Dad is 93 and is now experiencing difficulty swallowing. He doesn't choke, but says he has the sensation of food being stuck in his throat. I've been pureeing his food, which seems to help somewhat, but was curious if anyone else could offer suggestions as to how they deal with this problem. His primary suggested testing, but a recent bout with pneumonia has left him weak and he really can't travel the distance necessary to do this. He is living at home alone....which I know is time for other arrangements. But that is yet another situation we are dealing with........sigh.
Until then, make sure he always sits upright when eating, Try feeding/eating with a spoon. Take 1 bite at a time and make sure he swallows it thoroughly before taking another bite. If he can swallow water without choking, coughing, or sputtering... try adding more liquids to his foods.
added to whatever liquid he is drinking stops the gagging and choking. I have my mom drink some before she eats and the problem has helped 100%. It is difficult to find and the only place I could find it is st London Drugs or Save On Foods will order it in for you. Hope I have helped
I wouldn't disagree with the "mine field" comparison! That's very appropriate.
On the issue of finding someone to help in the home, my only experience with outside assistance was hiring a reputable home care service, with staff who allegedly had dysphagia experience background.
That was a falsehood for 2 of them. One admitted that she had observed speech pathologists in rehab and other facilities, but never managed food prep and/or eating. The other one was just so unqualified, with not even common sense knowledge. I dismissed her on the first visit when I found her "cleaning" an electrical strip (plugged in to the frig) with a wet wash cloth.
My father too didn't want to leave his home, and I understood that, but when he was unable to stand or even walk, I had no choice but to find a placement. I still feel guilty about that 4 years later, but I knew that it was the best decision under the circumstances.
Something I should share is that I found a wonderful care group; I was very impressed with them. Two of the officers were former military and they ran the business in a very professional manner. I met with, interviewed and had a proposed caregiver accompany me to one of the rehab facility's staff meetings, but when she realized the extent of the dysphagia, she consulted management and reported that they felt the potential liability was too great. So she didn't get hired. I was very, very disappointed.
I wish I had more suggestions as to your father's situation and apparent decline. It may also be that once he adjusts to "the new norm", he may feel more comfortable and adapt. I certainly hope so.
TriedandTrue raises an issue I forgot about, but was critical for my father's recovery after a long (7 month) hospitalization and rehab. The exercises combine consonants, creating a gutteral sound, a sort of "caveman" language. Apparently this strengthens the muscles.
I did them along with my father, but the speech therapist cautioned against this, given that I didn't have any speech difficulties and didn't need them. and she stated that the exercises could actually damage my own swallowing ability.
Dad had speech treatment in the hospital and rehab, and after being intubated for months, eventually was able to have the tube removed and gradually eat normally again. He was 85 then, and lived to 99.5 years.
It isn’t painful. Usually a person with dysphasia can get a EGD (Upper Endoscopy) where a small scope is passed into his esophagus and stomach. If the GI doctor sees a stricture then a small deflated balloon can be inserted thru a port in the scope it comes out the end
of the scope then the GI doctor has the balloon inflated to different sizes. He can see all this on video as it is happening cause the scope has a camera. He can inflate the balloon
several times till the stricture is gone
There are other tools that can be used to open a stricture. The GI doctor can also just inserts a rubber like dilator into the mouth down the esophagus these dilators come in different thicknesses till the stricture
is gone. All of this is done in an Endoscopy Lab or Endoscopy in a Hospital. They use lite Sedation.
What is actually happening is the stricture in the esophagus is getting ripped. The GI drs are inserting dilators bigger then the stricture in the esophagus. There is no pain
the person does not feel anything
except swallow the small end of the scope. Your Dad would be given lite sedation. He would have to travel to
an Endoscopy Unit. There are free standing Endoscopy Units or
most hospitals have an Endoscopy Unit. Because of his age most GI
doctors would probably tell you
to go to the Hospital Endoscopy Unit. It is lite Sedation. The person is still considered an outpatient and goes home after it is done. His Primary physician can refer your father to a GI doctor unless he already has one. Your dad could have a Schatzki's ring is a ring of tissue that forms inside the esophagus, the tube that carries food and liquid to your stomach. This ring makes the esophagus narrow in one area, close to where it meets the stomach. It can make it hard to swallow. You may feel like food gets stuck in your esophagus.
This Ring could cause a chronic
Problem which means your might
have to have this done yearly
due to scar tissue reforming.
If he has the Ring then your dad
might have to have his esophagus
dilated every year or 2.
Most GI Drs. also do Colonoscopies. So if your dad has ever had a Colonoscopy you can use that same GI physician for the procedure I described above. The back of the throat is sprayed with a numbing spray. It is very easy and most people don’t remember to much. Usually after the procedure
your dad should be able to eat
normally. He mite have a minor
sore throat for a day or so
As soon as he recovers from PNEUMONIA you should really get it
this addressed before your dad.
can’t swallow at all or the stricture gets bigger. If his swallowing issues
are the results of a stroke that is
a different issue all together. He still
could end up seeing a GI dr.
it depends on how severe symptoms
are after a stroke. It isn’t a painful
procedure but you do not want to wait till it becomes an emergency.
