Some weeks ago my mum ( 84, PD + dementia) began drooling. "Ah, another PD box ticked," I thought. I had been expecting the symptom to appear at some point.
Initially, it was not a great problem and I continued to provide her with her normal amounts of fluid/nutrition.
However, over a few days the drooling became much worse. Mum was hyper-salivating and there were hints of regurgitant in the drool.
Other symptoms rapidly emerged: coughing after swallowing fruity fluids, burping, some abdominal pain, and, most worryingly, a great reduction in her swallowing capacity.
Given all this, getting in fluids/nutrition became very challenging and over the course of perhaps three days mum's fluid intake dropped from c 1450ml/ day to c 800ml...and the persistent drooling became horribly destructive of her Q of L.
It became obvious: this was a case of reflux and not a decline in her functional swallowing capacity.
We are getting on top of the reflux and she's now back to 1150ml -1200ml per day and the drooling is much diminished.
Worth flagging this, I think. Searching for drooling on this site, I've seen a number of posters talking about very large amounts of saliva; others have mentioned things being much worse at night.
Classic drooling in PD is not a problem of producing too much saliva but of failing to swallow regularly (a thing non-PD folk do very frequently without giving it a thought.)
Therefore
If you produce very large amounts of saliva.
If drooling gets worse as the day progresses
If you have attendant heartburn, cough, burping, abdo pain.....
consider the possibility that reflux may be the principal driver - or a driver - of your drooling.
And, since we're here, I will not overlook the opportunity to jump on my hobbyhorse: reflux often goes hand in hand with, can be a downstream symptom of, gastroparesis / impaired gut motility / slowed digestion.
If you have PD, your digestion will be almost certainly impaired to some extent.
Therefore
If you are losing weight
If you are quickly full or readily sated at meals
If you think your absorption of levodopa is unduly compromised..
consider it very possible that you have gastroparesis/ slowed digestion and keep a very keen eye out for signs of reflux (and attendant hypersalivation/ drooling.)
HTH someone.
Written by
garygjs
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thx for this info. glad to hear u sorted it out for your mom!but im confused by one part here when you say : It became obvious: this was a case of reflux and not a decline in her functional swallowing capacity." How did it become obvious? Had u had experience or knowledge of reflux before or what? Appreciate a little clarification. TThnks!
Mum had some reflux symptoms perhaps eighteen months ago when she began struggling with gastroparesis...so I was already aware of the sort of symptoms to look out for. 18 months ago those symptoms were, if I remember correctly, limited to a persisent cough and a little post-nasal drip.
I should add that this time round she quickly developed a hoarse voice too......further confirmation.
Re swallowing capacity.
In the general course, mum has slight dysphagia. She drinks slightly thickened fluids and has soft solid foods very rarely. I fully expect that that capacity will slowly deteriorate over time.
However, with the reflux, she was suddenly unwilling/ unable to swallow small mouthfuls of thickened liquid that had presented zero problems just a few days before. (Reflux can, when bad, make swallowing very difficult even for your non-PD citizen .)
That decline in swallowing ability was so swift that it was clearly something more than the slow progression one tends to see with PD.
Complacency on my part, largely. And, on reflection, there were incipient signs of reflux for a perhaps a few weeks before the sudden deterioration. Signs I failed to pick up.
We overcame that bout of gastroparesis-induced reflux 18 months ago by getting her off a weak opioid and introducing a prokinetic (Motilitione).
Things have gone swimmingly for over a year. Zero reflux; constipation beautifully controlled; mum has been able to maintain a very healthy weight.
But over that year I have probably added, without giving it too much thought, to her digestive load.... quite a bit more omega 3....a touch more protein powder...all with the goal of keeping her at a decent weight, of maintaining physical robustness.
At the same time, given the dementia, mum is sleeping and dozing more. There is less time in which to cram in the nutrition, less time to reach the 14-1500ml/day fluid goal. So, say, instead of a 3 hr period of full alertness in which she drank 500ml...we now have a 2hr period in which she drinks the same.
In short, I think that her digestive system - even with the support of a prokinetic - has become overburdened.
And it all spiralled very quickly because - in spite of the early signs of reflux and of a digestive system that was beginning to protest - I dimwittedly pressed on and kept on plying her with liquids and nutrition.
Mum had little choice in that. Most folk with Parkinson's do. My guess is that some are - without giving it conscious thought - accomodating a slowing digestion, accomodating reflux or LPR. They are perhaps eating rather less at dinner. Not having an evening snack. Drinking a little less. Ordering takeaways less....all choices that could help keep a lid on reflux/LPR and gastroparesis.
And, all the while, they keep losing weight and just think it's one of those things.
"We are getting on top of the reflux and she's now back to 1150ml -1200ml per day and the drooling is much diminished. "
Bugger. Spoke too soon. I am managing the saliva production - and other reflux symtoms (compromised swallowing, hoarse voice etc) - but chiefly through limiting fluids to 1000-1050ml. If I press on above that, the saliva production is too much and greatly impacts QofL and mum's ability to fall asleep.
Aside the hypersalivation/ mouthfuls of liquid (also referred to as water brash), other symptoms of LPR/ reflux are evident: Post-nasal drip. Slighly compromised breathing....Respiratory difficulties are a feature of reflux and can present very real and urgent difficulties even to youthful sufferers.
It occurs to me that many of the respiratory difficulties suffered by those with PD may simply be a sign of reflux /LPR ( likely, a downstream symptom of gastroparesis) and not necessarily an indication of pulmonary / respiratory neuromuscular weakness (though such may also be present.)
I'm not happy with the present circs so am looking to take further steps.
This may include the introduction of another prokinetic..probably, and very cautiously, a macrolide antibiotic and/or dropping mum's Sinemet. The latter would not be an option for most but - peculiarly - mum has only ever slightly benefitted from exogenous dopamine and it may well be the case that, at this point, it is not helping at all....In the average citizen, Levodopa slows gastric motility...though that may not be the case in those with PD who obviously need and benefit from it.
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Botox for Drooling with PD?
practical suggestions for pwp and the 2am club......drooling
punch drunk and off time
Could I ask your opinion on my symptoms please?
"Awakening Experience"
