Oral and throat hydration; is there anything that can be done to provide moisture in the mouth and throat?

What about trying Biotene?

I knew there would be good answers and I was right. A humidifier is an excellent idea.

After some searching, I've found organic lip balms, one of which lasts 4 -5 hours, depending on the humidity in the house. One was purchased through an herbal supplier and was the best I've ever used. The beeswax makes it quite smooth and comfortable. The other is by EOS, not as much beeswax and not as tasty, but it does work.

I can't speak to biotene gel; I even had to google it as I'm not familiar with it.

Mydadcare, is your father getting any meds to decrease or cut through phlegm? I wouldn't think so since he's apparently NPO.

I ask b/c my father was prescribed scopalomine in conjunction with his dysphagia, and I noticed that his thirst level spiked after the patch was applied below his ear. If I recall my research correctly, that could have been one of the side effects.

I was opposed to it at first, and reluctantly agreed to continue it b/c it did think the secretions, but it also made him thirsty, and decreased his appetite.

Is he allowed to "swish and spit" at all?

I think I'd be inclined to go beyond the nurse and ask the doctor or DON directly. I got better answers when I did that before the scopalomine was administered.

My mother had this issue. She had a hemorrhagic stroke, a stroke from a bleed in the brain. Initially she could eat puréed foods but it wasn’t long before she failed a swallow test and had the feeding tube placed and became completely NPO. The dry mouth was a constant issue. We used a wet washcloth to wipe out her mouth as there was often a buildup of white gooey stuff that she’d sometimes gag on if it got bad. We used moistened mouth swabs, lip balm, and Biotene as well. It was just awful to watch, no great solutions and a constant issue to take care of.

My father experienced the very same problem over a decade ago and again more recently. At that time only the swabs were used. This time around, we could use a wet washcloth to moisten his lips as well as a good lip moisturizer, but there were different issues and he still was able to drink thickened liquids.

What you might try to clarify is whether or not he can drink thickened liquids, little sips at a time, or if he's completely NPO.

The other issue, and I don't wish to frighten you, is one raised by a speech pathologist and speech therapists: whether the deprivation of food, of oral stimulation, the chronic dryness of lips and mouth, were worth it to extend his life, or if he wanted to just eat pureed foods with the recognition that there would be aspiration pneumonia.

I feel your pain; this is a difficult situation in which to find oneself. I think dysphagia isn't addressed enough in co-morbidity issues, but it's a serious situation. If I ever reach that point, I think I'm going to eat anyway and at least have some oral pleasure before aspiration pneumonia takes me.

How about a small Personal Humidifier? If he is sitting up and it got too much, he could just dribble out the excess?

Just uses tap water. So no alcohol or glycerine products, which would dry it even more.

I take a medication that dries my mouth terribly. I use ice chips occasionally. There is a biotene gel that put some on a Q-tip and and apply inside my mouth on the the worst areas. I'm fortunate my isn't all day. I take the med twice a day and the dryness lasts about 3 hours each time.

Thank you everyone for your support and information. I should have been more descriptive but it was late when I posted by question. I've had sleepless nights for the past 3 months. My father (76) suffered a severe brain bleed and had to get a drastic life saving skull/brain surgery having him in a scary state physically and mentally. He also has a stage 4 wound on his tailbone. They believe he suffered 35-40% brain damage. In and out of rehab / hospital due to fevers and pneumonia. He had a feeding tube through his mouth for 1 month. They started speech therapy but he could not stay awake or follow commands well. He was able to communicate slightly but with a faint whisper but now that has stopped. He does still very slight nod his head but you have to watch close. They inserted a pic food line into his stomach and he has had nothing orally not even a swish and spit. We only could do the swaps around his mouth but he must be having his food/phlegm backing up into his mouth. I see huge amounts of hard shell like coating all in his mouth/lips. I tried to get it out as much as I can but he bleeds as well. I noticed on the roof of his mouth is horrible and scary. It looks like large dry tree bark chunks in his mouth hard like a shell. I've asked the staff to do oral care every two hours when they change his position. I don't believe its been happening. I asked for them to see an ENT specialist and now I am waiting for that. Yesterday, the facility doctor and head floor nurse worked on him to removed a lot of it out of his mouth & I believe throat (his wife told me). I was hoping to the ENT specialist to do it yesterday so they could see the extent of it and guide the facility/staff to prevent this from happening. It must be so unbearable for my dad. His wife told me they are going to give him a type of biotene rx for his mouth. I've been stressing he needs a humidifier running 24/7 but I don't believe its there. I feel hopeless. I don't understand why they can't put a cool moisten rag in his mouth to give him relief. Even drop lets of water? I can't see him choking on that. I asked for tiny ice chips but they won't do it. I just dont understand. If he was coughing up phlegm he could push out a droplet of water, right? What to do? They are only focusing on the nutrition to help the wound and put weight back on him. He is beyond bone thin but his comfort is just as important. If he could ever talk again, I feel that there may be damage to his throat and vocal cords from no moisture. 

Please let us know how things go for him..

I send you hugs and strength.

Remember to take care of yourself too. You will be no good to anyone if you are also ill.

This must be such a traumatic experience for your family. I hope you're able to at least get some down time to offset the strain.

Thanks for the explanation; it helps put create more perspective. Just a few comments - there's not much I can offer otherwise.

1. Not being able to talk. My father was in this situation for months after he had been trached. Being unable to speak is so frustrating for everyone. I eventually took a thick piece of 8.5 x 11" paper, divided it into high priority to lower priority wants and needs, clipped it to a clipboard and left it with him to ask for what he needed.

Divided into squares, some were things like "cold, need blanket", or "hot", or "call daughter, when coming to visit?", "need urinal -STAT", and similar requests. It helped, but unfortunately the staff kept removing it from his bed and putting it where he couldn't reach it. They apparently didn't realize it was his only method of communication.

2. Humidifier: I would go above the staff, not to chide them but to get a higher level involved. Ask the DON or someone at a management level. You might want to request a meeting so you and your family can discuss the highest priority needs, such as the mouth dryness.

You could probably find a small humidifier that you could even bring up; I've gotten them for $30 to $40 in pharmacy departments at grocery stores or Home Depot or Lowes.

3. As to a cool rag in the mouth, I saw different protocols from the long term care hospital and the SNF. The SNF focused more on comfort, but there also were more aides there to help. I think the reason why a cool rag isn't put in his mouth is b/c of the possibility of aspiration, even a little bit of water could trickle down into his throat. And that could lead to aspiration pneumonia, which would add another layer of complication to the mix.

4. The condition of his mouth is disturbing. I'm glad it was addressed yesterday, but it does sound like some type of softening agent is needed. This is beyond me; I've never experienced that. But what does concern me is any bacteria that might be trapped in the residue/coating. Has a thrush or other infection been diagnosed?

5. I've gone beyond the staff and contacted doctors' offices directly. Don't feel shy in doing that. Most doctors these days will respond and be more aware that the family is heavily involved.

Personally, I WOULD contact the ENT and raise the issues you've raised here, such as the humidifier, coating in his mouth and potential damage from the dryness of his skin.

6. Beyond the medical issues, you might want to bring a portable CD player, or iPod or whatever you might have and play music softly for your father to help relax him. That's what I did for Dad, and it made a big difference in anxiety level.

I wish I could offer more insight, but some of these conditions are ones with which I have no experience, and therefore have nothing to offer.

Sending best wishes for relief, comfort and calm for you and your family.

This could be called negligence....