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MSWA Bulletin Magazine Winter 18

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SWALLOWING AWARENESS GEORGINA HETT, MSWA SPEECH PATHOLOGIST YOUR VOICE MATTERS STEPHANIE PERKOV, MSWA SPEECH PATHOLOGIST If you were to search the date March 14 on Google, you would find that it is the 73rd day of the Gregorian calendar, the birthday of Sir Michael Caine, and a global day of celebration of the Greek letter and mathematical constant ‘Pi’. Keep scrolling, and you will read that March 14 was also Swallowing Awareness Day – an annual event created to bring greater attention to the significant impact that swallowing difficulties can have on an individual’s health and wellbeing. Each year, Swallowing Awareness Day has a new theme, 2018 reminded us that “Swallowing is Ageless.” This sentiment emphasised that dysphagia (disordered swallowing) can affect everyone from the youngest babies through to older adults and offered us a chance to reflect that swallowing difficulties do not discriminate – they can impact people at all ages and in all walks of life. Although changes to swallowing are common for people living with neurological conditions, they can be associated with a broad variety of other medical causes. Dysphagia frequently impacts people living with head and neck cancers but can just as easily be an unwanted side-effect of a urinary tract infection. A day of awareness offers the opportunity to acknowledge the impacts disordered swallowing can have on ‘getting on with life.’ Chest infections, choking, and reduced nutrition and hydration are some of the many indications that dysphagia is influencing a person’s quality of life. Increasing awareness can help people recognise that dysphagia can vary significantly in terms of appearance, severity and duration – it truly looks and feels different for everyone. One person living with dysphagia may experience difficulty managing their saliva throughout the day. Another may have difficulty swallowing effectively during times of fatigue. Some people may have difficulty breaking down food to swallow, while others may be at significant risk of choking and aspiration. From a positive viewpoint, increasing awareness of swallowing difficulties means we can also increase awareness about swallowing interventions, and those who work to lessen the effects of dysphagia on a person’s daily life. Intervention for swallowing difficulties forms a spectrum, incorporating approaches such as education, rehabilitation, compensation, caregiver support and the use of adaptive equipment. Approaches to interventions can focus on the person, their food and drink, or their environment. As part of a healthcare team, speech pathologists, dietitians, occupational therapists, nurses, and physios all have a role to play in lessening the impacts of swallowing difficulties on quality of life. Finally, to add a bit of fun to what can often be a serious topic, here are a few fun facts about swallowing that you might use to spread the word about swallowing awareness: 1 The word ‘dysphagia’ comes from the Greek root phagia, which means ‘eating.’ Other words that share this root include ‘phagocytes’ – cells that ingest bacteria, small cells and other particles, ‘phagomania’ – an insatiable craving for (or preoccupation with) food. 2 The average person swallows about once per minute while awake (more when eating), but only around 3 times per hour while asleep. 3 Swallowing requires the use and coordination of 26 muscles! 4 The average human tongue is about 3 inches long – that’s 7.62cm – measured from the epiglottis to the tip. The record for the world’s longest tongue is 3.97 inches, or 10.1cm. 5 Botox isn’t just for beauty – it can be used to help with excessive salivation, disorders of the oesophageal sphincters, and some voice disorders. 6 Although we often associate peppermint and spearmint flavours with relaxation and digestion, these flavours can trigger gastro-oesophageal reflux. Other ‘triggers’ may include: coffee, tea, chocolate, red wine, spicy and fatty foods as well as acidic foods and drinks such as citrus fruit and soft drink. 7 Saliva production varies from person to person. However, on average, a person produces 700ml of saliva daily. Also, saliva production lessens in response to a fight or flight response – that’s why people associate a dry mouth with feeling nervous. 8 Saliva is multi-talented – it protects teeth, allows us to taste, begins food breakdown, helps to suppress reflux and works to control lubrication and bacterial balance in the mouth. 9 Does my tongue look big in this? If you gain weight, so can your tongue. A high percentage of fatty tissue within the tongue can increase your likelihood of obstructive sleep apnoea. 10 Sword swallowing is one of the world’s rarest hobbies, which only a few dozen practice in the world. To complete this amazing feat, the swallowers must repress their gag reflex, slide the sword through the upper oesophageal sphincter, avoid the airway, repress peristalsis (the motion of the oesophagus), relax the lower oesophageal sphincter and allow the sword into the stomach! We exercise and choose to have a healthy diet to take care of our bodies, but what do we do to take care of our voices? For most us, we use our voice to communicate with loved ones, at work, and out in the community. We rely on our voice to assist us with socialising with others, asking for help, teaching or learning, and to participate in activities such as singing. People living with MS and other neurological conditions can find that the way their voice sounds and feels can change over time. This can depend on your health, how much you use your voice each day, and how you use your voice. For example, someone who needs to speak on the phone all day for their job uses their voice much more than someone who might only speak to friends and family for small amounts of time over the day. So how do we know that our voice has changed? You might find that your voice is sounding hoarse or strained, it hurts to speak, it’s harder to speak more loudly, or you might lose your voice with overuse. This may then make communicating with others more difficult or frustrating. So, what can we do to care for our voice, and help to preserve it? Just like we take care of our bodies, it is important for us to take care of our voice. Vocal hygiene is a term used to describe the habits used to support a healthy and strong voice throughout our life. Even if you are not having trouble using your voice at the moment, it is important to start using habits to care for your voice for now and for the future. Some important vocal habits to use are: • Drink plenty of water throughout the day to hydrate your voice box and lubricate your throat • Eliminate or reduce smoking, caffeine and alcohol as they can dehydrate the voice box • Avoid yelling or speaking loudly over background noise, and speak at a comfortable volume • Reduce coughing and throat clearing which can cause pain and aggravate the voice box • Try to restrict medications that dry out the mouth and throat • Schedule in vocal rest to allow your voice box to recover and rest • Use breathing techniques to relax your voice box and reduce strain when speaking • Monitor symptoms of reflux as they can irritate the voice box • Understand what behaviours and habits are hurting your voice and what you can do to care for your voice If you are interested in learning about your voice, or are experiencing difficulties in using your voice, please contact one of our Speech Pathologists on 9365 4888. 22 | MSWA BULLETIN WINTER 2018 MSWA BULLETIN WINTER 2018 | 23