Starting to have trouble swallowing. Any suggestions?

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.

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

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 ..

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.

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.

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!

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.

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.

We crush pills into mango peach apple sauce and add a little cinnamon. It masks the flavor of the pills really well.

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.

Be sure to find out if the pills can be crushed...some can't be if extended release kind. Yogurt, applesauce, ice cream...foods like that. Let Dr know the swallowing issues ASAP. Diagnosis Alzheimer's? This is a symptom

First what is your wife's diagnosis. Regarding the swallowing make sure she hasn't had a stroke a ct scan or Mri. Then if everything comes out fine try using applesauce. To put her medications in that should make it easier for her to swallow. Add one pill at a time. Regarding her hacking since I don't know her history I can't help in that area other than get a pathology report done on it.

My mom kept shoving too much food into her mouth at once. We started using teaspoons instead of tablespoons. And a child-sized (not baby) fork. She has two meds that can't be crushed so we keeo canned whipped cream on hand. A squirt onto a spoon, drop the pill into the middle, and she usually swallows it with no problem. We follow up with another squirt or two so she wikl swallow a few extra times to make sure the pill goes all the way down.
Regarding straws, sucking through a straw uses the mouth muscles differently than swallowing. It can be too hard for people with swallowing issues to remember to alternate, suck, swallow, suck, swallow. It leads to sucking too much and gagging or swallowing but not getting anything through the straw.
Applesause is great for taking pills. But boring to my mom. So we will put canned pears or peaches into a blender and pour in just enough of the liquid to get it to the right consistency.
One last thing, the consistency that she is able to swallow will change so watch for any struggling. Sometimes mom can eat regular but soft food like tuna sandwiches. Other times she needs food like pea soup consistency. You should be prepared to set a meal aside to try again tomorrow and give something else. We keep pureed soups for those days in single serving plastic bags in the freezer. Not every day will be the same.
I applaud your efforts to make sure your wife is eating suitable healthy foods. It's not always easy.

My mother had her throat dilated to make swallowing easier. Speech therapist may make an evaluation. One friend had a problem and it ended up being ALS. Throat cancer? Dementia confusion? Lots to consider.

Mix her meds with applesauce. I also include a couple of blueberries. It mixes quite nice and goes down well. Relative to her swallowing, my mother had this issue and in my research it is common with the elderly to have Dysphagia. I spoke to her doctor and to determine, its a peek a boo procedure down her throat which is outpatient. Mom had a Hialeah hernia (picture a funnel) so now she eats in small portions and soft foods. Salisbury steak, mashed potatoes, mashed sweet potatoes, etc. Also foods high in potassium are great. Green leafy vegetables are great they slide down throat better and are good for loosening bowels.
Soft foods that do not require a lot of chewing is essential at this stage. I would not mix her meds with liquids. Even in the hospital, they will mix with applesauce and there are flavors now. I get the 6 pack and count on 1 for each time she takes meds. I bought a mortar and pestle to grind up her meds. Good luck.

You can always check with your pharmacist. Ours has been very good at helping with my dad’s meds. Seniors love sweets. It’s their most prevalent taste bud. My dad loves chocolate pusding so I grind down his pills and mix it in there for him. Of course, depending on the med.

The most helpful tests I found for my husband were by a Speech Therapist. They are specifically qualified to do swallow tests. And they are essential. Ask her doctor to recommend/order such a test. Arrange to be present when it is done. She (and you!) will then learn tips and tricks to help control the choking, understand why it is so very dangerous, and how to prepare and present safe, but nutritional and tasty foods for her.

You can also research dysphagia diets and see recommendations. However, the first and most crucial step is getting the evaluation.

Dysphagia. Trouble swallowing. If you have HomeHealth, mention it. I had to have DH tested and it showed Dysphagia.

I had to thicken everything he drank for 3 years. You can google Dysphagia for an appropriate diet. DH wanted soft foods so that is what I fed him.

No straws! I don't remember why, but no straws. I had to thicken his Ensure Plus too.

I use a nutribullet to purée my mom’s food and then add seasoning and spices everything must be soft

I crush her meds with a pill crasher ( the doctor said it was ok) and put it in a small amount of ice cream or vanilla pudding to make sure she gets her medicine.
I add fruit to the vegetables and vegetables to her oatmeal or cream of wheat , or fruit to her cereal than add seasoning after I put it in the nutribullet
she will only eat if She likes the food
I had to make my own recipes and changed her meal times to get my mom to eat

GA gave you a very thorough answer but in my experience every person is different and has different abilities and preferences - my mom was eating 90% of her food pureed but still enjoyed and was able to eat grapes and little crunchy snacks like small crackers, potato chips and other "junk" foods, probably because the high fat content helped them dissolve in her mouth easily. She also did much better with straws when she first needed thickened fluids, probably because the weird texture was less noticeable when sipped through a straw. Sadly she eventually forgot how to use the straw and now needs her fluids spoon spooned into her.

