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He has a hard time eating many foods. He is also in hospice (at-home care) for cancer and has lost over 100# in the last 2 years. He has also started with dementia. Because he only has one kidney, the VA recommended I give him a supplement called Suplena, which he likes & will drink, but is still losing weight. I have tried pureeing some foods, which he refuses to eat. Recently sent for a book of recipes for foods for dysphagia. He likes soups, but not much for cream soups. I am at my wit's end on this. He can still get around, but refused to go out to eat.

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My father had trouble eating. He like scrambled eggs. I liked them, too. They were loaded with calories, protein, and vitamins, and were easy to fix. They were gentle on his stomach, which was important to him, since he suffered from nausea.
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Thank you Jeanne! This is what the speech therapist told me. I have taken all the other advice to heart & will use some of their suggestions, but you said it best. Our hospice nurse is a big help with this too. Hugs to you!
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Globetrotter: Nobody else (even our PCP) has ever heard of Suplena, but it is formulated for people with chronic kidney disease. It is low in protein, phosphorus & potassium. Made by Abbott Laboratories in Columbus OH. The VA dietitian recommended it over Boost or Ensure.
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Aspiration can be serious. It can lead to death. But this man is on hospice. He is already dying from cancer. Would it be worse to die from pneumonia?

I'm sorry to be so harsh, but the truth is that this is a different situation than for someone who may have years ahead of him.

I say give him what he wants to eat and that he seems to be able to manage. Ask the hospice nurse for suggestions. I wouldn't bother with another ENT visit. He will still have terminal cancer no matter what other issues are there.

Aim for pleasure and comfort.
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I think he needs to be assessed to determine (a) what level of dysphagia he has and (b) whether or not he's aspirating. The possibiity of aspiration is serious.

If you have a pulmonary doctor, ask who she/he would recommend as a speech pathologist. If you have home care, ask the scripting physician to issue a new script for speech therapy. If neither, and if your local hospital at which you treat has a nurse navigator or some kind of assistance, ask for a recommendation for a speech therapist.

Research dysphagia diets, look for one that has 4 levels, then review the differences between the levels. Level 4 is closer to normal; the lower levels are more severe conditions. These levels are established by the National Dysphagia organization - I don't remember the specific name of it and am having too much trouble with the computer rebelling and deciding to take breaks before I'm finished typing so I can't do that research now.

If he chokes on meat or chunky foods, switch meats from those such as roasts which are cooked whole to ones that are chopped up when cooked - hamburger or sausage (which isn't that ideal though b/c of the high salt levels). Avoid thinly sliced meat as well. It may seem easy to eat, but it's chewy, especially when piled up as sliced meats such as corned beef typically are.

Either cut up chunky foods into much smaller pieces, or puree them.

Other techniques advised by our therapists are (a) chin tuck (bringing the chin down toward the chest) when swallowing food and (b) drinking water after each mouthful of food and (c) swallowing all food before adding any more in. Young people can shovel food into their mouths but older people can't necessarily manage that technique.
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PAgal, what about pea soup or other lentil soup, meatloaf that is done very soft (although I find hamburger meat can be tricky; I got some gristle caught in my throat and it has never been the same since). Muffins, especially if you can make them yourself with less sugar and finely process what you add to them. I make French toast for mom and I - mixing the egg, milk and cinnamon, then dipping the bread in the mixture and frying it. I also stew fruits into what I call jam, although I'm sure others would beg to differ. I boil blueberries, apricots, strawberries and plums, and add sugar to taste. I spread it on bread or mix it with custard (the canned Devon custard). Cream of wheat is also a good, soft breakfast cereal. Beef or chicken broth might be another option as well as blended vegetable juices.

I know this is a very painful time for you right now; it's hard for us to watch them not eating (I went through it with my dad), but if it's any consolation, apparently they don't desire or need the food and water at that point.

I was interested in what you said about Suplena for one kidney; I haven't heard of it here where I live. My mom has only one kidney, and her other one is only functioning at about half capacity, so I have to be careful of how mineral and vitamin supplements will affect her.
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Are you saying he still coughs even with the modified diet? Aspiration of food is not a minor inconvenience, it can cause pneumonia and lasting health effect. It sounds as though you need a better understanding of his problems and strategies to cope with it. Ask the speech pathologist for answers and referral a different doctor.
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I did not want to take him back to the ENT who ordered the swallow test (because his office staff ticked me off), so I do not know what level he is at. The speech pathologist did mention that aspiration could be an issue. He seems to be able to drink milk, water, juices easily enough; it is mostly meat or chunky foods that cause problems. He coughs with nearly every mouthful of food. He also has a lot of mucus drainage in his throat.
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What level of dysphagia does he have? Is aspiration an issue? Is he choking on foods?

I recently posted on dysphagia, seeking to find commercial sources for food. The issue is now moot, but the responses were excellent.

There are differences beween the dysphagia levels. At one level, e.g., white bread is easier to swallow than, say artisan or whole wheat or grain breads. Similarly, liquids need to be thickened.

What your husband can eat really depends on those issues, and the dysphagia level at which he's been diagnosed.

There are several other posts on dysphagia on this site:
https://www.agingcare.com/search.aspx?searchterm=dysphagia+diets
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When the speech pathologist found out he was in hospice, he just said feed him whatever he wants. I am not looking to put weight on him, just want to be able to feed him things he can enjoy & swallow. Too often what I give him are sugary & that gets tiring too. Might think the "quiche" idea with finely chopped veggies.
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If he is on hospice I assume his cancer is considered terminal, so it may be impossible to help him gain any weight or recover strength, at some point the body just can't make use of the calories any more.
You will have the best success if you can modify the foods you would normally eat. Try to look for foods that you might find appealing yourself, things like mashed potatoes loaded with butter or gravy are "normal" treats. Oatmeal loaded with cream and brown sugar for breakfast is a staple breakfast for us. Any soup, even chicken noodle, can be whizzed in a blender and thickened with cornstarch or thickeners like Thicken Up. Refried beans? Guacamole? Milkshakes? Custards can be sweet or savoury (think quiche). Depending on his ability he may enjoy pasta casseroles cooked very tender... think of mac and cheese or tuna casserole. Have lots of condiments on hand like deli mustard or salsa, chili sauce or hot sauce according to your preferences.
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Did a speech pathologist give you suggestions for diet choices? Start there.

I'd say under the circumstances (he is on hospice) give him whatever he wants and can swallow. Milk shakes? My husband's favorites included ice cream, a packet of Carnation instant breakfast, a banana, and chocolate syrup. Lots of combinations are possible.

Among pureed foods, those that are generally served that way seem most acceptable. Mashed potatoes, pureed squash, pudding -- anything that he could eat that other people without dysphagia would eat.

If he likes and can eat soups, great -- serve him soups. When my husband had trouble with noodles in a chicken soup I blended the whole thing and called it a cream soup.

This is not a time to worry so much about nutrition. Think more along the lines of what he will enjoy and will supply lots of calories. A well-balanced eating plan is not going to cure his cancer. All you want to do is keep his energy and strength up for maximum quality of life.
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