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He is unable to stand, even holding onto the walker, while
coughing and sputtering. I'm reluctant to whack between the
shoulder blades when things seem out of control because he IS
still managing to get air, but he is not able to stand, bend over,
or have me try to do the Heimlich maneuver. Eventually the
choking subsides, leaving him weak, exhausted. This doesn't happen too often, but it is, of course, awful when it does.
I hope some of you caregivers out there have reliable knowledge how to handle such a frightening situation.

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This sounds like an acute choking risk situation - not just the usual dysphagia where a little bit is getting into the airway and could eventually build up and cause respiratory trouble. While you are waiting to get the swallow study done, go with soft foods and liquids - if he coughs less with thicker liquids, go with that, but maybe he is just not chewing well, or maybe the esophagus is spasming, in which case solids will be more difficult and dangerous than liquids.
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Madison that is a lovely piece You shared, and I am very thankful for that tip on choking. What a frightening experience. I think most of Us know that feeling as sometimes when eating in company our food seems to go down the wrong way and it is exhaustingly horrid.
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I will need to come back when I have time to take notes.
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Look up "swallowing" on Amazon and you'll find plenty of books both scholarly and laymen's level. Swallowing problems take out a lot of the elderly, They'll stop eating, or aspirate and get troubles in their lungs. My mother chokes some times and I feel so helpless. But here are a few things I have done to help her.

Find the EXACT level of texture she will endure. She can no longer even do oatmeal, and there is no level of meat puree she'll tolerate, without adding so much fat to make it go down. I ended up with Yogurts, and I can whip in applesauce, strawberries, bananas. And I add soluble fiber, cause yogurt itself has none. I found that the Campbell CupInHand tomato cheesy soup was great, but better was to reuse the containers. Now I get tomato soups, the boxed kind, from Trader Joes, cause it doesn't contain HFCS sweetener. The top of this cup has two openings, for the drink and small one for air. Sometimes mom uses the air hole.

Find the EXACT size of glass or mug or yogurt cup that's handy to eat. I found that regular tspoons were too heavy and long, so always use plastic spoons. I use spoons, white or black, that best contrasts with the food. Save those cups/tops from iced lattes and smoothies...they are light, tight lids, and one uses a straw.

When mom was having more trouble, I used both a sports drink cup with spout, and a baby sippy cup with rubber "stop" valve so the drink really needed to be sucked. That stopped the drink from whooshing into her mouth and hitting the back of her throat. (She's back to drinking from regular mugs and cups now) I found that a children's translucent red plastic cup was too confusing, as she could not see the level of juice or milk in it. She had no visual clue when the liquid would reach her lips.

What else, I got some small spatulas so she can lick the yogurt, or better, scrape the container clean. A kid thing.

This is another approach to this, one seldom talked about on this forum. Traditional Chinese Medicine is known more for using acupuncture, though there are powerful treatments like acupressure or Jin Shin that won't stick. When I was assisting an author (coincidentally Jane Heimlich, or Ms. Maneuver as I teased her) on a pop medicine book, I interviewed many TCM doctors/practitioners. One had a clinic in SF just for the elderly. He said the first place a TMC doctor looked at was the digestion; often diagnosis is done by listening (feeling) the levels of pulse in the wrist. Not just rate of heartbeat, but the strength of pulse as it passes under two sets of four fingers...both deep and surface levels. They do things like "read the tongue" and even smell the urine. Anyway, a TMC doctor who specializes in the elderly might be worth checking out.

Another option one usually doesn't consider is chiropractic. Of course with brittle bones, one has to be careful. However there may be an adjustment in the neck vertebrae that may unlock a pinched nerve that has to do with swallowing or other problems. I used a chiropractor for years for breathing problems. 15 minutes and $25 bucks and I was ready to go.
Google "chiropractic and swallowing" and you'll find some posts.
Look up "TCM and swallowing" and you'll find references to the way they dx these problems.