Use common sense when it comes to preparing meals, pick things she likes and foods with a soft smooth texture that seem normal to eat - mashed potatoes, polenta, creamed soups, stews and chilies, tender casseroles, puddings, custards...

I guess I have to go shopping today for yogurt, pudding,ensure to find out what she will eat or drink. Then make notes for the Dr. to answer, including the study. I just wish I could get some of her meds in gummy form. She eats those very well.
If she gets real bad I may be able to buy one of the syringes that is designed for children if none is available for adults or use the one for injecting turkeys, without the needle.
More fish on the shopping list. Search for some simple fish recipes. Cut some foods into smaller pieces. Less fried foods, more boiled or steamed. Crushing pills and mix with something.
Look into jelly and chip dip. And chips. hmmmmm, would salsa be acceptable?
She likes chips. I regulate them because of a possible gout attack.
Okay, we will be hitting the store today. Need a new skillet anyway and a mini muffin pan for cornbread.
I really do appreciate the responses and suggestions. All will be looked in to and applied where they fit.

Ch. 3.   Hope you have a nice cool glass of lemonade while you're reading.

18.  I haven't addressed vegetables or fruits; they require more fluids to process, but corn and peas were harder b/c of their "soft skin".   Cooked peaches, pears, and other soft skinless fruits were easy to puree.

19.    While I don't like to criticize someone else's suggestions, I think the idea of "shooting" pills into the throat of anyone, let alone someone with dysphagia, is an unsafe suggestion, and is asking for trouble and a trip to the ER.  

If your wife does have  compromised swallowing ability, food and liquids need to be prepared in an easy to swallow form.    Whole pills do not fit into that category.   Nothing should be poured or "shot" into anyone's throat unless given by specific medical advice.

And, first, swallowing muscles need to be used to maintain what strength they have.   Second, a pill "shot" into the throat could get stuck (as some pills did with my father) and cause emergency level choking.

20.   And another "lastly"...There are exercises that can be done to strengthen the swallowing muscles, as did swallowing exercises (the "Shaker" exercises) the first time around.  Dad was given easier exercises years later when dysphagia again became an issue.  

You can ask the pathologist who performs the study about these.

If you do decide to get Ensure or Boost, contact your local Meals on Wheels center to see if they offer it. I got 2 +/- weeks' supply through MOW, at about 1/2 the cost of retail price.  Vanilla, butterscotch and I believe chocolate come in cans; strawberry comes in a soft pouch.

10.   Fish is good b/c of its nutrients, and its effect on emotions.    I eat fish when I need to calm down.     Avoid the fried; the little crumbs can cause coughing.   I would try baked or steamed as you suggest (probably the best choice); I used to add orange juice as fluid, so the fish wouldn't dry out and would have a touch of Vitamin C.  

I'm not sure about tuna from cans; it's stringy, and would have to be pureed a lot - I found that stringy foods (such as roast beef) took much more time to puree.    OTOH, the rehab facilities pureed them as well as ham.   The food definitely wasn't appetizing, but for Dad it was edible.

11.    Cold foods and gagging:  I don't have any input on this other than juices that Dad drank.     The pathologist did point out that drinks should be altered with softer food, but in sips and not gulps, to help flush food down and out of the mouth pockets.   

Actually, Dad had no problem with ice cream, and it was refreshing, so cold foods might be a good idea, as long as they're thickened (like yogurt is).

But don't let her keep the ice in her mouth long enough to become unthickened liquid.

12,  Thick mucous:   During his last months, Dad had a scopalomine patch applied behind his ear to allegedly thin the secretions.  I couldn't determine if it actually did any good, and it can have side effects.   

Suctioning was used as well; that was more effective.    The rehab/PC/hospice facility provided a bedside machine for suctioning.    The doctor who orders the swallow study might be able to order a suctioning machine, if appropriate, through a DME supplier.

13.   Straws.  No, not for anything.   That's what we were advised.  

Caveat:  my father's dysphagia progressed from a manageable level to more complex; that's when the restrictions became so much more limited, i.e., no straws.

14.    There are charts for different levels of dysphagia; your speech pathologist who interprets the swallow study could probably give you copies.    If not post back; I'll dig out my dysphagia material and see which institute published them.

15.    Lastly, don't worry about being a pest.  It's not the number of questions you ask, it's the approach, the research you do, your concern for your wife and the interaction between you and the staff that are important.     You're obviously very intelligent, do your research, and have a good grasp of what's happening.    Med pros like that - they can interact with you on a higher, more specific level.

In my experience, if you're educated and knowledgeable on the subject you're more likely to be treated professionally than if you don't know anything and take a hostile approach, like some of these people who have very negative preconceived notions about interacting with professionals. and approach in a defensive manner.

16.   Lastly, thickening in general.   The swallow study will help the speech pathologist determine whether liquids need to be nectar or honey thick.    Or your wife may just need mechanically soft foods.

Thik-it and other brands are fairly easy to find.  I was surprised that the major chain store carried them.  Pharmacies do as well.  

