Dysphagia on Mars: My story from the future

By George Barnes MS CCC-SLP

As an SLP dedicated to dysphagia management today, I can’t help, but wonder what opportunities tomorrow will bring. In 30 or 40 years when I am getting ready to retire, what will I look back on and think, “How could we have been so naive?” So since space travel is obviously a given in that time period, let’s take a look at what managing dysphagia will look like while we are on Mars. 

In the year 2061

Picture me feeding my pet alien, Scopey in my home on the top of Mount Swallowmanjaro in the southeastern part of Logemannchester (SLP’s and dysphagia management are all the rage on Mars). At the moment I am seeing a middle-aged 104 YOF (there have been many advances in extending life). She is complaining that she’s coughing with her morning tea, particularly after she has been drinking it for a while. It’s a telemedicine appointment since she lives on Earth so I teleport her to Mars for a full assessment. No signs of stroke, no recent falls, and no other physical or mental changes are observed. But the coughing is making her really uncomfortable and sipping her morning tea is her favorite part of the day. No problem, I do a quick analysis of her pharyngeal neuro-receptors to assess sensation to determine that they are at peak stimulation for liquid temperatures above 120 and below 45 degrees. The coughing only occurs after she has been drinking for a while because the temperature drops below 120. She simply has to keep her tea hot as she drinks it. Easy enough- I give her a recommendation for a solar-powered self-warming mug and a happy little lady gets teleported back to Earth. 

How genius phones will help us

The next patient on my list is a 76 YOM (practically a teenager) whose wife has been begging him to get checked out because he is coughing every time he eats and drinks. He says he has been doing it as long as he can remember, but his wife is concerned. Being that he’s so young, I decide not to have him go through the trouble of teleportation and instead do a quick risk-benefit analysis to determine if any further interventions are needed. I pull out my handy-dandy genius phone and plug in his full medical history as well as his dietary preferences. Turns out there’s only a .03% risk of him developing any kind of pulmonary issue even if he is aspirating every meal based on the data. Let’s let this young buck continue to eat and drink as he pleases, shall we?

Diamond standard

My employer caps my productivity off at 25% so I have to wrap things up. A 137 YOF is at high risk for developing aspiration pneumonia, but food means everything to her. Let’s take a look at what’s going on. After I teleport her I decide to do the diamond standard of swallow imaging, which includes a .06 mm 3D FEES scope with a simultaneous radiation/radiologist-free eyeglass-fluoroscopy at 233 FPS. The results are crystal clear- the patient is aspirating during the swallow on thin liquids. No compensatory strategies are effective. So I put her on honey thick liquids and that’s the end of my day (just kidding!). I of course assess her with 19 varieties of a single drop thickening agent to determine the formula that keeps her airway protected, but would continue to be detected as a thin liquid to her neuro-receptors. Another happy customer. 

Looking back

I turn off my lava lamp (real lava from Mount Swallowmanjaro of course) and lay my head down at the end of the day. I think about the days of the past when we used to serve people globs of gobbly gook that nobody would even look at, let alone eat. When we used to make the elderly haul themselves to a disease-ridden hospital only to wait uncomfortably for 10x the length of time it takes to do the whole study. Worst of all, we used to be so terrified of aspiration, we would use draconian measures to stop it at all costs, having no idea of the actual chances of infection. Thank goodness we woke up. Now we can finally stop treating the swallow, and start treating the patient.

About George:

George Barnes MS CCC-SLP has clinical experience in a variety of settings including acute care, acute rehab, skilled nursing, and critical illness recovery. This variety has developed his specialization in dysphagia management with a focus on diagnostics through instrumental swallow evaluations. His concentration is on geriatric patients with complex medical status. He is co-founder of FEESible Swallow Solutions, a mobile speech pathology company dedicated to improving access to high-quality dysphagia services for patients in the skilled nursing setting.

George has a track record of supporting the field of speech pathology by paying his knowledge forward to other professionals via graduate-level education, clinical fellowship and student supervision, the Student to Empowered Professional (STEP) mentorship program, The Medical SLP Collective mentorship service, ASHA special interest groups, peer review for ASHA course material, the SIG13 dysphagia editorial committee, and participation in various interdisciplinary teams and committees in the hospital setting. He is a multiple ASHA ACE Award recipient for his dedication to continuing education. George actively conducts and supports new research aimed to improve efficiency and accuracy in dysphagia diagnostics, management, and care.