Swallowing difficulty (dysphagia) usually occurs late in PD, but may occur at any time and early on might be difficult to recognize. It can vary from mild (an inconvenience), to marked, resulting in significant weight loss. Some of the symptoms of difficulty swallowing include:
- Swallowing repeatedly after taking a bite
- Coughing and/or choking while eating (this results from food particles being swallowed into your trachea and lungs, instead of your esophagus and stomach)
- Changing voice (swallowing and speaking share many of the same muscles so a disorder that affects your swallowing muscles is likely to affect your speaking muscles as well)
- Drooling (this results from difficulty swallowing your saliva)
- Eating slowly
- Weight loss (the most common reason for weight loss in PD is difficulty swallowing)
Swallowing requires the coordinated action of many muscles, both voluntary and smooth. First, your tongue and jaw muscles prepare the food to be swallowed by chewing it and mixing it with saliva.
Then the muscles in the back of your mouth and throat start the swallow. They also seal off your windpipe and nose to keep food and liquids from backing up into them.
Next, the muscles of your esophagus propel the food into your stomach. Slow or rigid muscles at any level can result in difficulty swallowing. The same slowness and rigidity that affects the muscles in your arms and legs affects the muscles in your throat.
Understanding the mechanics of swallowing and educating yourself about steps you can take to facilitate the process may decrease your difficulty swallowing. For instance, people with PD unknowingly tend to bend or flex their necks when they sit, forcing themselves to look down. This makes chewing and swallowing difficult because your jaw is at a mechanical disadvantage.
However, raising your neck and chewing is much easier on your jaw muscles. One way to ensure this happens is to straddle your chair at meal times, which straightens your spine and forces you to look up. Another trick is to rest your elbows on the table, which will also straighten your neck and force you to look up. Lastly, if you have difficulty swallowing you can take your car-bidopa/levodopa in the form of Parcopa, which dis-solves in your mouth.
Take the Parcopa one hour before you eat so that when you’re ready to eat, the Parcopa will be at peak concentration and your muscles of chewing and swallowing will be at their best.
Swallowing difficulty is best evaluated by a speech therapist trained to evaluate disorders of speech and swallowing.