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Swallowing and Difficulties and phnemonia

Hi All

I want to understand more about the above subject, my Dad is experiencing more than usual difficulties swallowing tablets, so some medicines are being changed to liquid format. What happens though when someone can't or has difficulty swallowing (i.e. If something goes down the wrong way)? What I mean is, why/how can they develop phnemonia? This may seem like a stupid question post but I need it all clearer in my mind!! By the way, there won't be any peg intervention x

Simple explanations greatly appreciated x

Ps if someone chokes on their food/drink, then what do you suggest?

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HI, Amanda,

These are questions I would also like to know. Not needed so far.

How's your dad ? Is he joining in more ?

p.s. I think its pneumonia ! Although the " phew " bit seems appropriate !

lots of love, Jean xx

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Hi Jean, dad has been joining in more but for the last 3 days has been very very tired, the nursing home had the gp out today due to high bp, the bp medication will be issued in liquid format! This could just be a stage....his bp can be temperamental (like mine lol)! It's all so hard isn't it?! Breaks my heart into little tiny pieces!! How are you? X

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Doing alright but becoming a bit of a harridon with incompetent people. I think those who deal with me either think I'm great or a witch !!

Breaks my heart too ! I'm always saying to helpers " but if you'd known him - - - "

Hows your mum doing ?

xx

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Aww bless you, mum says that all the time, if only you'd known him before?!!! Mum is alright thanks but we are together having a few emotional days, just constantly stressing out about dad! X

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Hope he settles.

big hug x

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Thx Jean x

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Hi Amanda

Archie had that but as you know he has peg now

Basically he went onto soft food diet and thickened fluids

Salts explained to me that when eating you have two tubes one for the food and other lungs . When you eat there's a flap that should cover the lungs one while eating that becomes weak so that's when it can go into lungs and cause aspersions

Hope that I put it ok for you

But that's my take one it

Sue xx

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Thx Sue! You've explained that very well!! How's tricks your end? X

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Hi

All quite at moment with Archie

Carers ok just ripped at boss yesterday and told him he will loose package next time I flip

Ha all sweet now I just ask and get what I want and no divvys to come

Hope you end all ok

Sue xx

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Bless you, keep en on their toes, girlfriend x

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Hi. The issue when someone's swallow mechanism degrades is that food can travel into the wind pipe and become lodged in the lungs - usually the right lung as far as I know.

Once debris gets in, it can cause an infection - known as an aspiration pneumonia.

My father suffered from this a few weeks ago resulting in a lenghty hospital stay. Thankfully he responded well to antibiotics and was able to beat the infection.

Hope this helps

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Yes it does help, a lot, thank you x

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This comes straight from the National Institute of Health (NIH)

How do we swallow?

Swallowing is a complex process. Some 50 pairs of muscles and many nerves work to receive food into the mouth, prepare it, and move it from the mouth to the stomach. This happens in three stages. During the first stage, called the oral phase, the tongue collects the food or liquid, making it ready for swallowing. The tongue and jaw move solid food around in the mouth so it can be chewed. Chewing makes solid food the right size and texture to swallow by mixing the food with saliva. Saliva softens and moistens the food to make swallowing easier. Normally, the only solid we swallow without chewing is in the form of a pill or caplet. Everything else that we swallow is in the form of a liquid, a puree, or a chewed solid.

The second stage begins when the tongue pushes the food or liquid to the back of the mouth. This triggers a swallowing response that passes the food through the pharynx, or throat (see figure). During this phase, called the pharyngeal phase, the larynx (voice box) closes tightly and breathing stops to prevent food or liquid from entering the airway and lungs.

The third stage begins when food or liquid enters the esophagus, the tube that carries food and liquid to the stomach. The passage through the esophagus, called the esophageal phase, usually occurs in about three seconds, depending on the texture or consistency of the food, but can take slightly longer in some cases, such as when swallowing a pill.

How does dysphagia occur?

Dysphagia occurs when there is a problem with the neural control or the structures involved in any part of the swallowing process. Weak tongue or cheek muscles may make it hard to move food around in the mouth for chewing. A stroke or other nervous system disorder may make it difficult to start the swallowing response, a stimulus that allows food and liquids to move safely through the throat. Another difficulty can occur when weak throat muscles, such as after cancer surgery, cannot move all of the food toward the stomach. Dysphagia may also result from disorders of the esophagus.

