Can any aspect of treatment increase tendency to choke on food liquid saliva? - 1264144

agent99
Posts:40

Hi cancergrace,
It's been a month or so since my last question. My sweetie (T2N1M0 NSCLC Adeno, 2TBI, NPH) completed adjuvant chemo (4 rounds carbo/alimta). His labs were "normal" throughout but he has had excessive fatigue and started loosing weight after the 2nd infusion. My sweetie who normally grins & bears it was vociferous about his fatigue so onc recalculated dosage for last infusion reducing carbo by 25 units and alimta by 50 based on weight loss. During chemo he dropped around 20# but continues to loose although he won't agree to be weighed his pants appear to be on the brink of falling down. I am preparing high calorie meals that are only causing me to gain weight. His 6 month post robotic right pneumonectomy ct scan is in early July. At last post-surg follow-up none of his organs appeared to have shifted except his esophagus(?) had developed a curve but was not considered responsible for what I am going to ask about.

After 2nd TBI, June 2012, he had to relearn how to swallow. Between then & lung ca dx in 12/2013 he would occasionally choke on liquids. Coincident with chemo his choking increased dramatically (at least daily) to include food and saliva even while sleeping. Roughly a month since last chemo and choking started to happen less often and has now decreased dramatically but not back to "normal" frequency yet. TS PA said a swallow study might be advisable if choking didn't abate. Finally my questions are:

Is choking a side effect of chemo? If so will it stop?
I guess no choking is the ideal but how much choking would justify a swallow study for a person with one lung?

Off subject, but would like to announce that he has no scheduled doctor's appointments for a month. I feel liberated, my mood has improved and both of us are looking forward to this so called vacation! No offense to medical providers. It's truly a love/hate relationship.

No need to answer right away. Thanks in advance, Lisa

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Reply # - June 2, 2014, 06:03 AM

JimC
Posts: 2753

Hi Lisa,

There are so many factors present in your husband's situation it can be difficult to assign blame for his symptoms to just one of them. As the American Society of Clinical Oncologists states on its website:

"Dysphagia (difficulty swallowing) occurs when a person has trouble getting food or liquid to pass down the throat. Some people may gag, cough, or choke when trying to swallow, while others may have pain or feel like food is stuck in the throat.

Causes

One cause is the cancer itself, especially throat or esophageal cancers, which can cause the esophagus to become restricted or narrowed. It is also a common side effect of some cancer treatments, such as chemotherapy, radiation therapy, and surgery. Side effects of cancer treatment that may also cause swallowing difficulties include:

Mucositis (soreness, pain, or inflammation in the throat, esophagus, or mouth)
Xerostomia (dry mouth) from radiation therapy or chemotherapy
Infections of the mouth or esophagus from radiation therapy or chemotherapy
Swelling or constriction (narrowing) of the throat or esophagus from radiation therapy or surgery
Physical changes to the mouth, jaws, throat, or esophagus as a result of surgery"

- http://www.cancer.net/navigating-cancer-care/side-effects/difficulty-sw…

Most side effects from chemotherapy diminish over time after treatment, although for some patients they can linger for longer periods. Thankfully, your husband's choking problem seems to have abated significantly after chemo.

As far as a swallow study, I don't think there's any specific threshold for when to recommend it. It would be a question of how bothersome is the current frequency of choking episodes, what conditions his doctors feel the test might reveal and whether there are good remedies for such conditions. Those would be issues worth discussing with his doctors.

I hope he continues to improve.

JimC
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Reply # - June 2, 2014, 09:56 AM

agent99
Posts: 40

Thanks Jim. More often than I would like to admit I'm debating whether to call neuro, onc, TS or just watch and wait. I really need a home MRI or CT scanner. Hubs sounds and looks very uncomfortable when it happens. I'm ready to do heimlich. He has been able to clear whatever on his own so far. I'm so worried about aspiration pneumonia. It will take an act of congress to get him to agree to another test. Just had another scary worry - is heimlich even appropriate for a person with left lung??

Reply # - June 2, 2014, 01:31 PM

catdander
Posts:

Hi Lisa, you said, "I am preparing high calorie meals that are only causing me to gain weight." OMG, that's the exact same side effect I'm experiencing with trying to find things my husband will eat. Unfortunately I've gained over 30 pounds and he's still 20 under. And he's almost 2 years since chemo and over 4 post surgery.
I found it difficult to find his new eating habits, new tastes, and patterns. All seasoning has to be less than normal and packaged and fast foods are mostly out (though, fast food was in during chemo).
If he weren't such a thin man to begin with it wouldn't still be an issue. But we continue and that's great.

When the conference calms down we'll get you an answer about thoughts on the esophagus but it's probably something his surgeon needs to address. If you're worried his airway may be blocked by one of his choking episodes than please contact his docs office asap as that's an emergency you want to avoid having second thoughts about.

Janine

Reply # - June 2, 2014, 08:47 PM

Dr West
Posts: 4735

I think this is about 100x more likely to be due to a mechanical shift in the esophagus after the pneumonectomy than due to chemo. It's exceptionally unlikely to be from chemo -- almost unprecedented. Meanwhile, there is evidence that the esophagus has been contorted from the surgery. I don't know how someone could dismiss what I would interpret as the overwhelming probability that esophageal issues, likely caused from mechanical shifts after surgery, are causing his swallowing difficulty.

There is no unit of choking above which we worry, but below which we're fine. It sounds like you're concerned enough that a swallowing evaluation would be very appropriate.

-Dr. West

Reply # - June 3, 2014, 07:22 AM

agent99
Posts: 40

Thank you Janine & dr. West,

Dr. West, if I may be so bold to say that when I read your comment, "I don't know how someone could dismiss..." I saw steam coming out your avatar. May be you should attach not such a smiley face for some of these posts. I concur with you 100% and I try so hard to communicate concerns before appts by emailing within the fancy med records system they tout or sending explicit letters stating why I am bringing my husband to them for consultation only to find out at the appt they couldn't help before we stepped in the door. This has happened to us at the community health care level and hate to say it, more so at the top notch tertiary cares with docs that are heads of centers and have so many endowed chairs I can't imagine how they decide which one to sit on each day! Kidding aside, I have been asked by these docs if I was a doc so I am a pretty savvy advocate and exhausted caregiver. It is so difficult especially when patient does not want to go to another doc appt. I keep a phone nearby and think I will train our dog, chaos, to dial 911. I would rather know that something could have been done but didn't do than regret not knowing and finding out later. One of the many reasons this website is so valuable and important for me.

Janine, I joke that my sweetie likes me "zaftig" - that's Yiddish for plump, and that's being kind. Before NPH I lost 40# which came back on and then I started a new way of life, dean ornish based lifestyle change, lost 40# again! exercising regularly and counted garbanzo beans daily. That was BC (before cancer). I gave up at surgery and have put it all back on. This time it sounds nutty but I just let myself enjoy the process instead of being angry about it. Back to my extra hot mocha....

thanks again.
Lisa

Reply # - June 3, 2014, 09:21 AM

Dr West
Posts: 4735

I don't know about steam coming from my avatar, but I will admit it was befuddling, and I try to give the local docs the benefit of the doubt but also can't escape certain conclusions. I don't always know all of the details, so there may be a good reason for the conclusion I'm not seeing, but I do think that the onus is on the person dismissing the obvious link to explain why they feel it's incorrect.

-Dr. West

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