Monday, March 9, 2009

The Challenge of Eating

Many people ask me why I have difficulty eating. There are probably others who wonder why, but are either too polite or shy to ask. This post is for the curious as well as for others that may have a similar problem. As a bit of background, I had major cancer removal surgery in July of 2006. That surgery removed:
- a 7 by 2.5 inch lining of skin, muscle, and tissue within my upper throat area (and was replaced by tissue from my leg),
- a small portion of my tongue (including a major tongue nerve),
- my left lower jaw (which was replaced by a long piece of titanium and a bone, the tibia, from my leg), and
- last, but not least, half of my epiglottis.

Swallowing is a very complex anatomical mechanism. When it works well, like breathing, it happens effortlessly and naturally. The following link illustrates how the anatomy accomplishes eating and breathing. It is a motion illustration with the red flow representing the breathing and the green flow representing the food movement.

Here’s a still picture of the above link. I recommend using the above link however as it does a much better job of demonstrating how the epiglottis works.

After my July 2006 surgery, I had a tracheotomy that allowed me to breathe for about 2 months and a feeding tube that allowed me to get all of my nutrition for about 4 months. Obviously, it’s easy to see that my anatomy has changed. The rest of this posting described exactly what has changed and how I’ve tried to compensate for those changes.

First, the muscles and their associated nerves which controlled them in the back of my throat which help push food down the esophagus (which connects to the stomach) are gone. Second, half of my epiglottis is gone. A normal and healthy epiglottis moves with each swallow to protect the airway (trachea or windpipe) from food and liquids entering the lungs. Third, I don’t have the crewing power that I had before the removal of my lower left jaw.

There are techniques to eating which help me get food into my esophagus while helping to avoid having food or liquids going down into the trachea (which is attached to the lungs). Food and liquids going into the lungs cause one of two issues. The first is severe and immediate chocking which can cause almost immediate asphyxiation and death. The second is a slower process of illness which is a build up of food and liquid in the lungs which can lead to pneumonia. I’ve read many cases of people in my situation either getting pneumonia or giving up and going back to a feeding tube, or both.

My swallowing therapist a while back taught me to try swallowing using a chin tuck. This is where one takes food into their mouth, tucks their chin to their chest, and then swallows. I’m not sure what this does to the anatomy, but it helps me a bit. Unfortunately, it does not help enough. What I added to this technique is 1) eat in a reclining position, 2) take a breath and hold it before each swallow, and 3) focus intensely on what I’m doing. The result of this is that gravity replaces some of what the muscles in my throat used to do, a small air pocket is created in my trachea thereby helping to keep food and liquids out of my lungs, and by concentrating on what I’m doing, I rarely choke or aspirate. I’m sharing this not so that you can run out and try it, but maybe it can give you a few ideas to talk over with your swallowing therapist. What works for me may not work for you and in no way is an endorsement of something that you should try. We have all been compromised in different ways.

90% of my nutrition comes from liquids (e.g., Boost). The other 10% is a variety of foods, mostly soft and small, to avoid the likelihood of choking. It is not a particularly social way to eat (which is why I don’t eat in public), but it has allowed me to maintain my weight for 2+ years without a feeding tube. I chose to get the majority of my nutrition through liquids because it is easier for me then the intake of solid foods.

I hope this was helpful to some and educational to others.

Thanks for checking in. Take care of yourself.

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