I've been having difficulty these past few weeks with my throat, muscles and vocal cords. I'm extremely hoarse, when I talk I get more hoarse and fatigued and exhausted. After I eat, about 15 minutes after I eat, I start feeling like I'm choking and have a chronic cough. I'm aspirating without a doubt. I have an appointment to get in to see my doctor but not till the 13th.
For my research, it's obvious I'm going to need some help from a speech pathologist. And probably at ENT until then. I've read that I need to eat soft food. Sit straight up when eating. Don't talk. Take small half teaspoon bites. In between the bites. Drink liquid. And I need to buy a thickening agent for my water and tea. I do not have trouble swallowing my food. I do have trouble swallowing once the choking and coughing. Begin. Then it feels like my throat is closing down on me. As the muscles tighen and constrict.
Currently there's nothing wrong with my voice other than the hoarseness. In other words, I speak loud and clearly. I do not have a soft voice. Though. Sometimes I do slur my words. Or I stutter. The biggest concern is the aspiration for me.
If anyone has gone through this and has any advice until I get to my doctor, please let me know. If it becomes serious. Of course I'll go to ER but I'm currently staying in a rural area and the nearest emergency room is not close by. And there is no urgent care where I am.
Thank you for any advice or help you can provide
Margie
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LVST Loud exercises might help to some degree but it seems like it is important to have a thorough evaluation. LVST is to help speech but it may also help with strengthening the throat muscles.
"Diagnosis of swallowing disorders may be accomplished in a number of ways:
An interview, examination of the structures of the mouth and throat and observation of normal eating and drinking behavior together with information about an individual’s medical history is often the first step in the diagnostic process and is known as a clinical evaluation of swallowing.
Another exam may be conducted in which an individual eats food and liquid mixed with barium and is observed with X-ray known as a videofluoroscopic swallowing study or a modified barium swallow.
Another exam is conducted with a small, flexible scope which is passed along the nostril and allows visualization of the throat and voice box during breathing, voicing and swallowing. This is known as a fiberoptic endoscopic evaluation of swallowing or FEES study.
Treatment of swallowing disorders usually involves a number of elements including:
Strategies for the individual and/or caregivers regarding the best position, speed and method for eating/drinking
The best diet and textures/consistencies to avoid choking or aspiration
Exercises designed to increase the range of motion, speed and strength of the muscles involved in swallowing
Electrical stimulation of weakened muscles may be used to enhance the effects of a home exercise program, in some cases
Biofeedback, a technique in which an individual can monitor their swallowing behavior on a screen or on handheld device in order to better reach treatment targets"
Thank you very much! I'm sure my doctor will give me a referral to a speech pathologist, or ENT or both. I've heard of LSVT and was not sure this was the proper treatment for me since I can successfully use my voice in terms of articulation and loudness. The Hoarseness and choking being the predominate issue. I've read there are a few things I can try until I can get into to see someone. Food needs to be very small bites and soft or puree. I'll try some of these exercises for the LSVT. I saw a speech pathologist prior to my PD diagnosis as it was a prodomal symptom for me. I was sent to an ENT who sent me to a speech therapist. The technique she was using, singing and vocalizing, worsened my hoarseness to the point that my throat just shut down. Same thing is happening. If I talk too much or sing or exercise those smooth muscles, my throat tightens and closes. I feel like I'm choking. I'm in a rural area and no urgent close open and ER in another city.
I'm sure the specialist will know best what you need but my husband does the LSVT exercises and they did seem to provide some help for swallowing and his vocal cord evaluation was good but the LVST seems to help maintain the voice strength
"Please see your doctor to find out what is causing the difficulty of swallowing. If you have done that then you can do the exercises that we are going to do today to improve your swallowing, decrease drooling, and ability to open and close your mouth.
If you have this problem then you are at risk of aspirating which will again send you back to the hospital. So it is necessary to address your swallowing problems."
