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Tuesday, 30 August 2011

Swallowing - An Annoyance

Sharing by Mr. Peter Tang (30 August 2011) - NPC cancer survivor  

Last year I was having lunch at the food center. I ordered my food from a “ zhi cha” stall selling all kind of cook food. As part of my healthy eating regime, I usually order vegetables, steam egg and a fish. I would remind the cook’s assistant twice, to add generous amount of gravy to the dishes so that the rice will not be dry. If the stall gives a free bowl of soup, I will be very happy and appreciative and will make a point to always patronize the stall for lunch again just because of that bowl of soup.

Moving to the nearest empty table, I began my lunch. Two gentlemen came to share the table with me a few minutes later.  Looking at their food, I realized that they have ordered from the same stall.  One of them looks like in his late 40s the other in his 60s. Five minute later, they have literally finished what were on their plates and I was still struggling to finish the last portion of my food.

I have noted that for the past two years, lunching out has began to be a chore for me not because of being unable to decide what to eat but more because the act of eating has began to be a task and a challenge. Twenty years after completing radiotherapy for my nose cancer, I realized that swallowing food (especially food with dry texture like chicken, fish or some type of vegetables) has to be deliberate, occasionally forceful (if the food gets stuck in the throat even after washing it down with fluid). Sometimes I gag suddenly because of small remnants of the food (e.g. Kit Kat) get stuck in the dry areas of the throat. However eating food that is watery will eliminate most of these unpleasant experiences

Late last year, I requested for a medical test to check the strength of my throat muscles in swallowing different kinds of food.  I called it a Barium Meal as the radioisotope barium liquid was added into each of the three categories (meat, salad and bread) to see the swallowing motion on X-ray. I was told to chew them and swallowed them when I was ready. The strength of the muscles was captured on dynamic X-ray film and this was recorded. The results showed that overall; my throat muscles were still functioning well although there were some signs of muscles fibrosis.  I will be repeating another similar test again soon.

Swallowing for me is an ANNOYANCE but it is not a major ISSUE. Notwithstanding, I am appreciative that I am able to eat and enjoy the food (although at a lesser extent) and more importantly to be able to eat with the people I want.  One of my house rules is that I make it a point to eat out once a week with my family because this is the time for my family bonding. For me, this reason far outweighs the small annoyances of swallowing.

Finally let me end with this Charlie Brown’s quip which I believe, resonates loudly not only with me but with all nasopharyngeal cancer survivors.

Lucy remarked: “ I am making a list of all the things that I have learned in life, well actually, I am making two lists.” Charlie enquired, “ Why is one list longer than the other? ”. To which Lucy replied, “ These are the things I have learned the hard way!”

Peter Tang

19th year old NPC cancer survivor. Treated with radiotherapy.  


  1. Agrees with observation – Mr. Yip KG (30/08/2011)

    Thanks Peter for the sharing. I am weary of such long-term side effects.
    I am not sure how we can reverse this or prevent it from occurring.

    I have noticed this problem in many of the survivors - shrinking neck. This is where and when many of them would develop eating and swallowing problems.

    As I have been concerned about this narrowing and shrinking neck, I have been working on trying to develop neck muscles by doing some exercises relating to the neck. I am not sure if this is the way to go.

    Regards, Yip KG – 2nd year cancer survivor

  2. Dear Peter and Yip,

    Longer term radiotherapy can cause muscle fibrosis and this will result in shrinkage like a contracture. There are 2 groups of muscle, the external neck muscles like what Yip describe as shrinking neck and another internal muscle group called the intrinsic constrictor muscles of swallowing.

    The external neck muscles moves the neck in 6 different positions - looking upwards and downwards, looking to the left and right and lastly tilting the ear towards the shoulder on the right and left beside able to do a full rotation movements. Some of the muscle groups also help to lower the lower jaw for mouth opening. Exercising these muscle groups help to maintain the flexibility of the neck as when fibrosis or contracture sets in, it will be painful to turn the neck and impair mouth opening. So, in a way, Yip is right. Developing a set of neck exercises can help maintain the normal function of the neck.

    The second group of muscles is the muscle for swallowing and these are located at the inner throat area. If you do a swallowing movements and put your hand and grab your throat, you can feel these muscles move up and down as you swallow. These muscles again can become less functional with time. Doing a set of swallowing exercises can also strengthen the swallowing. Actually, it may be more difficult to swallow liquid like water compared to food. The reason is that the water goes down very fast down the throat and due to the slow reacting swallowing muscles reacting, patient can choke on water alone. In turn, solid food then to move a little slower than water, and this can produce a more timely swallowing reflex. However, bigger solid food is difficult to swallow and hence need to be chopped to smaller pieces. The easiest food to swallow is actually a mixture of small solid food with water or thick gravy and the classic example is a rice porridge with minced meat. These mixture then to be easy to swallow and serve an adequate combination of carbohydrate, protein and water. Additional small chopped or cut vegetables can also be added and patient typically like pumpkin or sweet potato that is boiled to very small and easy to swallow portion together with the porridge. If a cancer survivor need to put some weight on, eating ice cream actually add some high calorie protein and fat content and this is readily swallowable. Hope this helps.

    Dr. Choo - Medical Adviser