What are some problems caused by dysphagia?

Dysphagia can be serious. Someone who cannot swallow safely may not be able to eat enough of the right foods to stay healthy or maintain an ideal weight.

Food pieces that are too large for swallowing may enter the throat and block the passage of air. In addition, when foods or liquids enter the airway of someone who has dysphagia, coughing or throat clearing sometimes cannot remove it. Food or liquid that stays in the airway may enter the lungs and allow harmful bacteria to grow, resulting in a lung infection called aspiration pneumonia.

Swallowing disorders may also include the development of a pocket outside the esophagus caused by weakness in the esophageal wall. This abnormal pocket traps some food being swallowed. While lying down or sleeping, someone with this problem may draw undigested food into the throat. The esophagus may also be too narrow, causing food to stick. This food may prevent other food or even liquids from entering the stomach.

What causes dysphagia?

Dysphagia has many possible causes and happens most frequently in older adults. Any condition that weakens or damages the muscles and nerves used for swallowing may cause dysphagia. For example, people with diseases of the nervous system, such as cerebral palsy or Parkinson’s disease, often have problems swallowing. Additionally, stroke or head injury may weaken or affect the coordination of the swallowing muscles or limit sensation in the mouth and throat.

People born with abnormalities of the swallowing mechanism may not be able to swallow normally. Infants who are born with an opening in the roof of the mouth (cleft palate) are unable to suck properly, which complicates nursing and drinking from a regular baby bottle.

In addition, cancer of the head, neck, or esophagus may cause swallowing problems. Sometimes the treatment for these types of cancers can cause dysphagia. Injuries of the head, neck, and chest may also create swallowing problems. An infection or irritation can cause narrowing of the esophagus. Finally, for people with dementia, memory loss and cognitive decline may make it difficult to chew and swallow.

How is dysphagia treated?

There are different treatments for various types of dysphagia. Medical doctors and speech-language pathologists who evaluate and treat swallowing disorders use a variety of tests that allow them to look at the stages of the swallowing process. One test, the Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST), uses a lighted fiberoptic tube, or endoscope, to view the mouth and throat while examining how the swallowing mechanism responds to such stimuli as a puff of air, food, or liquids.

A videofluoroscopic swallow study (VFSS) is a test in which a clinician takes a videotaped X-ray of the entire swallowing process by having you consume several foods or liquids along with the mineral barium to improve visibility of the digestive tract. Such images help identify where in the swallowing process you are experiencing problems. Speech-language pathologists use this method to explore what changes can be made to offer a safe strategy when swallowing. The changes may be in food texture, size, head and neck posture, or behavioral maneuvers, such as “chin tuck,” a strategy in which you tuck your chin so that food and other substances do not enter the trachea when swallowing. If you are unable to swallow safely despite rehabilitation strategies, then medical or surgical intervention may be necessary for the short-term as you recover. In progressive conditions such as amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), a feeding tube in the stomach may be necessary for the long-term.

For some people, treatment may involve muscle exercises to strengthen weak facial muscles or to improve coordination. For others, treatment may involve learning to eat in a special way. For example, some people may have to eat with their head turned to one side or looking straight ahead. Preparing food in a certain way or avoiding certain foods may help in some situations. For instance, people who cannot swallow thin liquids may need to add special thickeners to their drinks. Other people may have to avoid hot or cold foods or drinks.

For some, however, consuming enough foods and liquids by mouth may no longer be possible. These individuals must use other methods to nourish their bodies. Usually this involves a feeding system, such as a feeding tube, that bypasses or supplements the part of the swallowing mechanism that is not working normally.

Well that's all I've got to say on the subject....hope this helps

((HUGS))

AVB

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Wow, thx AVB x

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Pneumonia can develop if, as you said, something goes down the wrong way, into the lungs. My husband had a PEG when he couldn't swallow food without choking but amazingly, right up to the end he could swallow tablets in yoghurt. He couldn't take any liquid by mouth but yoghurt was no problem.

X

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Thx Bev, how are you doing darling? X

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I'm doing fine thanks. Cramming so much in I haven't done any decorating etc. Only got rid of the stair lift last week. It's nine months since Colin left me. Sometimes it feels like yesterday, other times years, weird how life is. Being in the U3A with nearly 300 over 60's it reminds me how fragile life is, several have gone since Colin so I make the most of every day.

Sending you a big hug.