I watched his video and I just wonder if swallowing is my issue since I feel I swallow food and liquids ok. Seems tho there is a delay in the response of about 15- 20 minutes when I start coughing and then choking and aspirating. Almost as if food is coming back up maybe but I don't feel the food in my throat. I'll keep researching and hoping I can get in sooner rather than later
hi! I had a similar issue and was sent for a swallowing test and esophagram, both were negative. I do work with. A speech therapist with the Parkinson’s Voice Project, similar to LSVT but different. I exercise my expiratory muscles with a device she recmmended online called the EMST 75lite. Choking, swallowing is a very real concern for us and should be taken very seriously as you know. But as my tesst were negative I really feel my own fear drives many of my symptoms. Parkinson’s Voice Project taught me a lot about doing things with intent. Being intentional in my eating and chewing has helped me. I was always a fast and furious eater, which is bad for many reasons. I hope you find some answers and techniques that help. A softening of my voice was a prodromal symptom for me, so the speaking out approach helped me. However my speech therapist sees many PwP and says weakening of the vocal folds is very common. I also have a friend that had esophageal stretching which helped for awhile
I suspect you have GERD (reflux). You may also have a swallowing issue so the referral to SLP is fine but you might see about an ENT referral as well. There will be some crossover to the ENT anyway (for medical clearance to begin voice treatment by the SLP) so it won’t be a waste of resources. When asking your doc for a referral to speech, see if they’ll refer you an ENT to rule out other issues and point out that ENT clearance is likely to be needed to start SLP anyways…
Good input. I too thought I should request first and ENT referral. I had GERD about 20 years ago. Sphincter valve not closing. Protonix was prescribed. After 3 heals it healed. But I still may have thought I don't experience heartburn per day
The fact that you’ve had it in the past reinforces my opinion. Whatever maladies were present before your diagnosis are likely to re-emerge (because they are an existing area of weakness). Reflux is a much more common problem in individuals with Parkinson’s than they are in the general population so that also increases your chances.
The delayed timing of the appearance of the problem some time after meals also points more towards a reflux issue than a direct swallowing problem (although both can occur and I strongly urge you to continue with your thoughts about seeking referral to an SLP).
Normally, I would expect the “aspiration“ indicators (coughing, watery eyes, sometimes runny nose) to appear very soon or even immediately after you swallow as liquids and bits of food escape your body’s natural defenses and get into the general region of the airway, triggering the coughing.
However, it is Parkinson’s disease so that means anything is possible, which is why I think you’re smart to seek out a referral to an ENT and an SLP. In the meantime, you could experiment with a reflux-friendly diet that improves things somewhat in the run up to your ENT consult.
I got in to see my primary care doctor today about my symptoms. There are no ENTs in this rural area that will run the tests she felt I needed nor do much for my situation. She felt that 'maybe' I might benefit from speech therapy but she did not feel that was the place to start. She referred me to a Gastroenterologist and wrote up an order for an x-ray esophagram (barium swallowing test). We'll take it from there and see if there is anything structural going on and rule out esophageal stricture. This is what she is suspicious of based on the presentation of my symptoms. I wonder how many PD patients are referred to a Gastro over an ENT. Or is it just assumed for swallowing, choking, coughing in PD you go the route of ENT/Speech Pathologist? I like the route she is taking.
I have had trouble with hoarseness, & coughing when my dopamine level is too low. Several years ago, I aspirated food 3 times in one day before realizing it was my low dopamine. It seems to control almost everything and swallowing becomes a fine motor SKILL that we kind of don't have without it. Now I am more careful. If the first bite doesn't work well, I go take some fava pod tincture and wait maybe 8 to10 minutes before starting to eat again. Then, the throat works properly.
I try to eat after my medication, about 1 hour after. I could try a bit more juts to see if in fact it effects my throat. I had read because the throat muscles are smooth muscles that they don't respond as well to levodopa.
One thing I'd like to add to all this good information comes from my husbands speech therapist who says everyone over 60 should do this easy exercise every day to reduce aspiration risk and strengthen throat muscles - take a small sip of water and do a 'hard swallow' - where you can hear it (and feel it) in the back of your throat. He says do it 3 x a day, 30 times each. I put notes around to help both of us remember to do it. When HWP was in hospital for aspiration pneumonia, the speech therapist also recommended this. Hope it helps, any issue with swallowing can be scary and painful. Cheers to hard swallows!
I am so sad reading all this. My husband is in hospital right now with aspiration pneumonia, had the video fluoroscopy and everything was going into the lungs. Your story is so like my husband’s. Once he got to hospital everything went downhill fast! Drainage tube inserted into cavity outside the lung to drain fluid, yanked out when they were turning him in bed, emergency button pressed because his blood pressure plummeted, hospital tried to cover-up by saying 3 times that my husband pulled the tube out etc etc. Sorry to rant. I could tell you more but it’s too horrible.
