It was so great to be together in the Zoom room on Wednesday, September 6. Our guest speaker was Speech-Language Pathologist Susan Wranik, whose years of experience and extensive knowledge informed her talk on the swallowing challenges and vocal issues of Parkinson’s. She shared her enthusiasm, passion, and positivity with us, as well as her inspiring perspective on life.
According to Susan, everyone swallows 500-700 times a day. Every time we swallow, we stop breathing as the epiglottis seals the airway to direct food to the esophagus. So it’s important to eat slowly and develop a swallowing training program. “Don’t put your head back when you swallow or speak, which pulls and stretches the vocal cords apart and leaves your airway unprotected,” Susan explains, adding “And don’t move your head in any direction at all when you swallow.” To better understand the mechanics of swallowing, Susan sent the link to this YouTube video.
Aspiration occurs when anything other than air goes beyond the vocal cords, whether you cough or not. Aspiration pneumonia can occur when bacteria from your mouth gets into your lungs and grows in the warm environment. Good oral care is the best way to prevent aspiration pneumonia, according to Susan. She suggests rinsing your mouth out at least once a day with mouthwash.
100% of people with Parkinson’s will have swallowing issues. Some people just live with it and others cough and clear. Susan believes that dining and eating are one of life’s greatest pleasures. Since swallowing issues may be from a weakness that can be rectified, it’s worthwhile to have evaluated.
If you are having swallowing difficulties while eating, (1) take smaller bites; (2) chew thoroughly; (3) tip your head down a little and swallow 2-3 times, keeping your head down each time you swallow; (4) take a sip of a liquid before you eat and alternate sipping a liquid and eating. If you are having difficulties swallowing medication, put medication in jelly or applesauce, then drink a glass of water to distribute the medication into your system faster. Remember you only need to take one pill at a time.
“Drink your water,” Susan says. “You can’t have too much water.” Water is a good energy source and if you have to use the bathroom more frequently, it keeps you moving. Dehydration can cause sudden dementia. Oxygen deprivation at night can also affect cognitive status and if this is an issue, Susan suggests having a sleep study, which can be done in your home. Some people experience digestive problems such as heartburn if the upper esophagus sphincter isn’t opening or closing enough. To help alleviate, Susan advises remaining upright (at least a 45-degree angle) for 30 minutes to an hour after eating, avoiding spicy foods, and drinking lots of water.
A few of Susan’s closing thoughts on swallowing challenges: “All swallowing starts in the brain. Your mouth is your first and last frontier. Babies put everything in their mouths to explore their world. Swallowing is the most intimate and independent function over which we have power. You can’t make anyone else swallow.”
Moving on to vocal issues, Susan, who is a LSVT Loud certified clinician, tells us, “You want your voice to be clear and audible.” The major issue with the LSVT Loud program is it requires an hour a day, four days a week, for four weeks, to complete. You can also do the exercises on your own at home.
“Are you a night owl or a morning bird,?” Susan asks. Let your family know when you’re at your best instead of pushing yourself to accommodate others. Fatigue is a real issue affecting the quality of your voice. Susan says to keep LSD in mind when you speak: How you LOOK; what you SAY; what you DO when you say something. Much of what we hear comes from visual clues, such as a person’s facial expression. Practice smiling in the mirror every time you use the bathroom so your face doesn’t have that flat affect. A smile invites people in. For a rich vocal quality, opening your mouth improves voice resonance. To make your voice heard, move your lips and open your mouth. Over articulate. Aim for an audible voice without shouting.
Thoughts Susan shared throughout her talk which reflect her perspective on life:
- “Things move more slowly as we get older.”
- Say, “I’m worth the wait,” when stress slows you down.
- “Everything in moderation. Life is too short to live a life of self-deprivation.”
- “Remember word choice. Try “give me a moment” rather than “I forgot.” Instead of “end of life,” use “closing the circle of life.”
- “Parkinson’s is what we have, not who we are.”
Susan also shared this General Aspiration Precautions handout (PDF). Feel free to contact Susan with any questions or individual concerns. She is happy to be a resource for you. You can also connect with her through her website https://www.susaniwranik.com
NOTE: Our next meeting is on Wednesday October 4 and will be IN-PERSON in Reston. No outside speaker. Just-Us Share Time about our personal Parkinson’s journey. Details to follow.