💐 XxxX

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As always Bev, you are an inspiration to everyone on here! Life is too short and we must all take a leaf out of your book! X

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If for some reason you can't change a med to liquid form, ask the doctor or pharmacist about crushing or opening pills and adding to applesauce/yogurt etc.

Some meds are time released and this method can't be used as it messes with time release.

Ron

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Thanks Ron

The main meds are being changed to liquid format x

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Dear Amanda,

Sadly this was the beginning of the end for Keith, he just couldn't swallow any more, he agreed to a peg feed but then changed his mind again, sorry I can't add anything more positive, it's such a relentless, cruel disease!

Love and hugs to you and your dear Mum....Pat xx

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Thanks pat, sending you a great big hug x

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😘😘😘

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Hi lovely Amanda George is unable to swallow tablets we crush them and put them in yogurt, we have been doing this for the last 9 months xxxxx

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Thanks darling, I do hope you and George are doing ok, Psp ok x

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This is what my husband died from, aspiration pneumonia, but had previously been explained to me sometime before he reached that stage. Basically there is a flap in our throat that opens and closes so that when we breathe air goes into our lungs through wind pipe and when we eat it goes down food pipe when a healthy person swallows it closes so that food doesn't enter the lungs and goes down food pipe, with PSP, the flap doesn't close quick enough and food/solids enter the lungs and can cause infection/pneumonia, lungs are very delicate and can't cope with foreign bodies.

Debbie

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Debbie, HI,!! How are you? Haven't seen you on here for ages. Please Message me and tell me your news,

Lots of love

Anne

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Thanks Debbie, a nice clear explanation! How are you doing? We don't hear from you much now x

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Hi Debbie

did you guys think about a PEG? if you did, what were the reasons you didnt go ahead, my dad is at this stage now were even puree foods and thickened drinks just stay in his mouth for 10 minutes sometimes

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Hi Amanda,. Steve couldn't take medication in liquid form, I had to thicken it, which caused loads of problems. The best is to crush pills and mix with yoghurt, or something similar, but not all pills can be crushed. It does make me laugh, giving people liquid medicine, when they Can't swallow liquids, could never get anyone to understand that!

Lots of love

Anne

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Thanks Anne, it's all a bit of a minefield really, cos my Dad can still eat soft foods and drink ok, but we all now how things can change in just a few hours 😥 X

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A syringe driver is what V had District nurses came in every day and filled it with a cocktail of drugs which can be monitored and increased as the need arises .Simple and effective and bypasses all swallowing problems.

Love Georgepa

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Agree with you Georgepa, my Dad had this when in hospital last year. Anyway my lovely, how are you managing? X

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Bloody awful ,excuse my French

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Bless you darling, I'm not surprised!! One day at a time Georgepa, sometimes one hour at a time is enough to cope with! Much love to you and Kate x ❤️

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Hi I read most of the information that was given to you. I wanted to let you know I had pneumonia about four years ago and they thought I had been having problems they did a test to see where what I was swollwing was going to it was not going into my lungs but I was told whenever swollowing not to bend my head back but tilt my head slightly forward. It does work.

Good luck try to take care of your self and your mom.

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Thank you x

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Everyone has explained this better than I could so just saying that my Dad suffers from this. He is also refusing a PEG and is now going to be treated at home for future infections which are inevitable. He's been in hospital 6 times this year and has had enough, understandably. He is enjoying his food which is the main thing at the moment.

Love Sue x

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So so sad Sue, huge hugs x

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Hi Amanda. Dad has drug patches so no swallowing involved. Xx

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Ooh Vron, I didn't think the meds could all be done in patch version! Great idea, thank you! Dad has patches for pain but I'll ask about this today. How are you and john? I must get round to calling you x

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Hi my Mum has PSP too and her swallowing is becoming much worse. Shoe isn't having a PEG tube either.The chances of developing aspiration pneumonia increases massively when the swallow gets worse. Basically, the food goes down the wrong tube instead of the stomach it can be inhaled onto the lung and cause an infection n the lung. Because usually the immune system is weaker and especially if the person is no longer very mobile this can increase the risk of it becoming a serious chest infection which can be quite dangerous. for the patient and especially in the advanced stages of the disease it can be the cause of death. My Mum has had a couple of chest infections but not full blown pneumonia yet. Hope this helps.

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Yes thank you it does help a lot x

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