He’s been in there since 2 December.
Don’t want to scare you but do as many exercises as is humanly possible!
And clean your mouth every 2 hours, we’ve been told. If there’s bacteria in your mouth and it goes to your lungs, then the pneumonia takes hold but if your mouth is germ free you have a much better chance.
Re-read everything Boscoejean has written!
Sorry this is all over the shop… I’m exhausted as I spend approx 8 hours with him daily.
I wish you every success with your throat exercises 🌷
Jenny I'm so sorry to hear about your husband the trauma you both are going through. How horrible for you both. Thank you for sharing your story for others to read and be aware of. 🙏
I forgot to say with all the coughing my husband was doing he was sore under the rib cage. He had this for a couple of days as we didn’t realise at the time it was the aspiration pneumonia, please be aware of this. And he didn’t have a temperature.
Thank Jenny. So it seems that aspiration pneumonia doesn't necessarily come with a temp. I was checking my temp keeping an eye on it for some infection. I did go to Urgent Care over the weekend because I was up till 3 am in the morning coughing and choking so badly I could hardly breathe. It was a good 8 hours after I ingested food, so there was no connection to swallowing or food and my symptoms. It was horrible. But I wanted to get my lungs checked for pneumonia just in case. They took an x-ray of my lungs and said they were all clear. no signs of pneumonia.
Today I saw a local primary care Dr who is referring me to a Gastroenterologist and wrote an order for a barium esophagram. She feels this is the best route to take, over an ENT. In this area there are no ENTs that can perform tests so she is taking a different route. I just hope I can get some assistance of some kind. Though I too realize, this is all part of PD and there is no Magic bullet fix. We have to take things into our hands sometimes and do what we can on our own.
Good Luck to you and your husband. I'll be thinking of you. I hope that he will be home soon to be with you. If it were me, I'd say, pull these plugs because I'm going home!
We must have caught it in the early stages so therefore no temperature.
After many many months of constant coughing, we found if my husband was propped up with pillows etc on a 45 degree angle and slightly on his side (more pillows stuffed under one shoulder) this helped tremendously.
It sounds like there is a light at the end of the tunnel for you. I’m so happy to read that, but please don’t take your foot off the pedal.
He desperately wants to come home and I feel mean but there are still things going on with him that have to be sorted. I’ll tell you another day, can’t talk about it at the moment 😢
Take care and please keep us posted on how you’re going because if this whole thread can motivate just one more person to do their voice exercises etc, and to avoid hospital, it’s worth it.
My heart goes out to you and what you have been through. I'm grateful you are brave enough to be vulnerable and share your story. It will help others along with the rest of the amazing contributions on this thread. 🫶🏼
Had evaluation along with a modified barium swallowing video test. After 6 weekly visits, the Speech Therapist recommended routine at home exercises and a EMST150 device that I blow into.
I feel that it has helped voice and swallowing in the past. Need to get back to using the Emst150 regularly again to help with swallowing issues.
Thank you for the feedback. What is a 'modified' barium swallowing test? I ask because I saw my primary care Dr today (not neurologist) and she wrote an order for a barium esophagram, but nothing about a 'modified' version. what's the difference? Were you seen by an ENT first? Gastroenterologist? What was your referral route to the Speech Therapist? Seems I'm going the Gastro route. One reason is because i'm in a rural area and there are no ENT's here, none that can do the type of testing my Dr wants me to have. And she wants to rule out other issues before assuming it's automatically related to PD. I'm thinking it's a multi layered issue, as it seems to be with us who have Parkinson's. And why we need a team of care providers working together - no one said this would be easy 😜.
I actually live most of the year in Washington east of Seattle, where I get excellent care. But I spend winters in a small rural area on the coast in CA. Healthcare here is not what it is back in Seattle. Finding specialists who understand all of the idiosyncrasies of PD is not easy.
The speech pathologist required the modified barium which uses a 'video' vs still xrays. The primary dr. made the correction to the order after we finally got SLP appt at the local mostly rural hospital.
Modified Barium Swallow (MBS): Also known as a videofluoroscopic swallow study (VFSS), this test focuses on the oral and pharyngeal phases of swallowing. It is designed to assess how well food and liquids move through the mouth and throat. The MBS uses a fluoroscope to take video X-rays of the swallowing process, allowing for a detailed examination of the swallowing mechanism.
