Starting to have trouble swallowing. Any suggestions?


DW is starting to have trouble swallowing. I haven't noticed any pocketing but will start watching for that.

I am thinking of starting her on some softer foods like yogurt or cream of wheat. I have noticed that she seems to have a bigger than normal amount of food in her mouth when she gags. I suspect she is not swallowing before she puts the next bite into her mouth. Will watch that as well.

The part that bothers me the most is getting her to swallow her meds. She holds pills and liquid in her mouth for a long period of time like she is refusing to swallow.

I have read several post here about this and will mention it to the Dr. next visit or sooner if need be.

I am curious about pulverizing her pills and mixing them with her liquid. I have done this with ice cream and it seemed to work. What about doing it with other foods. would the heat of foods reduce the effect of the meds?

What other soft foods could I mix them with. I am considering getting her some ensure or a similar product to help with her nutritional needs. She seems to handle most foods pretty well, it is just once in a while she gags and has spit out a large amount of food but will still cough or gag with a seemingly empty mouth. Today it was with pancakes. I think I will take them off of the list of foods to let her eat.

Do any of you think more fish would help? Maybe steamed fish as opposed to fried. What about mixing the meds with a chip dip? This might limit the amount of food going into her mouth also.

Has anyone tried using cold foods to help with the gagging? I did notice that instead of drinking to clear her throat she ate a spoon full of ice today and it seemed to help her recover.

Also today during her bath she tried to spit and it was very thick and just ran down and hung on her chin. Like mucus.

I may be over reacting but I worry a lot and I don't really care if I become a pain in the side to the medical community.

Can ensure be consumed with a straw?

The only stupid question is the one that is not ask in my learning experience.

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Please do not heat up food after putting crushed pills in it. The heat will not be good for the pill. Consult a pharmacist about each pill and whether it can be crushed. Some pills are extended release and crushing them is a problem. The pharmacist wants to help, please consult them on all med issues. With any swallowing issues, I would have an evaluation with a speech therapist. Ask the doctor for a referral. Speech therapy deals with swallowing issues. I have had this done with several relatives and it is very helpful. Medicare pays. The Ensure will go through a straw. If you can manage it, try making a "milkshake" type item for her instead. Experiment with fruit, some sort of fat (coconut oil?) and protein powder. There is a product called "Thick and Quick", This is added to pureed food or liquids to make them easier to eat.
Helpful Answer (1)
Reply to Toadhall

When care giving there is no stupid questions ... however there can be stupid answers so look at things carefully [usually not here however as most answers are from the on-the-ground troops]

I find mom is usually given crushed up meds [buy a proper crusher] at NH in pudding, apple sauce, & such - whatever she will take however they rotate so that the sight of chocolate pudding doesn't make them stop taking that too

I get a glass with a sippy top with ice in it from NH then I put something in it for her & swurl it around so the ice makes a small noise which can bring on a responce that she is having a cocktail or treat drink - she loves even diet 7UP this way - I make a variety of drinks -

