Jump to content


E-Newsletter Signup Like us on Facebook Sign Up For Our e-Newsletter
Photo

finding food that is honey like for husband


  • Please log in to reply
3 replies to this topic

#1 lindau

lindau

    Newbie

  • Members
  • Pip
  • 2 posts

Posted 13 January 2014 - 10:56 PM

hello, my husband at 71 has Parkinson,does does not shake, he has a little dementia he s wreckd his pickup went to the ER last Monday,he was ok ,but had low BS and he is not diabetic,they said he had a touch of Phenmonia and was aspirating,He had been eating food the reg way, his lung Dr. said that was ok as long as he did not get phenmonia, but he did,at one  time his  Parkinson Dr wanted him on a tube , he refuses that.I can work out breakfast lunch and snacks,but supper is hard to think of what to give him,I have to puree his food,how can I do meats???Soups???it is just me and my husband and I am diabetic and am over whelmed with this new way.sorry about the miss spells I could not find a spell check here

thanks

linda



#2 Dr. Mahler

Dr. Mahler

    Advanced Member

  • Speech Clinician Moderators
  • PipPipPip
  • 114 posts

Posted 14 January 2014 - 09:55 AM

Dear Linda,

 

Thank you for writing with this important question about how to alter a diet to maximize safe swallowing while still optimizing enjoyment.  Swallowing disorders (dysphagia) are common in people with PD so you are not alone in dealing with this problem.  We know a lot about swallowing changes associated with PD and make individualize recommendations to maximize safety and efficiency of swallowing with the least restrictive diet.  As I read through your email, it looks as though he has seen a lung doctor and his Parkinson doctor but I don't see any mention of seeing a speech-language pathologist (SLP) for a swallowing evaluation.  Did he by any chance see an SLP when he was diagnosed with pneumonia?

 

He should have a swallow evaluation because there is such heterogeneity about the reasons people can have swallowing problems. 

There are a number of reasons why swallowing can be "difficult" for a person with PD so an evaluation with a speech-language pathologist (SLP) is essential to determine the specific causes for a given individual.  The evaluation usually consists of an examination of the muscles for chewing and swallowing and then possibly a modified barium swallow study if the SLP suspects a problem in the pharyngeal stage of the swallow which is more difficult to observe directly than the oral phase.  When the evaluation is done the SLP should be able to describe the swallowing problems, the underlying physiology causing the problems, the risk for aspiration, and treatment strategies that appropriately address the cause of the problems. 

 

Although people with PD share a common etiology there is great heterogeneity within the population regarding the cause of swallow problems.  Appropriate treatment techniques to address swallowing disorders in PD need to address the motor and sensory components.  Common treatment approaches for swallowing deficits in PD include:

  • Modifying bolus flow with postures
  • Maneuvers to improve airway protection or airway clearance
  • Alterations in diet consistency
  • Sensory stimulation
  • Swallowing exercises
  • Alterations in feeding environment

 

The chin down posture can be used for PD patients who demonstrate a delay in swallow initiation to widen the valleculae and narrow the airway entrance to decrease the likelihood of aspiration (Logemann, et al., 2008; Martin-Harris, Logemann, McMahon, Schleicher, & Sandidge, 2000; Shanahan, Logemann, Rademaker, Pauloski, & Kahrilas 1993; Welch, Logemann, Rademaker, Kahrilas 1993).  An effortful swallow maneuver can be used to increase tongue base retraction and reduce depth of penetration (Bulow, Olsson, & Ekberg, 2001).  Thickened boluses can be used when there is difficulty with bolus manipulation and control because they are easier to control (Bulow, Olsson & Ekberg, 2003; Kuhlemeier, Palmer, & Rosenberg, 2001; Troche, Sapienza, & Rosenbek, 2008). Sensory stimulation with ice chips or pressure on the tongue can be used to improve speed of swallow response (Logemann, 1998; Lazzara, Lazarus & Logemann, 1986).

 

Muscle strengthening exercises may increase tongue strength and range of motion in elderly and may also help people with PD.  (El Sharkawi et al., 2002; Logemann, 1998; Robbins, et al., 2005).  A randomized study of 3 interventions on immediate aspiration of thin liquids in patients with PD (with and without dementia) was completed by Logemann, Gensler, Robbins, Lindblad, Brandt, Hind, Kosek, et al., (2008).  They compared nectar thickened liquids, honey thickened liquids and chin tuck.  They found that honey thickened liquids were best at eliminating immediate aspiration but there were other complications that resulted from decreased fluid intake.  Compensatory strategies may prevent aspiration but do not influence or improve the underlying pathophysiology of the swallow.  Principles of exercise applied to the behavioral treatment of swallowing disorders have demonstrated improved swallow function.  Those principles include: intensity, specificity, and transference (Burkhead, Sapienza, & Rosenbek, 2007; Robbins et al., 2007).

