Too much mucus or phlegm in 102-yr old LO, interferes with swallowing. What doc for her to see: ENT? Pulmonologist? Other?
My 102-yr old aunt is having an issue with either mucus or phlegm (not sure which) that interferes with her ability to swallow and therefore, eat. She had been taking Mucinex preemptively (she said it was recommended by her pharmacist) and also takes spoonfuls of very hot water while she's eating, which sometimes seems to help (not sure if it's thinning the mucus or opening up her esophagus). Often she has to preemptively clear and clear and clear her throat before eating. She has to spit it out because it's just so much and she can't swallow it. Last night she couldn't clear it and it was running out of her mouth. She couldn't eat much. It doesn't happen at every meal but more often than not, at differing severities. She has not seen a doc yet but don't know where to start since I don't know if it's mucus or phlegm. If I had to guess, I'd say it's phlegm. Anyone familiar with this issue? Any recommendations on what type of doc to see first? Thank you in advance!
https://www.agingcare.com/Questions/does-anyone-have-experience-with-scopolamine-patches-for-someone-with-dysphagia-437151.htm
Others offered good insights, and I think that other than the complaints about the sports med practice that became involved w/o my knowledge or consent, there are some on topic suggestions. Others also addressed how their loved ones' oral accumulations were handled.
In retrospect, I do believe the Scopolomine helped (as did the suction machine) to clear some of the mucus; it wasn't as bad as when I first brought him to the rehab center. But he also was less capable of drinking anything as time went on.
He was suctioned there, but the mucus kept accumulating. No D/X had been made yet, and when I asked an ER nurse to suction him, she told me to do it myself. She was not responsive to my statement that I wasn't a trained medical personnel and wasn't comfortable suctioning; I could easily injure something since I wouldn't know what I was doing. I can't recall now if another nurse came, or if I went above her (which I probably did) to get help.
I believe that Dad was later diagnosed with a throat infection, but I don't recall for sure.
I think if I were you I'd try to get a speech pathologist to determine what the accumulation is, i.e., just mucus or a throat infection. That would determine what treatment would be appropriate.
From your experience, I'm assuming you're familiar with dysphagia and escalation from the basic level to a higher one in which inability to swallow is more dangerous. If she's in a facility, I'd try to get an immediate exam by a speech pathologist. If not, I'd arrange for an ER visit.
Later on that night, I was so glad I went to the ER. And if I don't have my dates confused, that was the night that I received a 1 am call from one of the treating physicians telling me that Dad had become cyanotic . I was soooo glad I took him to the ER with experts; I was already terrified at his house when I saw the volume of white "stuff" in his mouth earlier.
He did have aspiration pneumonia, was repeatedly suctioned in the hospital as well as in the follow-up rehab placement, during which suctioning still needed to be done, while he also segued into palliative care.
A med was considered and used (after I investigated and researched) to help control the mucus accumulation. A lot of what happened about that time isn't clear, as we both knew he was dying and our thoughts were heavy with emotion and concern, but I believe the drug was Scopolomine.
(I remember b/c in one Alistair MacLean espionage movie I watched several times, that was the drug used to interrogate someone, to "relax" his mind enough to reveal confidential issues. So I initially didn't understand why a doctor or nurse would recommend Scopolomine.)
As to your aunt, I'd act and call EMS, now. I don't like to scare people, but the thought of turning blue might be enough to encourage her to agree to an EMS visit. I'm sure if I hadn't called EMS, my father would have died shortly after I arrived at his house. At least he had some more time to say goodbye to his family and friends.
Hopefully that's not what your aunt has, but it might be worth having it checked.
Also when my husband was in his 6 week dying process and he started to build up a lot of mucus, and phlegm, hospice provided patches to put behind his ears(the same patches they use for nausea, as they supposedly help with phlegm as well)and provided some kind of drops for me to give him for the problem as well. Sorry I don't recall the names of either, but a Dr. or pharmacist will know. Best wishes.
I had tried Benadryl at one point then I tired it myself one night and woke with a "foggy brain" and I figured if it did that to me I can imagine how my Husband with dementia felt having an even foggier brain so I stopped giving it to him.
When he started on Hospice he was prescribed an off label use product. Atropine Eye drops to be given orally to dry or lessen secretions. That did work to some degree.
When he was in bed I would roll him on his side to allow the secretions to drain out.
I know there are other medications that can help dry secretions it might be worth talking to the PCP first rather than subjecting her to a lot of testing.
If the PCP will not prescribe anything I think the first appointment I would make would be with an ENT.
Are there any other problems with swallowing? It might be possible that the reflex that closes the esophagus from the trachea is "confused" and does not know what to close off. There is a possibility of aspiration even small amounts.