17.   And, finally, I suspect that you'll do all the food prep yourself.   You'll want a processor that has speeds for blending and pureeing.    You'll also find that some foods require additional liquids to reach a pureed stage. I used different gravies, OJ and cider.   

I'm P'M'ing you with the brand of processor I used after doing research on a variety of them.

Out of space again.

OS, several comments...

1.    Do get a swallow study done as suggested.  It's a videoscopic test revealing (like an x-ray) whether or not frank (direct) aspiration is occurring, i.e., if fluids and foods are going directly into the lungs, which can cause aspiration pneumonia.

My father had that more than a few times, but it was only the last time that his health had declined to the point that he could no longer overcome it.    So anticipate that aspiration pneumonia just may become a part of her life.

2.    If your have a pulmonologist on your team of care for your wife, ask that doctor to script for a study, as early as possible.    I'd choose a specialist over a PCP or GP for this kind of issue.

3.    Results of the study will determine the level of swallowing difficulty, or dysphagia, and dictate the level of alteration of food.

4.    Mechanical soft, nectar thick and honey thick are the only levels with which I'm experienced.    Each has a different associated list of recommended and definitely not to be given foods.    You can tailor her diet from there.

E.g., oatmeal or cream of wheat might be tolerable, but the oatmeal needs to be the powdery level, not steel cut.    There are fine distinctions in levels of food that would be allowed.

That's why a speech pathologist needs to perform the swallow study and interpret it.

5.    Foods:  yogurt is good as long as it doesn't have fruit that's not pureed.   The pro-biotic properties are helpful generally as well.    But it's fairly easy to eat, even with dysphagia.

6.  Pocketing, or pouching will occur, but the individual is not aware of it.    Our speech pathologist recommended periodic "swish and spit" procedures.    Dad kept a S & S cup close by and could relieve his mouth of extra food that couldn't be swallowed by spitting it out.     That can also facilitate fresh food being taken into the mouth.   

Coughing and choking is a reliable sign that there might be too much food in the mouth.  

Slowing down the eating process and absorbing one spoonful at a time will become critical.

7.  Meds:    I asked Dad's doctors if the one med he took could be crushed; I don't recall if it could, but it was D'C'ed for other reasons.    This is a question for her specialist doctors, i.e., whether meds can be crushed.    If I recall correctly, time released meds couldn't be crushed.   

I would stick with room temp carrier foods for the meds; don't take a chance with heat altering the delivery or potency of the meds.

Applesauce was recommended as the carrier for crushed meds.   Puddings were always on the menu, and I do have a vague recollection of their also being suitable as a carrier food.

I'm unfamiliar with blending crushed meds and chip dips, but if the dip is thick enough and not watery, that seems like a possibility.

8.   And a caution on ice cream:   at some dysphagia levels, ice cream is not an accepted food.    What I did was to put a few spoonfuls at a time in a bowl, then add to that if more was desired.  That keeps the ice cream in a non-liquid state, as melted ice cream would fall into the category of fluids that aren't thickened.

9.    Ensure or Boost:    Ensure Plus was recommended for my father.    I don't recall but believe the "Plus" version has more needed nutrients.    And it did need to be thickened.    Straws were not allowed; our pathologist told us that it's too easy to suck in too much fluid w/o swallowing it first.  It's another way for excess fluid to accumulate in the mouth.

Milk shakes fall in the same category; they can only be drunk if thickened, or if they're already so thick that they aren't melted, which obviously is a problem with ice cream.

Out of space; continued in the next post.

First get the swallow study done and follow their advice. A lot of us mix the pills in applesauce or pudding but Teepa Snow recommends using jam because it is ultra sweet to mask the flavour plus the texture isn't smooth so the pills are less noticeable. And as has already been mentioned you might need to change some of her meds to similar ones that can be crushed.

And sure the ensure can be given with a straw if that works better!

She needs to have a swallow study, which is done by a speech language pathologist. I would call the doctor today to get that ordered; aspiration pneumonia is very common in dementia patients. DW may need a thickener added to her liquids to prevent aspiration.

At mom's NH, they crushed her meds and put them in either pudding or applesauce. Not sure about the effect of heat; your pharmacist would be a good resource on that.

I doubt she's "refusing" to swallow. The brain stops sending the swallow signal, is more like what is happening. (((((((hugs))))))))

Oh, and yes, heat could affect some meds and absorption

Many meds should never be broken or crushed because this would cause too much to be absorbed at once!! Some need to be broken down over time in her system. Meds the Dr. says ok to crush put in apple sauce and just pour a spoonful down the back of her throat or dissolve in a little liquid and use a syringe (no needle of course) & shoot it down the throat. Try to be gentle so you don't make her gag. Some meds can be prescribed in liquid form by request. If you have to give a pill you can try putting it in a spoonful of pudding and feeding it to her, again aiming toward the back of the mouth. Any liquid can be drunk with a straw & the sucking action can encourage swallowing, you can also chill Ensure like a milkshake. Talk to the Dr. about the mucus, this could be affecting her swallowing ability and is treatable. Your doing great keeping an eye on her. Keep up the good work!