There are a number of reasons why swallowing can be "difficult" for a person with PD so an evaluation with a speech-language pathologist (SLP) is essential to determine the specific causes for a given individual.  The evaluation usually consists of an examination of the muscles for chewing and swallowing and then possibly a modified barium swallow study if the SLP suspects a problem in the pharyngeal stage of the swallow which is more difficult to observe directly than the oral phase.  When the evaluation is done the SLP should be able to describe the swallowing problems, the underlying physiology causing the problems, the risk for aspiration, and treatment strategies that appropriately address the cause of the problems. 

 

Once the SLP has determined exactly which consistencies are safe for you husband then there are lost of recipes that can be recommended.  In the meantime, using a blender to make foods thick but easy to chew is my best advice without seeing your husband in person.  Add some spices to make it more interesting.  Then get advice from an SLP who can do a live evaluation.

 

Please write again if you have questions.

 

Sincerely,

Dr. Mahler


Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island

#3 lindau

lindau

    Newbie

  • Members
  • Pip
  • 2 posts

Posted 15 January 2014 - 01:48 AM

yes, my husband has been through all that, they wanted him on a tube a year ago he said no ,he  continued to eat normal food,last week he had a wreck totaled his truck went to the Er his BS was very low, they thought he was diabetic, after a day or so they found he had phenmonia (sp)and was spitting and aspirating .He has never had phemonia  (sp) before, he sees his lung ever 3 months and his lungs has been clear he is very upset about never being able to go out to eat again and eat normal food.They did a test in the hospital about his swallowing and  the Dr. there wanted to have that all checked with drink and food,he has always used thick it in his drinks by the way for quite a while and about a year or so ago he saw a  speech-language pathologist (SLP) for a swallowing evaluation and  excercises etc  He also sees a nurolgest .he is just not happy eating pruee  food, he says he should be able to go out to eat once a month, we were going very often and he was doing pretty good.I am doing the best I can, hard to feed him one way and me another we are both 71,I am diabetic with stage 3 kidney failure ,but doing pretty good.We just got a new primary Dr.due to our insurance saw he yesterday, poor lady she has a interesting two some with us.Going out to eat was a treat for us both, we would go about 2 times a week, now our enjoyment is gone for the 2 of us and I feel like I am going crazy with this 3 times a day fixing him something he can eat.he used to fix his own breakfast, and lunch and I would fix dinner, he also has a balance problem, but no shakng .Oh the new Dr. said his lungs were clear yesterday but wants him to get a xray in about a month.Sooo, he can never go out to eat? He lved BBQ ribs and trimmings and Chinese buffet and fried chicken, we are from the South. help 

thanks



#4 Dr. Mahler

Dr. Mahler

    Advanced Member

  • Speech Clinician Moderators
  • PipPipPip
  • 114 posts

Posted 05 February 2014 - 12:31 PM

It can be very challenging to find foods that are safe to swallow and enjoyable.  The tradeoff is somewhere between eating foods that are aspirated (go down the wrong way to the lungs instead of the esophagus) and eating foods that taste good and are swallowed safely.  As it becomes more difficult to eat, it is also important to assure that the foods that are eaten are high in nutritional content to meet nutrition and hydration needs.  The speech-language pathologist can clarify the appropriate consistency but then there are many creative ways to make foods of the appropriate consistency enjoyable to the individual by using seasonings and sauces.  For example, BBQ can be enjoyed in beans or minced or pureed meats.  A consult with a registered dietician can assist with ideas about ways to maximize nutrition intake.  For example, adding protein to milk shakes (when they are still thick) is a way to increase protein intake in a honey-thickened food that most people with PD find satisfying.  One tip, avoid ice cream flavors with seeds such as strawberry.

 

A note about alternate feeding methods such as tube feedings.  Please be aware that having a tube placed for feeding does not necessarily mean that oral feeding is over.  A tube can even make eating more pleasurable because it takes the "pressure" off of eating and drinking enough to maintain nutrition and hydration needs and take medications on schedule, which is very important for people with PD.  A person can eat as much as they can of the appropriate consistency (measure this) and then take the rest as a supplement throught tube feedings.  This allows the person to participate in the social emotional pleasure of meals without the pressure to eat and drink more than the person can of feels up to eating.  Smaller more frequent meals and/or nutritious snacks between meals are a good idea.  For more specific recommendations appropriate specifically for your husband, please consult with the speech-language pathologist who is part of his health care team.

 

Sincerely,

 

Leslie Mahler


Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island




0 user(s) are reading this topic

0 members, 0 guests, 0 anonymous users