Today the grocery store had a sample of sangria which I found too sweet but bought a bottle for her then went to NH with it but I poured 2 oz over ice & added some perrier style sparkling water - I did this in front of her so she liked the ambience of having a nice drink made for her & drank it so fast that I gave her some of mine - FYI she likes to share the drinks with whoever is helping her & we did a 'cheers' clink of glasses together
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Reply to moecam
Toadhall Aug 15, 2018
Many great ideas! This is the kind of flexible thinking that really works. You have to meet a person where they are now instead of trying to get them back to who they were.
Hello there fellow caregivers .. I have some swallowing tips that i do with my 92 yr old mom that is late/end stage with contracted arms and legs just not quite to fetal position. Last year it hit hard within a month she lost all of her movement and now only grunts. Neurologist confirmed not a stroke but infact dementia.
My mom always had taste for hard candy even at bedtime she would take some to bed. About a year before her transition she developed sundowning issues and slow speech and a very annoying calling out or rather a ah..ah..ah..ah..ah sound non stop.
On a 1300 mile car trip she started that. I had a bag of trip candy and decided to give her a blow pop. And she stopped until the gum stuck to her dentures lol..
So i bought a bag of dum dums YES I SAID DUM DUMS SUCKERS.
Eventually i had hospice come to the house. They have been here 9 months what a god send.
They were concerned of her choking. Sugar intake.. Like hello you just approved her for hospice.
Comfort care...
Every morning i wake her for nourishment usually a Enterex strawberry diabetic shake. They are hands down the best tasting skake..But i stick a straw into her mouth and nothing.. Doesnt even close her mouth... I wet a dum dum and stick that into her mouth and wait a few minutes and she is working that dum dum over. I just pull the dum dum out and insert the straw and she off to the races on that shake.. Hospice workers thought it was crazy but they have come around. Maybe the constant eating of suckers keeps her muscles in memory mode and that helps swallowng too. Needless to say sams clubs sells a bag of (small head pops for about $13 )
Small head means the pop head is smaller than the traditional size.
Dum dum of ohio heard of my moms love of their product tjey sent us a whopping 60lb case.
My mom is on seroquel ( decreasing dosage from the intial dose). Baclofen for muscle pain. Xanax, fentynal patch and morphine for break thru pain. I have been thru a lot with my mom i view this as a journey.. I am a sole caregiver with worthless older brothers. I consider us fortunate.
Day by day. .. Never never never...
Give up.
A final thought... I see commercial s on tv about what smoking does to a body. Not many people (except medical people) know exactly how bad dementia diseases can affect a person
Its like no one wants to talk about this insidious final stages of the disease ,at least until it happens to their loved ones. I just didnt know about it myself... No one should have to go through this.. Caregivers you are special. Please tell the world about this disease .please educate.. And then maybe more will be spent on research. And caregivers only truly know the sacrifices this disease takes .. Im done ... Lol hope this helps. I have lots of tips that i do ... For my mom . lm always eager to share and learn
Have a peaceful day..
Also pills are crushed and mixed with applesauce.
Sweet is last taste to go.
There is a product that some hospitals have by Hormel called " magic cup" google it about 300 calories.
Ninja smoothy maker is good for puree foods. $60 at walmart..
You can buy pureed dinners in bulk
But they will cost a bit.
Let hospice help you when its time.
Sometimes we want our loved ones to eat a lot however when a swallowing incident happens . aspiration is a real serious reality. So when that almost happened to us. Now we tend to be less robust in the amount of food . but taste and does it have a great amount of nutritional value.. As disease progresses more of " thick it" is needed in liquids .. Antibiotics do not try to crush them . they taste awful and you cannot mask the bitter taste with anything ask for the liquid form and put it in a half full shake..
God bless ..
Helpful Answer (4)
Reply to Selfless954rr
PrairieLake Aug 11, 2018
Great problem solving. No one knows your mother better than you.
See 1 more reply
Has your loved one been checked for Barrett's Esophagus?
From continued reflux of stomach acids, the esophagus can become not only irritated, but degraded. It's very painful, and often the result of Alzheimers...just a thought.
Helpful Answer (0)
Reply to Tomago

Someone asked about a swallow study being refused by a doctor because failing it meant a feeding tube. Perhaps just ask for doctor’s orders for a dysphagia evaluation to determine compensatory strategies to make your loved one more comfortable. You can still keep requesting a modified barium swallow study with a SLP present.

Even if the recommendation is for tube feeding, no one has to have it placed if they don’t want to. People and their families refuse them all the time. They are also a diagnostic tool.

There is a lot of information from watching a video swallow that a professional can use to make it safer and more comfortable. A lot of times we do bedside swallow evaluations first, and try different strategies, some texture changes, some short term therapy. It helps a person avoid excess choking, spitting, coughing.
And speech language pathologists and occupational therapists are also trained to help people with dementia continue to feed themselves as long as possible with different utensils, cups, strategies.
An example: When a person has a delayed swallow, a straw is not recommended because the liquid is more difficult to control, or too thin when coming through a straw. Also soups with different consistencies are too difficult to swallow. The thin liquid goes down first often while the person is chewing the pieces of noodles or vegetables.
I have seen patients that cough, choke, gag on most any food. But then they can eat a piece of apple crumb pie or a sweet chewy cinnamon roll without any problem.
So there is a lot we do know, and a lot we don’t.
But working together with the family, the patient, the nursing and dietary can improve the quality of end of life.
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Reply to PrairieLake
disgustedtoo Aug 11, 2018
I wondered about that refusal to attempt a test as well. Like you said at least an evaluation can be done, with recommendations provided based on the input from the caregiver. Another alternative to a feeding tube is TPN (Total parenteral nutrition.) I had this done when I had a torn esophagus, during which I was not allowed to eat or drink anything.

