At the age of 78, Maxine was a poster girl for an active senior lifestyle. She loved being the unofficial social director of her assisted living community in the Texas Hill Country, organizing shopping trips to San Antonio and calling the numbers at the daily bingo game. Physically, Maxine was in great shape. She took a brisk walk every morning and had a regular annual physical exam. Her only chronic health problem was mild Parkinson's, which she controls with daily medication.

Since Maxine especially enjoyed sitting with her special friends at dinner, she was very concerned when she began to experience prolonged coughing fits at the table. At first she thought the problem might be simply trying to talk, eat, and breathe at the same time—so she decided to listen more and speak less. Things got better for a while, though her friends did notice how quiet and subdued she seemed.

Eventually Maxine began to skip going to dinner and ate in her room instead. She also began to have difficulty swallowing her medication and vitamins. Sometimes she needed a whole glass of water to get them down. Worried, she began to have trouble going to sleep, which made her look tired. This change was very apparent to Maxine's daughter when she came to visit from out of state. Maxine had always been so upbeat and positive. Now, for the first time, she seemed confused and depressed.

With her daughter's help, Maxine's story began to turn around. Her daughter arranged for Maxine to visit her primary care physician, who referred Maxine to a speech and language pathologist in the outpatient department of a local medical center. Janice, the SLP, asked Maxine about her medical history and her current medical status. Then Janice performed a "tabletop clinical evaluation", examining Maxine's facial and throat muscle strength, and watching her swallow measured amounts of water, pudding, and Lorna Doone cookies. This wasn't at all an unpleasant or threatening experience. In fact, Maxine began to feel better right away because Janice assured her that there were definitely ways to improve her swallowing even if she were found to have a dysphagia.

Janice recommended that Maxine's doctor refer her to the medical center's radiology department for an x-ray procedure called modified barium swallow, or MBS. Maxine was impressed by the fact that the radiologist would watch her swallowing in real time and could see exactly where she was having a problem -- but she was also apprehensive about having to swallow the small amount of barium. But it turned out to be no problem, and no more uncomfortable than the "tabletop clinical evaluation," and Janice was with her the whole time.

As it turned out, Maxine did have dysphagia, probably brought on by her Parkinson's. But by identifying the problem early, she was able to improve her swallowing and go back to her busy social life. Janice taught her exercises to improve the strength, range of motion, speed, and coordination of her swallowing process. She also learned which foods are most likely to cause choking. These can vary from one person to another. In Maxine's case they included anything with vinegar and foods such as watermelon that have both solid and liquid consistency. While she will always need to be careful, Maxine is back to her cheerful self, presiding over meals and bingo games.