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    What causes swallowing difficulty after a stroke?

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Posted on Tue, 8 Aug 2017 in Headache and Migraines
Question: My brother in law had a mild stroke and is having problems with his speach and swallowing. He is also coughs a lot while speaking. Is their anything that will help him. His specialist is not even attempting to help him. What can I do?
doctor
Answered by Dr. Dariush Saghafi 43 minutes later
Brief Answer:
With strokes comes swallowing difficulty (DYSPHAGIA)

Detailed Answer:
I believe your brother will benefit from a thorough evaluation of his stroke by a neurologist and if possible a specialist in STROKE. Following a stroke if speech or swallowing seem to be involved then, we typically send the patients for an evaluation with the speech pathologist. They will assess the speech and determine what is needed in terms of a rehabilitation program based upon the types of vocalizations problems that are suffered. At the same time if the patient is known to cough, drool, or choke then, a speech pathologist or therapist can do a SWALLOWING EVALUATION. This generally, involves the use of something referred to as BARIUM which is swallowed and then, measured for how much penetrates or breaches the glottis (i.e. goes down the wrong way). If there is any amount at all that is ASPIRATED into the wrong passageway (i.e. the larynx/trachea) then, we will recommend measures to THICKEN up all foods and drinks. There is a substance called THICK-IT which is a powder that you can purchase in virtually all grocery and pharmacy outlets. You would add this powder according to instructions to anything of a liquid or thin consistency and stir. In a few minutes there will be a semi-thickened liquid which will be much harder to choke on when it is passed.

There are also techniques at how to swallow optimally in order to minimize the amount of food or fluid that is aspirated into the windpipe. These are generally taught to patients once they are cleared to swallow by their doctors.

If THICK IT is not available or if the person does not care for the taste of the substance then, one could resort to liquefying or blending foods to make them thicker. This is usually referred to as a PUREED diet and can be just as HEALTHY nad good for a person nutritionally......which goes down a bit easier but it's NOT FUN since it's mostly for people without teeth or babies......but it's an alternative to the THICK IT that is reasonable to try.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 15 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi 10 minutes later
The concern is that his medical insurance denied the speach therapist and with his speach and swallowing issues things have gotten a lot worse. He is getting discouraged. is their any way he can recover or at least can things improve. He is not getting much help from his neurologist at all besides getting informed that he had a mild stroke. is their anything that might help him.
doctor
Answered by Dr. Dariush Saghafi 9 hours later
Brief Answer:
So very sorry for the trouble he's having...ESPECIALLY with insurance

Detailed Answer:
There is always hope after stroke that things will improve and in general they do, however, the sooner one gets in with something like Speech Therapy or Swallowing Therapy and THE MORE the person not only works with the therapists during sessions that are scheduled....BUT PRACTICES at home....not just eating and drinking....but the actually techniques employed......the more likely he will be of having a positive outcome.

Insurance rejections for services can always be appealed by both patients and supported by their physicians. Generally, insurance companies will yield to evidence showing that a person's condition is deteriorating and in need of additional services. But this would have to be supported by the patient's doctor's input and recommendation for increased or additional services.

Swallowing and speech recovery can take time. Staying as physically and mentally active will also help MORE THAN YOU THINK in even the specific recovery of these functions so laps in a pool, walking a treadmill, getting apps on the computer that he can use to practice and help with vocalizations and sounds he can work with are all other ways to make the best out of the situation at hand.

If in the end you feel he is not getting the maximum amount of assistance from his present neurologist then, perhaps a 2nd opinion from another neurologist...perhaps from an ACADEMIC CENTER close by where they usually have more cutting edge information on therapies, strategies, and maybe there are even trials that he can get into for stroke patients that would offer him FREE medical attention and assessments as well as the advantage of the latest scientific breakthroughs that are in the pipeline for approval by the FDA, etc. I know that may sound like the "guinea pig" approach but again, I'm only trying to throw some ideas out there that could potentially improve his situation as opposed to just sitting and not doing much.

Stroke recovery with work and daily practice can take months and even years to get things back and running to an acceptable level.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 20 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi 1 hour later
Can he really recover. He is so discouraged and negative. Before he is able to see a speach therapist is their anything that can improve his way of life over the counter. I also started looking elsewhere since I don't know what else to do. I was given Dr. Kyo XXXXXXX a former associate professor from a school of acupuncture and oriental medicine.
doctor
Answered by Dr. Dariush Saghafi 6 hours later
Brief Answer:
Consider hiring speech therapist privately

Detailed Answer:
Yes, definitely, improvement is possible after stroke with proper guidance AND EXERCISE therapy. I can understand why someone would be as discouraged as you say he is, however, he must also remember that in order to GET BETTER...one's state of mind and mood must be READY to get better, make sense?

It's interesting that you mention an associate professor of oriental medicine because if you do end up seeing that person (whom I'm not familiar with by the way) I'm sure one of the first things that your brother-in-law will hear from the doctor is that in order for him to begin the healing process he will have to elevate himself as highly as possible and BELIEVE that he can get better. Makes intuitive sense, right?

How many times have you heard the expression that "You are who you believe you are?" Same idea in this case. Therefore, as a preface to virtually ANY KIND of therapy or help whether Eastern, Western, or otherwise.....patients MUST HELP us as doctors and other health care professionals by coming to the session, consult, or appointment, with a POSITIVE MENTAL ATTITUDE (PMA) and an intent to do whatever it takes. If not, then, a self fulfilling prophecy of failure is inevitable and then, the fight is futile.

What I mentioned to you THICKIT is in fact, over the counter and is the most commonly requested and used brand name item available in any pharmacy for the purpose of mixing with drinks and certain foods in order to make them less risky to swallow. Other OVER THE COUNTER solutions as I said before would be to blend or puree all the food he eats, and add some THICKIT to that mixture as necessary.

I can't comment on the utility of oriental medicine or acupuncture since I'm not expert nor do I know much of those fields when it comes to restoring strength and function in poststroke patients but if nothing else seems to be working I don't see it as a problem to try a few sessions. I know acupuncture seems to work for a lot of things that I've sent patients for such as headaches, insomnia, and chronic pain.

Cheers!

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 35 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

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Practicing since :1988

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