I also question why the doctor approves a 91 yo with Parkinson's and dysphagia living alone - that is a disaster waiting to happen!
When my mother started experiencing problems swallowing food and liquids, it was exacerbated by a risk of aspiration (items going into her lungs when she attempted swallowing. ). The doctor recommended using a thickener for liquids, machine-chopped food (consistency of coke slaw), and pulverizing her tablets and mixing them into applesauce. We had to change one of her meds (time-release capsule) to a tablet form with more frequent dispensing.

I hope this helps!
Helpful Answer (0)
Reply to sb23508

My dad had the same thing. He worked with a speech therapist and had the thickening packets added to everything - even coffee. It is better now, but he still has to have meat cut up. Aspiration pneumonia is horrible! My dad had that 16 years ago after he had a cerebral hemoraghe.
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Reply to sallyb13
Jessie7410 Aug 10, 2018
My mother in law had aspiration pneumonia and passed b/c of it
Dear Old Sailor, please call her doctor and make an appt as soon as possible. Then when there ask for a speech/language pathology referral for a dysphagia evaluation.

After an evaluation is done, usually including a modified barium swallow study, the therapist can do some short term therapy to determine textures, strategies and whether different methods will work. There are different strategies that really help-for example chin tucks, head turns, and some positioning strategies also. But you really need a professional to determine how to protect her airway, and also how to help her be more comfortable when eating.

The gagging, trouble initiating a swallow, and trouble handling secretions are red flags. She is at a very high risk for aspiration pneumonia or malnutrition.
I have treated people with swallowing problems for over 20 years.

There are also some special cups and eating utensils that can help. But first, you have to know exactly what the problem is.

You are a great husband, and it sounds like you are excellent at problem solving. A professional can work with you to make it safer for your wife.
Helpful Answer (6)
Reply to PrairieLake
BeckyT Aug 10, 2018
PrairieLake, would you explain a bit further? My Papa has Parkinson’s and swallowing issues. The doctor won’t send him for the test because he will fail it which means a feeding tube, which Papa has refused.
I should add that Papa is 91 and we are just doing are best to help him as long as he is here. This means he is alone, in his own home, until injury forces him elsewhere - all with his Doctor’s blessing.
We crush pills into mango peach apple sauce and add a little cinnamon. It masks the flavor of the pills really well.
Helpful Answer (3)
Reply to MHenderson

My husband began to experience swallowing difficulties about age 63, had a stretching procedure of the esophageal sphincter, then Botox injections into the sphincter twice--after that one becomes immune to Botox. Eventually he had surgery that cut the esophageal sphincter and wrapped the upper part of his stomach around the esophagus (Dor wrap) to prevent reflux. He lost a lot of weight after that as size of his stomach was reduced, but he was overweight so that wasn't a big problem. Over the next few years he began to experience "senses of impending doom" that in retrospect were probably TIAs. Occasionally he would black out completely. He showed signs of dementia, so had a full 7 hr evaluation by a neuropsychologist who diagnosed Vascular Dementia and said he was at high risk for major stroke--which he had at age 41. The stroke completely paralyzed his left side and eliminated his central vision, as well as leaving him again unable to swallow. He had advance directives against gastric feeding tube, and he no longer had any fat to live on, so he died in three weeks. Vascular dementia is a tough diagnosis because the TIAs rarely leave a trace, but keep happening until there is "the big one." Despite taking preventive drugs. So add vascular dementia to the list of things your LO may have.
Helpful Answer (1)
Reply to Arleeda
disgustedtoo Aug 11, 2018
They tried the stretching for me several times (it doesn't always stay "stretched") and then the botox (precursor to excision)- I had allergic reaction to the botox, so I list that with all my allergies (bees, poison ivy, some meds.) I was very leery of having that botox and breaking out in hives after, that was it for me!

Depending on one's age and medical condition, doing these procedures may not be indicated as the sedation and/or anesthesia may be an issue.
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