Oh, sure. Here in what you HUMANS call the REAL world, I am hobbled by Parkinson’s disease. I’m unable to walk outside without the assistance of a cane, and even then I walk very slowly. My balance is terrible. I choke on food and liquid. Basically, I’m a slow, shambling wreck.
But in the VIRTUAL world… FREED from the restraints of your puny physical laws… I RULE! I am an ATHLETE! I am a KING!
Nay. I am a GOD!
Behold! And be amazed by my prowess with the sword!
Call me KING OF ALL SAMURAI!
Then BOW to me.
Unless, of course, we meet in the REAL world (so to speak) and I wet my diaper if you so much as raise your voice to me.
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My genius nephew, Tommy, of whom we all love and his sainted mother would be so proud, had a thing or two to say about the video I posted here earlier today. He’s a grad student, a future speech pathologist.
I just had 4 different speech paths look at your MBS. We all agree your epiglottis is indeed very naughty!
MBS means “modified barium swallow.” I asked him to elaborate.
I saw penetration with the thin and thick liquid, but no aspiration. (Although the movie is very fast…. most of the time we watch it slowed down) But that makes sense. It sounds like you have more trouble with liquids. Liquids move very fast, so if you have weak muscles the epiglottis will not close off in time for the liquids to pass. I would be interested to see the report. Did the speech path recommend a chin tuck when you drink liquids? That will make it so your epiglottis doesn’t have to travel as far.
I had to look it up to see what he was talking about.
The delineation between ‘laryngeal penetration’ and ‘aspiration’ has been better agreed upon recently, with the term ‘laryngeal penetration’ reserved for entry of materials into the laryngeal vestibule but not below the true vocal folds and ‘aspiration’ for when material passes below the vocal folds…
So, it’s like the epiglottis doesn’t keep the slop from getting into the TOP of the airway, but during the act of swallowing, that slop gets stripped out of the vestibule and down the hatch… as it were.
Tommy further elaborated that “swallowing” is “gross” and that he prefers to work with communication. But without “swallowing,” Thomas, how will one have the nutrition with which to communicate? Hmm?
Here are two videos, slowed considerably. The first is the thin liquid swallow, the second is the thick liquid.
I’m no genius, but I think I see what he’s talking about.
If you look carefully, you can see the contrast (barium) pass over the epiglottis and poke into the upper part of the larynx before being swallowed completely down the esophagus.
I did some MORE looking up. This from my friends at Viartis.
Silent Laryngeal Penetration is when material enters the top of the airway and is subsequently removed during the swallowing. People with Parkinson’s Disease who produced excessive saliva during the day were evaluated. Of those in which Silent laryngeal penetration or silent aspiration (SLP/SA) was observed, most developed respiratory infection. Some of them died of it. The authors claim that the results suggest that patients with Parkinson’s disease with diurnal sialorrhea (excessive saliva during the day) and SLP/SA have an increased risk of respiratory infections, which is the main cause of death in Parkinson’s Disease patients.
Oh, well. Gotta die of sumthin’.
Well, we figured out what the problem is. It’s not that I aspirate food and drink on every swallow. But, according to the delightful speech pathologist who fed me barium in various forms and explained the video she shot, there seems to be some weakness around my hyoid bone (the only bone in your body, by the way, that is NOT connected to another bone. Save that for your next Trivial Pursuit game) and my epiglottis — that flap that’s supposed to close off your windpipe when you swallow — closes enough (most of the time) to keep stuff out of my larynx… but it doesn’t close all the way! So, from time to time, when I’m not careful, some stuff is gonna leak through.
See, the muscles around the hyoid bone control the motion of the epiglottis. My hyoid is supposed to move up and forward further than it does. As a result, the way I understand it, the epiglottis inverts… but not completely.
Now — THE VIDEO!
And that, jolly readers, is that!
I will continue with my speech pathology and physical therapy in my ongoing effort to improve this thing that is me!
I feel like quite the little social butterfly all of a sudden! Not only do I have a physical therapy appointment tomorrow, next week I will have appointments on Tuesday, Thursday and Friday. In addition, next week Wednesday I will have the modified barium swallow that will determine what level of dysphagia (trouble swallowing) I have… if any.
I couldn’t believe how sore my arms and legs were last night. I guess that’s because I’ve been exercising muscles I haven’t exercised in awhile.
Check out the video. I demonstrate the three homework assignments I’ve been given. The hardest one is the one I call my “Big Boy Walk” where we attempt to lengthen my stride. I actually freeze up when I try to do this… as you will see…