I had just dozed off to sleep last night when I was awakened by Java, my lab. She was perched on her bed, on a trunk, at the foot of our bed. The sound of her repeatedly licking her paws was keeping me awake. Finally, I turned on the light and instead I found she was licking her lips and then trying to swallow. Over and over.
I confidently thought to myself, "Hey! I should be able to take care of this!"
I clicked my brain back to my old days of dysphagia (swallowing) treatment at Stanford Hospital and began to work through an assessment and treatment plan.
1. Complete an oral mechanism exam. Check for foreign body or mass near the back of tongue that might be stimulating some sort of gag or swallow response. With repeated grasping of her slimy jaws, heaving them open and thrusting my hand to the back of her throat, I discovered-nothing. As she perked her ears and licked my hand, I judged her oral-facial symmetry to be wnl's.
2. Perhaps what is triggering this behavior is lower in her pharynx! Off we went to the kitchen where I gave her a dog biscuit to serve as a solid bolus swallow to clear any residue in the pharynx. There was much joy and celebration on her part at the presentation of the biscuit.
But, the irregular swallowing soon returned.
3. Okay. Next up. Outside to the water bowl where I encouraged her to drink. The plan here to present a thin liquid chaser or to begin a pattern of alternating liquids and solids. She obliged, drank and promptly drooled on my bare foot.
And yet, still the funny swallowing thing continued...
4. Mmmm. Like I would with a global aphasic, would I be able to nonverbally teach her a swallowing strategy? All she needed to do was to lap up a sip of water, put her head to her chest and then swallow so as to complete a chin tuck and hence clear the valleculae bilaterally. Or could she do a head turn to the right and effectively close off the right side of her pharynx, thus steering the bolus down the left side of her pharynx? That was a better option as it didn't involve me modelling lapping water out of the dog bowl.
%. After a bit I gave up on the idea of being able to teach her a strategy. I began to look up Maria Larrenaga's number to schedule a modified barium swallow when I noticed the odd repeated swallowing behavior had stopped!
No more. It was gone.
Good news for Java. Even though Maria is an angel, that barium tastes like shit-even when it's on top of a dog biscuit.