This test is particularly useful for diagnosing dysphagia which my husband was diagnosed with, which I understand as a throat valve motility issue which may be different than your issue.
Also, this info:
Barium Swallow Test vs Esophagram:
A barium esophagram and a modified barium swallow test are both diagnostic imaging tests used to evaluate the upper gastrointestinal tract, but they have distinct differences in their purposes, procedures, and applications.
Barium Esophagram: This test is primarily used to assess the structural characteristics of the esophagus, including the detection of esophageal motility disorders, strictures, perforations, hiatal hernias, and other pathologies. It involves swallowing a barium-containing liquid, which coats the esophagus and allows for visualization using X-ray or fluoroscopy. The barium esophagram provides information on the anatomy and morphology of the esophagus.
Modified Barium Swallow Test: This test, also known as a videofluoroscopic swallow study, is designed to evaluate the mechanics of swallowing and assess the functional characteristics of the pharynx and esophagus. It is often performed in conjunction with a speech-language pathologist and involves swallowing various textures and consistencies of food and liquid mixed with barium. The modified barium swallow test helps identify swallowing disorders, such as dysphagia, and guides treatment and rehabilitation.
In summary, while both tests use barium and imaging technology, the barium esophagram focuses on the structural evaluation of the esophagus, whereas the modified barium swallow test assesses the functional aspects of swallowing and pharyngeal function. The choice of test depends on the specific clinical question and the patient’s symptoms and condition.
That's extremely interesting and helpful. Thank you for that. It's apparent the symptoms of coughing, choking, difficulty swallowing, hoarseness, short of breath, cross over into both domains of ENT and Gastro. Where to start? Should both be involved to ensure all areas of the upper digestive system are addressed - the esophagus and the pharynx - since one connects to the other. Why not do both tests in Parkinson's patients? When I see the Gastro after my esophagram, I will ask him about the test you had and why not do that as well.
Very good. I'll give this a read. There are so many possibilities. Most PD patients have GERDs. so no doubt in my opinion that's involved. And I don't have problems with swallowing. I can eat and chew and swallow just fine. it's about 10 - 15 minutes after issues can arise, however, my symptoms frequently don't involve food or drinking water or liquids. the choking, coughing and hoarseness can all worsen on their own. Hoarseness worsens when I talk. so it's complicated, I can see that. I'll have faith that I can work in collaboration with these doctors to figure it out. but all of the information I've learned on this thread has been so invaluable. I am no armed with information that will help me to advocate for myself and ask intelligent questions on my own behalf. I'm grateful for this community 🙏🫶
And, after all of this information there is the fact that Levodopa itself causes GERDs and motility issues. Man, we PwP can't get a break!
levodopa can contribute to GERD-like symptoms, including heartburn and reflux, even if the patient does not experience heartburn during eating. Here's how levodopa may be involved:
1. Levodopa and Gastrointestinal Side Effects
Levodopa is known to cause heartburn, acid reflux, and indigestion as potential side effects 156. These effects are likely due to its influence on gastrointestinal motility and the relaxation of the lower esophageal sphincter (LES), which can allow stomach acid to flow back into the esophagus.
Parkinson's disease itself often impairs gastrointestinal function, including delayed gastric emptying (gastroparesis) and reduced LES tone, which can exacerbate reflux symptoms 3.
2. Mechanism of Heartburn After Levodopa
Levodopa may worsen reflux by relaxing the LES or irritating the stomach lining. This can lead to episodes of heartburn that occur after taking the medication, even if reflux is not typically triggered by food.
Additionally, levodopa's common side effects include nausea and sour stomach, which may overlap with GERD symptoms 16.
3. Why Heartburn Occurs After Medication but Not Eating
When eating, the stomach produces acid to aid digestion, but if the LES is weak or not closing properly (a common issue in Parkinson’s), reflux may occur.
Levodopa taken on an empty stomach (often recommended for absorption) can irritate the stomach lining or increase acid production, triggering heartburn in susceptible individuals 35.
Management Strategies
Timing of Medication: Taking levodopa with a small snack (if permitted by your doctor) might reduce irritation without significantly impairing absorption.
Lifestyle Adjustments: Avoid lying down immediately after taking levodopa and consider elevating the head of the bed to reduce nighttime reflux.
Medications: Proton pump inhibitors (PPIs) or H2 blockers may help manage symptoms but should be discussed with a healthcare provider.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Does anybody fall asleep in their chair wake up choking/Coughing?
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