Mom is spitting out her food. Any advice?

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My mom who has LBD and Parkinson started a new thing. When I feed her she will chew a few times then spit it out. I don't care what kind of food chewy or soft like pudding. The only thing I can get her to do is drink 3 Boost a day and she love Popsicle. I am at the point of thinking I guess if she gets the Boost maybe that will be enough. She has lived with me and hubby for 21/2 yrs and until the last month I could get her to eat, but I do have feed her and now this. Is this normal? Thanks and have a blessed day!

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Part of advanced Dementia is forgetting how to do things that used to be automatic. She may not be able to remember that its ok to swallow chunky things and the autonomic reflex to swallow liquids is still intact. Consult a Dementia Doctor and have a swallow study to see what is up. My Dad was not able to swallow anything with a texture at the end of his life and eventually failed a swallow study. Together with the Hospice Dr it was decided to continue to give him both liquids and thickened liquids until the end of his life knowing that he could aspirate and get pnemonia that might shorten his life by a few weeks or months. We didn't feel that denying him food and drink was a humane thing to do.
Calculated Risk vs Quality of Life. He chose not to have a feeding tube early on in his Living Will. I felt that I needed to honor that request.
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If your mother's able to swallow liquids then it isn't going to be a swallowing reflex problem. It could still be a co-ordination issue, though - chewing and manoeuvring food with your tongue is one of those natural tasks that, when you analyse it, is actually really complicated. Not much has to have gone awry in the brain for the whole process to fall apart.

But I mainly just wanted to give a 'thumbs up' to consulting a speech and language therapist. The job title is a misnomer - they should be called mouth throat and tongue wizards!

You mention the possibility of a sore throat - is your mother appearing to spit the food out on purpose, or is it sort of making its own way? If she is 'actively doing it' so to speak, the other possibility is that her palate has changed and a flavour she used to like has gone weird on her. My mother suddenly found coffee too bitter and sugar too sweet (?!) - I think that, again, these are tiny neurological glitches.
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Auntkiki: As mentioned above, it is very good that she likes her Boost. They also make fruit juice drinks (Boost or Ensure) that have all the vitamins etc. that is in Boost. You might try some of those. Also, the making of yogurt pops is a wonderful idea.
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I was just watching this video on youtube last night - Teepa Snow demonstrating eating and drinking at diff dementia stages - she is an amazing dementia educator, the way she explains issues that people with dementia are going through is brilliant, I wish I found her years ago, I would have been much more prepared as a caregiver.
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From what you are describing, an additional possibility is that it hurts to swallow solids, but liquids are OK, not uncommon. There could be some trouble in the esophagus that might not be neurologic, but more directly GI related. I once had a patient who had Candida esophagitis - he could at least tell us it hurt - but there was no sign of thrush in the mouth or throat we could see, needed the ENT to look in for us. Reflux or an ulcer can make it painful as well.
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Her Neurologist put her on a new pill. I don't know but will give it a try. She as loss 10 pounds this month. When I moved her in she weight 84 got her up to 114 now back down to 104. If I don't see some improvement in a few weeks she is going to him or ER.
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I called the Neurologist yesterday and talked to the nurse. She said she would talk to Dr. and see if he wants to see her or send to her general Dr. Well she never called back so Monday I am going to call the other Dr to make an appointment. Let him see if maybe she does have a sore throat. If all is clear there then I will ask him to make her an appointment with the speech therapist.
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Kiki, letting pills dissolve before swallowing might indicate some swallowing difficulty. Maybe there is some chocking if she tries to eat solid foods or pills.

It just occurred to me that she may have a sore throat, throat infection, or something going on in that area.

The sauce on BBQ and cheese on the potatoes might be too "tasty" or sharp for her if there is something wrong with her throat. Yogurt generally goes down much easier though.

If the neurologist suspects a swallowing issue, you could ask for a referral to a speech therapist. He can get an appointment much more quickly than if you called on your own.

Good luck - keep us updated.
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That you GardenArtist, this really did help. I will call her Neurologist today and see if he can set her up with an appointment. I had bbq chicken, broccoli and cheesy potato's last night and she spit everything I gave her out. I even had the cut up pea size. So I got her some strawberry Greek yogurt and got her to eat most of that. The other thing she does is when I give her med she holds them in her mouth till dissolve. I will be glad to take her to his and find out what to do. Right now I want to pull my hair out! lol

Thanks everyone for your help.
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AuntKiki, the swallowing evaluations I've seen were when my father was dysphagic (completely NPO), suffered from "frank aspiration" and couldn't swallow at all. This was after being intubated for several months.

The speech therapists in the SNF gave him thickened liquids and watched carefully to see if he could swallow without coughing or choking. They also used objects (I can't remember the specific name of them) that were like lollipop sticks with small sponges on the end.

Certain tastes, of which I believe lemon was one, stimulate swallowing reflexes. The "stims" were used to prod specific areas of his mouth to stimulate the reflex, then he was given thickened liquids and observed to see if he coughed or choked.

When he was discharged and had speech therapy at home, he was given a set of exercises to do. One was akin to sit-ups for the neck, lying flat in his hospital bed, raising his neck and holding for I think 30 seconds. Another was to strengthen his vocal chords by making gutteral sounds, consisting of emphasizing consonants together. The sounds were something like Russian words. Sounds were something like ungh, thnk, but unfortunately I can't remember the rest. We joked that these were his Caveman exercises because the sounds were so gutteral.

There was another exercise but I can't remember it now.
I probably should mention that initially I did the consonant exercises with him so he wouldn't feel awkward, but the speech therapist advised me not to as doing them could harm my healthy swallowing muscles.

The most revealing and definitive test though was a videoscopic swallowing test (dysphagia videofluorscopy) during which he drank some fluid with a substance (barium, I think) that illuminated various areas of his mouth, neck and check. He sat in a room similar to an x-ray room, drank little bits of fluid, and the technician observed to determine where the fluid went - i.e., eventually into his stomach or into his lungs.

When he could tolerate fluids, little bits of food were added to see if he could swallow them.

This is a good explanation of the study: http://www.asha.org/public/speech/swallowing/Videofluoroscopic-Swallowing-Study/

There might be some less complicated tests that have been developed since 2004, which is when we went through this process.

He was again evaluated a few years back while in the hospital, but whatever was done was performed there and I wasn't present.

The therapist at that time did caution that sometimes dysphagia can, even if resolved at one time, contribute to weakened swallowing muscles at the person ages. She said to be sure to "flush" food down with water, rather than drinking water at the end of the meal as some seniors do. She also said NEVER to add more food into the mouth until it's completely cleared of the previous bits.

We have noticed that crumby foods such as cookies, bread crumbs, crackers as well as nuts and sometimes chocolate will provoke coughing attacks.

Hope this helps.
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