Announcer: Welcome to an MUSC Health Podcast.
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing today Dr. Mark DeLegge, who is the director of the Digestive Disease Center at the Medical University of South Carolina. Dr. DeLegge, you have a lot of interests but I know that one of them is in the feeding of patients. Now, that encompasses a lot of things that most people wouldn’t think about. What are some of those procedures?
Dr. Mark DeLegge: The feeding issues do encompass a wide variety of patients. Some people come in and have lost their appetite. Other people come in and can’t swallow. We need to actually place a feeding tube. Other people have difficulties with their intestines where they don’t absorb food. And those patients actually end up getting intravenous nutrition.
Dr. Linda Austin: So, let’s start with swallowing difficulties because it certainly is common as one gets older. First, what causes swallowing difficulties?
Dr. Mark DeLegge: The most common causes are neurologic or from the brain, and what I mean by that is somebody had a stroke. You probably have heard of Lou Gehrig's disease. It’s called ALS, which can affect your swallowing. Multiple sclerosis, even dementia, where patients not only get confused as they get older but they also develop a problem with swallowing.
Dr. Linda Austin: I would imagine with that latter group with the demented patients that for a long time the family tries to help them eat and feed them by spoon, and then they get to a point where even that doesn’t work. Is that right?
Dr. Mark DeLegge: Correct. What happens is that patients actually forget how to swallow or have complete lack of interest in food, don’t even know it’s there. People who can’t swallow, their families would sit there and try to slowly feed them with, as you said, a spoon or perhaps small quantities, give them liquids, and they end up seeing the patient coughing, choking, sputter, and they worry about them developing what we call an aspiration pneumonia or materials from their mouth going into their lungs.
Dr. Linda Austin: So, let’s imagine there’s a nursing home setting, where chronic care facility where patients with ALS or demented patients having swallowing difficulties and you’re called to evaluate that patient. What are some of the things you look for when you’re deciding what kind of approach to take?
Dr. Mark DeLegge: I look very closely at their ability to swallow. And I’m often helped out by a speech therapist who can come in and do a bedside evaluation of someone’s ability to swallow. There are some x-ray tests too that can help me.
And what I look for is to see whether the problem is that the swallowing mechanism is completely gone or perhaps it’s just not working as well as it should work, and there are things that we can do to accommodate the patient, or to get the patients things to do to help them feed by mouth, even when they have some swallowing abnormalities.
Dr. Linda Austin: Such as what?
Dr. Mark DeLegge: Well, interestingly, if you sat back and I said, “Think about swallowing. What would be harder to swallow when you lost your swallowing.” You would probably say solids, meaning that you couldn't swallow a hamburger, or a piece of chicken.
But in fact, with these swallowing problems that patients with post-stroke or with dementia developed is actually more problems from swallowing liquids. And the reason being is, when you swallow liquids, it goes to the back of your throat very quickly. And you have to swallow very quickly.
And as you lose your swallowing mechanism, as you lose muscle control there, you choke and sputter. So it’s actually liquids that patients have the most difficulty with at first.
Dr. Linda Austin: So, if you had a loved one, for example, an elderly parent who is somewhat demented and was choking a lot, thi