like, the patients really need this exposure.”
Humbert and Plowman point out that evaluation and treatment of swallowing disorders historically has not been taught to medical students or neurology residents.
This must change, says Michael Okun, M.D., chair of the UF College of Medicine’s neurology department.
“Aspiration pneumonia is a leading cause of death in multiple neurological maladies,” Okun says. “It’s amazing we haven’t paid attention to it.”
To build bridges across the related areas of expertise, Humbert and Plowman crafted the December think tank to bring together speech-language pathologists with UF experts in neurology, neuroscience and neurogenetics as well as anatomy, evolutionary biology, otolaryngology and kinesiology.
Participants pledged to incorporate screenings for swallowing disorders into medical training and address swallowing as part of treatment plans and research strategies for patients with neurodegenerative disorders.
“It was a neat mixture of minds to think about something that flies under the radar but is an extremely important problem,” said Todd Golde, M.D., Ph.D., executive director of the McKnight Brain Institute who served on the think tank’s scientific expert panel. “Two of our UF experts brought together a group of people to see what we can do and what the gaps in knowledge are to make a difference.”
One speaker made an impact as both expert and patient.
David Borchelt, Ph.D., is director of the UF Center for Translational Research in Neurodegenerative Disorders. A professor of neuroscience in the UF College of Medicine, he studies the types of diseases that often result in an inability to swallow.
In 2010, Borchelt underwent radiation to treat throat cancer and, near the end of treatment, required a feeding tube because he couldn’t swallow. Over the months that followed, he regained his swallow, but more than four years later he experienced “delayed secondary fibrosis,” or a hardening of the muscle fiber in his neck.
“When you swallow, there’s a little flap that’s supposed to close over your airway, and in my case that little flap is so fibrotic that it doesn’t close,” says Borchelt. “Now I do a lot of purposeful coughing to make sure I clear the airway.”
For him, eating has turned from a pleasure to a chore. Although he’s altered his diet to avoid raw foods to keep bacteria out of his airway and in favor of soft, calorie-dense foods, he has still ended up with aspiration pneumonia. He worries about getting it again. And Borchelt, 59, has lost so much weight he could fit into his high-school jeans.
“It’s more difficult to go out to eat,” he says. “I eat very slowly. Many, many minutes after everyone else is finished, I’m still trying to finish my dinner.”
It brings a new dimension to his work studying ALS.
“I’ve got a firsthand understanding of what dysphagia feels like,” he says.