I was a GI Nurse for years and we were always on call 24/7 the main thing I was always called to come to
the hospital in the middle of the night is because a person got food
or meat impactions stuck in the esophagus. U do not want to wait to long then u have to bring your dad to the ER they will try to clear his esophagus first by giving him A coke or sprite because the carbonation might loosen the food impaction & it will force the food thru to the stomach. Most of the time the esophagus will be scoped in the ER. Do Not Wait 2 long. Good Luck
My husband has this happen often.
Following a bout with GERD or acid reflux, Tums helps with the heartburn, but his esophagus is inflamed.
Until things calm down in that location, he’s learned to turn his head side to side slowly a few moments to ‘move things along’.
And, honestly, I haven't quite figured out the best way to get mealtime support other than from 3 different people, or one who returns 3x daily. And to me, that's a big issue.
Abby, I can't find specific previous threads on dysphagia, although I do recall participating and writing a long response recently. So I'll start over.
You're wise to recognize the danger of dysphagia, and puree your father's food. There are different levels of dysphagia, which dictate different preparations. Sometimes food can be pureed, but the foods vary with the different levels, such as "mechanically soft".
Liquids generally need to be thickened, again in accordance with the levels of dysphagia.
Click on the white magnifying glass to the left of your avatar on the blue to green bar at the top of this page, and search for "dysphagia". There are a lot of threads addressing this subject.
I would agree that a swallowing test is mandatory, but it should not be performed by anyone other than a speech therapist knowledgeable of dysphagia. Specific equipment (like a "camera" that reflects the mouth and related areas) is used to provide videoscopic identification of the routes traveled when swallowing and/or aspiration occurs.
Small bits of fluids and solids are given to the patient, and the equipment shows whether they're aspirated directly or go into the stomach. Since I'm not skilled in assessment, I don't know how the speech pathologist determines the level of dysphagia. But it is something that's necessary.
I've watched a few of these; it's hard to follow the route of the consumed liquids and/or foods; hence, a specialist needs to interpret them.
At one rehab facility where my father stayed, a speech pathologist was able to visit, and bring the equipment as well. I don't know whether or not equipment could be brought into a home, but I think it could. Your father's primary might be able to make some arrangements with a referral to a speech pathologist so that the equipment could be brought directly to your father.
To me, given his condition, the state of the pandemic, and safety issues, this would be the better solution than taking him to a hospital. OTOH, the primary might suggest transit via a non-emergency ambulance. This is what we used for several visits. They aren't cheap though, but your father's health is too important to risk.
Was your father's pneumonia diagnosed? I.e., as "aspiration pneumonia"? If so, that's an indication that some portion of foods are going directly into his lungs.
Cite: Aspiration pneumonia Information | Mount Sinai - New York
(I'm having problems getting the actual URLs, as the browser reconfigures them, but search for "aspiration pneumonia", then click on the Mt. Sinai hospital link.)
Also check out the different levels of dysphagia diets, ranging from mechanically soft to pureed food, and including thickened liquids. At one time there were 3 levels, but I believe that's changed.
"dysphagia diets at DuckDuckGo" (again, a truncated URL)"
I suspect though since you seem to be knowledgeable that you may already be aware of these issues.
Another fact concerns me, i.e., his being alone at home. I don't want to stress you unnecessarily, but if he does aspirate and begin choking, it could have disastrous results.
I would raise with his primary the issue of having in home medical care from someone experienced in aspirations to act as an observer. He/she could call for medical help quicker than your father could if he begins choking.
I would also get a medical alert pendant with a very reliable company so that your father could press a button and get medical help ASAP. With the pendant we got through an already existing safety monitoring company, there were 3 choices for notice of an emergency. I was first, EMS was second, and I forgot who was third.
But this company was so alert that it responded even when Dad just bent over. You would (if I remember correctly) provide information on medical conditions, especially aspiration potential, so that this could be provided to EMS.
Thanks again for taking the time to share......I so appreciate it. :)
I was able to get a therapist to come to my home to evaluate my mother, but it was about 20 years ago. Still worth a shot.
It is essential because if he DOES have disrupted swallowing he may indeed aspirate swallowed material into his lungs and risk the reoccurrence of pneumonia, but almost just as serious, if he does NOT have a swallowing disorder, he may unnecessarily be placed on thickened fluids and foods, reject them, and lose his desire to eat and drink.
Please FIND out ASAP if you can arrange the home evaluation. Hopefully you’ll have even better information than taking him to a therapist, since he’ll be in familiar surroundings.
Dysphagia can lead to aspiration, which goes no where good.
Is he having problems with liquids? Those may need to be thickened.
Garden Artist is our dysphagia expert; hopefully s/he will be along shortly!
Ask the primary if the Home Health agency providing care for the after affects of pneumonia can send out a speech language pathologist to do an assessment, or get one via telehealth.