The good thing about these modalities is that the doctors actually are hands on, not just in a prodding way, but in a healing way. The patient might feel more "listened to" and considered. I really wished for a visit by a TCM/MD combo while mom was in Kaiser.
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Please do get a swallowing study done. I know someone that developed Aspiration Pneumonia from the food getting into her lungs. Because of the danger of this, my mother's doctor ordered her to have a feeding tube installed. This ended up being a blessing. We no longer had to worry about her choking. Plus she had lost so much weight from not being able to swallow properly, that and actually gained weight from what it was they fed her, after the procedure.
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definately do the swallow study, its really simple and easy. they just get xrayed while they eat something. (and its kinda cool to watch, the xray moves as they do!) its possible they just need a pureed or thickened diet. in that case all you need is a food processer.
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Mariannette- Sorry about that 'great divide of a void' I left you there with about the cold wet wash cloth; I will be glad to explain it in a little fuller detail. And please remember this is just something I learned from Grandmothers and my Mother. It may not work for everyone. But the cold wet wash cloth applied to the face, throat and sometimes forehead can ease a person from tension and anxiety they are experiencing from choking. Choking is a very scary ordeal. The worse the choking, the more tense that person is apt to be. About three months ago, while visiting my Mother at the nursing home and we were sitting in the dining hall, there was a woman who began choking over behind where we were sitting. Everyone was used to her choking and someone would always go over and help her through it. On this one day I write of, she could not get it out of her airway. The lady was very heavy-set and the nurse in her 60's was about 105 lbs.; nothing the nurse was doing for her was helping and the lady who was choking was flowing with tears coming from her eyes and beads of sweat pouring from her pores. Looking everywhere in the dining hall, down the halls, I could see no aides, no nurses, no nobody! So I ran to the bathroom, grabbed a towel and soaked it with cold water, wringing it out good and ran back to the lady and asked the nurse if we could lay it up by her face and throat. By then the nurse was about to lose it too, bless her soul, she was trying everything. No sooner than a minute, the lady coughed one big time and the piece of food flew from her mouth and out across the floor! She was so frantic, God bless her, she kept saying, 'Thank you. Thank you.'
You all know how quickly they can choke; and you know how even reading this can seem as if it were a long length of time but it was only a matter of four minutes or so but it was long enough and I'll never forget 'that cold wet washcloth' ever again.
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I too agree that he needs to have his swallowing ability analyzed by a doctor. There is a 94 year old woman in my friends building that has to have her esophagus stretched on a regular basis. The smallest of thing, she cannot swallow. It's awful.
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Madison, thank you for sharing your wisdom. There's always something new to think about and learn, as your reply illustrates.

mariannette, I agree with cutting the food into small bits. Sometimes mashed, or pureed foods help, and I always have flexi-straws for any liquids. Cut back on noise and distractions if any, and make meal times as serene as possible, always reassuring the elder. There is no such thing as foolproof for the symptom you have described, just better management and heightened awareness.

Madison, how does the wet, cold towel help, and at what point do you introduce the towel? I have never heard of that one. Am interested in better understanding the principle at work.
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Mariannette, All good advice above here! Believe it or not, a cold wet wash cloth will help him calm down a little so that he will normally try to swallow and breathe properly again. It may be a good thing for him to see a specialist about the swallowing and choking problems. I learned something very important when it came to the caregiving over my Mother eight years ago and it was to wipe the slate clean, drop the 'old-town-doc' she had been seeing for 40 years and swapped her to a Geriatrics doctor. This made a significant difference in having this doctor to treat her and direct her to the correct specialist that she would need instead of having only one doctor to do a lot of tests (and sometimes found nothing). She now has a team of doctors who knows her very well. My heart goes out to you because I know the fear you have when he is choking. Having it checked by a specialist will also take the stress and worry off of you. Any kind or amount of times choking is one too many. It could be anything, (something blocking his airways); do not let fear of that catch up with you because they have run this test on my Mother six times over the last three years and there is absolutely nothing there to be making her choke. Sometimes, especially the elderly, just swallow too quickly or forget to chew, they swallow and wind up choking. In my Mother's case, it was not proven 'It Was Food' but was believed to be a piece of food found in her lung from choking one time, three weeks before finding it. It had turned fungal and was making her very ill. Her lung doctor was the one who discovered this. After the removal and cleansing and the rest of her antibiotics were given she was better.
I continue to learn new things every day that can happen to the elderly. As bad as we see it all to be, I pray for God to bless them each one for they are the ones who are living in the state they are in. God bless you.
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What is he eating when he chokes? Is it dry, liquid etc. It sounds like he is aspirating on his food at times. This means he is breathing it into his lungs. Don't do the Heimlich or hit him on the back. you have to just let him cough until he is done. Try cutting his food into small pieces or feed him things like oatmeal, mashed potatoes etc. If he does better on liquids, then feed him soups and Ensure type liquid nutrition. Is he eating to fast? Not chewing his food completely before swallowing? Hope this helps.
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This person needs to have a swolling study done-if he is unable to swoll food other options need to be considered like a feeding tube or ng feeding a health care proxy needs to be in place if the pt, is still able to make informed decisions hopyfully this is allready in place and if not the family need to make arrangements of how this is being played out-it would be easier if the health care proxy is in place or some close relative knows their wishes.
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