused on swallowing there may be some leakage of saliva causing you to aspirate.

In your case, what MAY be happening is that, just before mealtime, you have increased salivation and a miniscule amount of is leaking past your epiglottis/larynx (is that right?) triggering your cough reflex. Not enough saliva to be perceptible or to result in a productive cough but just enough to trigger a dry cough. While you are eating any excess saliva is cleared away when you swallow food so there is no choking or coughing.

This is just how I make sense of it - I probably don't know what I am talking about.

 

[notme]

Generally, if you're coughing when you're eating solids--there is something going on. Be sure you sit up when you eat, and eat small bites.

We teach our students that coughing when eating is a warning sign that there is an issue with swallowing--whether it's the muscles or something else.

Aspiration pneumonia is very serious. As long as you ARE able to cough it out when you eat, though--hopefully you won't have any major concerns in that area.

If you are home alone and DO choke, though--there are ways to help yourself.

1. Use a hardback book and do abdominal thrusts on yourself
2. (after you dial 911) 911 has to respond--first dial that number, than grab that hard back book.
3. go to and open the front door as you continue the abdominal thrusts.

If you choke and can't alleviate it--they need to be able to get to you quickly.

This is actually what I teach all my students when I teach CPR.

 

[Sequoia]

Thanks guys...this is really helping me sort thru this in a sensible way. I think I should go ahead and schedule the peg probably mid August.
I appreciate your help in thinking this through. I do sometimes choose to eat alone, but I think I should probably not do that, so I am closer to help if I need it. I aspirated once while alone and it took too long for the nurse to turn up as she is on the 3rd floor at night. I did hunch myself over with my head between my knees and it stopped the choking. But is was really scary, like you are dying, and it did go on a long time.
I hate the thought of getting the peg, and so I have wanted some kind of facts to convince me. You have done this for me and I love you for it!