Barium swallow test necessary?

[Lynk]

My local neuro guy has ordered a barium swallow test to get a baseline. I'm not sure what the point of this would be. I don't have a swallowing issue now and when I do it will be obvious. the test seems unpleasant and I wonder if people have this repeated later when swallowing issues do occur. Thanks for your advice on whether I should do this or refuse.

 

[nebrhahe53]

Actually the problem may not be obvious when it first starts. My first swallow test showed what they called silent aspiration, that is, I was passing a small amount of liquid the wrong way into my lungs and I had no idea it was happening. As things got worse it became obvious but by then you could develop a case of aspiration pneumonia, one of the two highest causes of death for us lucky people.

 

[gooseberry]

Exactly what Neil said. Steve had his baseline in February. It showed he was holding thin liquids over his vocal chords but with multiple swallows could clear them. No liquid in the lu gs. This lead to recommendations for thicker drinks, food co sistency changes, etc to keep him stable.

 

[tripete]

Interesting. I have not had this done. Do the thicker liquids also potentially help with the food/drink going into lungs or just the vocal chords? Are there other ways to help with swallowing symptoms?

 

[MaxEidswick]

>one of the two highest causes of death for us lucky people

yup

 

[gooseberry]

The thicker liquids apparently help things to go down the right way and not head towards the vocal chords/lungs. Since steve is respiratory onset with more bulbar symptoms showing they did one. Might want to ask Pete.

 

[Lynk]

Thanks for the input. I guess I will go ahead and get the swallowing test done.

 

[Diane H]

My local neuro guy has ordered a barium swallow test to get a baseline. I'm not sure what the point of this would be. I don't have a swallowing issue now and when I do it will be obvious. the test seems unpleasant and I wonder if people have this repeated later when swallowing issues do occur. Thanks for your advice on whether I should do this or refuse.

As others have said, the onset of swallowing problems isn't always as obvious as we think it will be. It is so gradual that we are often well into it before we realize that the normal occasional little throat clearing while eating is becoming a cough. Add to that our tendency (need?) to deny that there is a problem and we can waste a lot of time risking aspiration before getting info on how to minimize it at each stage of progression. If you are absolutely certain that you are not having any problem it would probably be ok to wait on having the test if your insurance won't cover it well enough. My experience has been that the tips on swallowing are helpful but no more than common sense in avoiding the foods that don't go down well. A repeat of the swallow study may be needed to confirm that you are beyond safe swallowing enough that nutrition is a big problem. That probably isn't necessary for insurance coverage of a feeding tube and formula but may be needed to push you from denial to decision making!

A barium swallow test is different from the test where they have you drink a big cup of barium and then do x-rays to see how it passes through the stomach and intestines. In a barium swallow test the point is to see how foods of different consistency are handled by all the phases of the swallowing process. Instead of the Barnium Big Gulp, you are given small amounts of various foods mixed with barium. As you swallow each type of food, the passage of the food through your throat is watched by x-ray radiography. The food isn't bad tasting because of the added barium, just a little blah. Of all the tests done on people with ALS this one is by far the least unpleasant!

 

[gooseberry]

Steve had applesauce, apple juice, I think graham crackers, and just the barium. Not sure if there was anything else. I wasn't in with him.

 

[nebrhahe53]

Not to mention if you are unlucky enough to have ALS in a few months what you start to experience will make the barium experience seem like heaven in comparison. I'm sorry you are going through this. I've had 3 swallow tests so far, doesn't even show up on the radar.