My Dad coughs sometimes now and has been put on a puree diet. Anyone else experience this?

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My Dad's favorite thing is food. He no longer enjoys his meals & he still coughs. Since the pureed food isn't helping with the aspiration and he hasn't gotten pneumonia only once and that was 6 months ago, can't he continue eating the mechanical soft diet he was on? Since Dad is now in a facility, it appears I have no choice in this, or at least the memory care is resisting this idea and the same with the speech therapist. But I am his proxy and want to do what is good for his quality of life. And I think his doctor would give me an order for the mechanical soft if I asked for it. Anyone have any experience on this topic?

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Thickened liquid. Thickening agent, corn starch, ask the pharmacy. Tehy will find it.
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I have a gastric band fitted (doesn't work because I cheat it but I am just being honest. While it doesn't stop the things I can eat - some foods simple will not go through the now narrowed area. I can eat most things as long as they are very thinly sliced (bread cake and meat in particular) I cannot eat rice except rice pudding. I can eat cheddar cheese but not cottage cheese. I can eat soft boiled eggs but not hard boiled eggs or egg mayonnaise surprisingly. I can eat chocolate sweets and biscuits (cookies to you all in the US)

Sadly I cannot eat more than a quarter of a slice of bread but I can eat a full slice of toast. Unfortunately memory care wont have the time (and if I am honest the inclination) to establish what he can and can't eat.

Mum is moving towards limited eating (basically because she is too bloody lazy to chew I might add unless of course it is sweets - she will chew a toffee quite happily!)

I make a lot of chunky soups so the veg is there but nearly cooked to death but it doesn't matter because all the goodness is in the liquid, when she is having one of her moments I make it a smooth soup otherwise I leave it chunky but I used minced meat in the soup not chunks. I find a cooked gammon on the bone (Boiled) will give you a great stock to base a soup on or the boiled bones from the chicken and while Mum hasn't a clue I do it I often use an oxtail and make a really good broth from that too.

When she wants pureed food I make sure I have lots of colour in separate piles on the plate so she know she has the various veg etc. It's like I said earlier I can't think of anything worse than having a pile of brown slop on the plate and that does happen a lot although not so much these days.

The other thing you need to think about is order of eating. I like to eat my vegetables first meat last always have always will. Mum likes a little bit of everything on the fork each time - if you alter that and care homes sometimes don't ask this you sometimes find that appetite disappears because that is not the way they LIKE to eat their food.
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Thanks ohJude for your detailed description of differently textured foods. Makes me realize that it is not just mechanical soft versus puree but lots of stages in between depending on the type of food. Unfortunately they're not too big on subtle details at the memory care. I plan to retire in about a month so hopefully I can do more hands on.
GardenArtist, I will ask the speech therapist about the Shaker exercises next time I talk to her. She is visiting with Dad today so I expect she will call me afterward.
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Bearable, the barium swallow test should reveal if there is "frank aspiration", i.e., aspiration directly into the lungs because of a swallowing abnormality or problem. My father had 3 before he was finally able to eat real food.

His dysphagia was caused by being intubated for months. The speech therapist who eventually solved the problem prescribed exercises, Shaker exercises I believe they were. They were the key to strengthening the swallowing muscles.

You might want to ask the speech therapist about these exercises, if the barium swallow test shows aspiration. I don't know whether they're appropriate for all situations though.
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mashed potato not masse potato
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My father had throat cancer and a stent fitted and he too had to have soft pureed food. Some foods lend to soft some to puree and oddly some foods you would think would be fine are actually a nightmare.

Dad could eat a soft poached egg (with a runny yolk) but couldn't swallow scrambled egg at all. He could eat casseroled liver but not minced or even pureed chicken.

He could eat rice pudding but not boiled rice

He could eat cauliflower cheese but not macaroni cheese.

When we got to the puree stage he couldn't taste food very well so I tried to make each item as flavourful as I could.

One thing I would check is how they are serving the food to your Dad I have seen it all in a sort of slop that resembles the way it comes out some hours later and that has to be unappetising. I used to make sure he had very very soft masse potato and that it was separated from a carrot puree which was separate from the mushed peas and that the meat was separate so he got a variety of tastes in his mouth.

Always a dessert usually very soft with pureed bananas which he loved, stewed apple and cloves which he really liked and I used to mix it with yoghurt or ice cream too for that added zing.
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Thank you cwillie for your response. Yes, I visit him often. I have thought about taking him out. There is a buffet nearby that has a large variety of textures that Dad has enjoyed in the past.
Thank you also GardenArtist, The speech therapist is all about safety. Of course safety is important, but it is not the only thing in life (I tell them) You can be so safe that you no longer enjoy life. He will be having a barium swallow test soon. Speech therapist seemed to think this would give more info. Dad had a chest x ray last night so he has no sign of pneumonia. Yes, the therapist worked with him on taking small bites, eating slowly and tucking his chin before swallowing. None of which will stick without reinforcement. Maybe after I take him out a few times it would help me know whether to push for a return to mechanical soft. Very grateful for you time and kind attention.
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What's the speech therapist's position on this? He/she should be supportive of measures to avoid aspiration, so I would think he/she would be amenable to anything that was helpful.

Has he seen a pulmonologist or PCP for referral to a specialist to determine if there are other issues causing the coughing?

From my own experience, I know that foods with crumbs (such as toast and crackers) as well as chocolate and other similar foods can cause coughing. I've seen it happen repeatedly.

Another issue could be that he adds more food to his mouth before the previous food is completely swallowed. That was one caution a speech pathologist warned about.
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Are you able to visit him often? Perhaps you can bring special treats when you are there and eat with him. It would be nice if the nursing home would be able to use a little common sense with his diet, offering some more easily eaten foods without pureeing them first, but I'm not sure that is possible. When I sent my mom to a nursing home for a respite stay I ordered a minced, moist diet even though at home I am often able to give her regular food. They still managed to screw up and she choked badly on dry minced chicken.. not a whole lot of good judgement displayed there.
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