TORONTO - Hundreds of times a day, John Bible is reminded that a bodily function so basic most people take it completely for granted could actually jeopardize his health, his life.
Bible can't swallow safely.
In order to route fluid or food from his mouth to his digestive tract, he must focus on the task, methodically activating a complicated process involving 25 different muscles in the mouth, tongue and throat. As a consequence, Bible takes much of his food and the fluids that keep him hydrated through a feeding tube.
And while most people swallow - roughly 1,100 times a day - to clear their mouths of excess saliva, he reaches for a Kleenex instead. He can't take the risk the fluid will go down his windpipe, carrying bacteria that could nestle into his lungs and trigger a bout of pneumonia.
Bible, 63, suffers from dysphagia, a condition which in his case was brought on by a brain tumour surgeons successfully removed in May 2004. Motivated by a desire to eat regular food again, he continues to make progress and can eat some soft foods and drink some thickened fluids. But he hasn't regained full control over his swallowing - and he doesn't expect to.
"I probably will never get to meat," Bible, who lives in Orangeville, Ont., admits, adding that learning to live with dysphagia has been a challenge.
"Initially when it happens you think 'Well, this will be gone in awhile.' But then the longer it goes on, where you can't swallow, it becomes - to be quite honest - it becomes depressing."
For people with dysphagia, the reflexes that direct fluids and food away from the entry way to the respiratory tract, the trachea, don't work properly. That allows liquids and food particles to be drawn or "aspirated" into the lungs - putting dysphagia sufferers at risk of developing aspiration pneumonia.
Dysphagia isn't a disease itself but a side-effect of a variety of diseases or conditions. It's common in people who've had a stroke or a brain tumour or who suffer from a neurodegenerative disease such as Parkinson's or Alzheimer's.
It also quite commonly plagues young children - those with cerebral palsy or who have suffered head traumas as well as kids born with some neurological impairments.
"We don't have precise figures but the guesses are that in Canada at any given time at least 200,000 people are experiencing swallowing difficulties," says Catriona Steele, a speech pathologist at the Toronto Rehabilitation Institute who is working on a project she hopes will make life safer for people with the condition.
Steele's work, being done in conjunction with biomedical engineer Tom Chau of Bloorview Kids Rehab, is aimed at finding a way to accurately identify a subset of people with dysphagia, those whose swallowing is so impaired they don't even realize they are aspirating liquids or foods.
It seems unimaginable. For most people, having something go down the wrong tube is a nasty sensation, triggering a fit of uncontrollable coughing - the body's way of expelling the unwanted material from the lungs.
But for some people with neurological damage, that defence mechanism doesn't kick in. They show no signs they are aspirating fluids or food; it's called "silent aspiration."
Because they are at elevated risk of developing pneumonia, spotting these people early is important. In the case of stroke patients, for instance, hospitals are supposed to conduct a swallowing test within 48 hours of a stroke to see if it's safe for the patient to take nutrition and fluids by mouth. But the test isn't precise enough.
