Nancy was carted over to the hospital this afternoon and seated between the open ends of a horseshoe-shaped thingy that lit up a monitor with an image (in shades of white, gray, and black) of her mouth and jaw, and points south. Lowest on the screen were the top two metal sutures used to tightly re-close her split sternum. If you lower your chin to your chest you will come close to where the top one of these appears.
Nancy was given food items containing a small amount of Barium sulfate that acts as a contrast agent with respect to the body tissue and bones. That is, whereever this stuff goes can be seen on the screen as near black globs. Because Barium is of relatively high atomic number (Z = 56), its compounds absorb X-rays more strongly than compounds derived from lighter nuclei. Although barium is a heavy metal, and its water-soluble compounds are often highly toxic, the extremely low solubility of barium sulfate protects the patient from absorbing harmful amounts of the metal. Barium sulfate is also readily removed from the body.
The compound is administered as a suspension of fine particles mixed with foods of different texture. Nancy had grape juice, applesauce, a fruit mixture, mashed banana, and mashed chicken. Following her time in the ICU with tubes down her gullet Nancy existed primarily on non-solid foods, especially fortified drinks. As more-solid textures were introduced she became accustomed to small bites and tentative swallowing. Frequently she would chew something for awhile and then spit out the solid parts.
The passageway from lips to stomach experienced little real action for many weeks. The muscles along the way degraded, lost their tone, or underwent “disuse atrophy.” I think this is what we suspected and confirmed today.
As Nancy ingested the barium sulfate laced food all parts worked as they should except at the very lower limit of the image there was a just noticeable slowing of the material (the dark glob on the screen) and then it dropped out of range for the set-up being used. Thus, while her real food intake is improving she instinctively remains cautious and rightly takes small amounts and swallows carefully.
In the room today for the exam we had Nancy, the imaging specialist, two swallowing specialists, and me. Not that my opinion was needed, but we all agreed on what we saw, and what we thought it meant.
During Nancy’s time in the hospital (except when sedated) she continued to use her hands and arms – right more than left. Since January 20th she has had therapy on a regular basis. Yesterday she was able to play her violin for the hour jam session with her friends, and it is now six weeks since open heart surgery.
However, Nancy is not yet able to get herself out of bed nor into a standing position from a sitting position. Noticeable progress is apparent as regards these very visible muscular activities. The tone of these less used muscles is returning more slowly than those in her hands and arms. It seems reasonable that the equally atrophied muscles used for eating that we cannot see at work will likewise take longer to regain their capabilities.
So, having found nothing really out-of-whack, we expect continued improvement.
[whack? See: http://www.worldwidewords.org/qa/qa-out2.htm ]