Anyone attending a Parkinson’s support group meeting or seminar will recognize the familiar sound of alarms going off signaling time to take medication. And what follows is a common sight. A pill gets popped into one’s mouth with a sip of water, leaving me to wonder: did that pill ever get to it’s intended destination? Or, is it stuck somewhere in the oral-pharynx or upper esophagus dissolving slowly and perhaps never getting to it’s intended destination in the stomach or small intestine?
A patient lying in bed in a hospital or nursing home is brought their pills.One by one they place them in their mouth under the nurse’s watchful eye, each taken with a sip of water. The nurse leaves the room and the patient falls back to sleep, leaving me to wonder: did that pill ever get to it’s intended destination? Or, is the pill stalled in the esophagus, slowly dissolving without the patient or nurse knowing.
DIED (drug induced esophageal damage) is drug induced injury to the esophageal mucosa and some drugs produce severe esophageal injuries that can be more serious or even fatal. Potassium chloride in some solid forms remains one of the most potentially harmful substances when retained in a fixed location within the esophagus, stomach, or small intestine, but over 70 drugs have been reported to cause esophageal injury.[i]
Age, motility disorders, reduced saliva production, and reduced mobility are all risk factors for DIED.The size and characteristics of the medication may also predispose to esophageal injury. Gelatin capsules become sticky or adhesive as they dissolve, when taken with inadequate liquids or are otherwise delayed in transit. Capsules taken when sitting by healthy individuals are normally cleared from the esophagus within 15 seconds if taken with water. If capsules become lodged in the esophagus they may be difficult to displace even with repeated swallows of water.
Unless an individual has undergone an instrumental swallowing assessment, they may be unaware of a swallowing problem including DIED, but they may have a history of taking pills before bedtime with very little water or complain of a feeling of pills “sticking” in their throat or chest, which should alert their physician or speech-language pathologist to the possibility of a pill related dysphagia.
Some General Recommendations Regarding Taking Medications
- All oral medications should be taken in the upright position whenever possible.
- Remain upright at least 10 to 15 minutes after swallowing to allow gravity to assist passage of tablets or capsules.
- If possible, at least 3oz (size of a Dixie cup) of fluid should be taken after each tablet or capsule. When possible, take medicine just before or with a meal. If you suffer from a dry mouth, additional liquid before and after you take your pills may promote safer transit.
- When the possibility of delayed passage of tablets or capsules through the esophagus exists or an individual is bed-bound),medications should be in liquid form or crushed and dispersed in adequate volumes of fluid whenever possible.
- Special caution is required with potassium chloride, especially the wax-matrixed slow-release form.
- If you have difficulty taking pills, ask your physician or pharmacist if there is a choice of medication formulation, small oval tablets are best; if large tablets are needed, these should be oval, not round. Capsules of high density (weight) pass more easily than lighter ones.
Do You Have a Swallowing Problem?
The prevalence of dysphagia (swallowing impairment) in people with Parkinson’s disease (PD) is reported to be between 72% and 87%, suggesting that the condition is common, yet, PWP do not always report swallowing difficulties unless asked. Patients with atypical Parkinson’s diagnosis such as PSP, MSA or CBD, are even more likely to have swallowing impairment as an early symptom of their disease, and a simple screening questionnaire administered by a neurologist or speech-language pathologist can help identify individuals at risk.
In my practice, we have begun to include an instrumental swallowing assessment on Parkinson’s patients who report drooling, as we recognize that sialorrhea is often an early or related symptom of dysphagia. In addition, patients who report coughing or “choking” when eating or drinking, food or pills “sticking,” patients with wet or gurgly sounding voices, and patients with a history of pneumonia or other upper respiratory infection related to swallowing will all be candidates for an instrumental swallowing assessment as a part of their treatment.
[i]Drug-induced esophageal damage: diseases of medical progress H.Worth Boyce Jr., MD GIE Gastrointestinal Endoscopy Volume 47, ISSUE 6, P547-550, June 01, 1998.
Participate in Research from Home: People with Parkinson’s Wanted
Resarchers at Purdue are currently recruiting people with Parkinson’s disease to participate in a focus group on assessing wearable devices and accessing remote services (telehealth). Participants must be an adult diagnosed with PD, be fluent in English, and have access to a computer or tablet with a web camera. Participants will be asked about their experiences using wearable devices and telehealth, the interview will take about 90 minutes, and participants are compensated for their time. (IRB 2020-1839)
If you are interested in being a participant for this study, please email the lead investigator Dr. Carolyn McCormick: firstname.lastname@example.org. Make sure to indicate which study you are interested in, where you live, and your phone number.
Telepractice and Online Coaching No Further Than Your Computer
Using your home computer or tablet device you can connect with me for an assessment, treatment, or coaching, including help with use of any Voice Aerobics product. If you are no longer driving, this can reduce dependency on a spouse for travel to therapy and put the power and benefit from treatment in your hands. I currently am licensed to provide services to people living in Florida, North Carolina, and Ohio. Learn more or contact me: https://voiceaerobicsdvd.com/voice-aerobics-private-practice/
My Mission: To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice