Choking seizure

[T-val]

Good morning all, has anyone come across what looks like a mini seizure caused by choking/coughing. My mum has psp and her swallowing is declining but twice recently she has had a choking bout and then gone into what looks like a seizure just for a few seconds then she comes round and laughs, wondering why I am panicking, and is fine. Has anyone seen similar?

[Blueclouds07]

My mom had the same situation, you should observe carefully and when starts choking tilt the head a bit down and don’t give water just wait until the process ends but keep on talking to her to support her then if seizure happens then put her on a flat surface making sure airway is open and wait until it ends.

That what the doctor told us to do with my mother.

Take care

[T-val in reply to Blueclouds07]

Thanks for your reply. It was strange as literally a few seconds and mum brushed it off but when it happened a second time I knew I'd not imagined it. This monster just keeps on giving! x

[LuisRodicioRodicio]

Hi T-val!These are our experienes and informations about.

Hug and luck.

Luis

• Phlegm and choking: The first thing is to remain calm during episodes of truly shocking coughs. The second is that a physician rules out an infection in the respiratory tract. Get a pulse oximeter to control. (Fever is an indication usually either pneumonia or urinay tract infection (UTI) in PSP patients).

• It is not a big problem that the patient swallows his phlegm. For phlegm to be fluid, it is important to drink liquids. Ten minutes steam inhalation from boiling water in a bowl with a few drops of some floral essence (avoid mint plants and eucalyptus) that is pleasant to the patient, a small spoonful of marine salt and some pieces of lemon, with a towel covering head and bowl helps. (One to three times a day (*))

• Inhalation of the mentioned water steam together with abundant oral hydration are usually sufficient to improve the fluidity of phlegm.

• A steam atomizer to keep the air in the room moist helped too. (40% - 52% moist advisable.)

• Medications like "Mucosan" (Ambroxol hydrochloride) or “Fluimicil Forte-600” (Acetilcisteine) can help in some cases. Ask physician.

(*) We have observed that a steam inhalation session immediately before dinner can reduce appetite. Giving her dinner "before" the "steam inhalation" the results were better.

• In case of choking, raise both arms at shoulder height, breathe only through the nose intensely if posible. If not, inhale air intensely but not very fast through the mouth. Retain air a couple of seconds and then force the cough.

• Also here, to avoid in the diet drinks that can be irritating helps: coffee, carbonated beverages as pop or soda (or eliminate the gas by agitation before giving it to the patient), chocolate, orange or grapefruit juice, etc..

Note.- It has been described that: pineapple juice breaks down the protein very well and fluidifies the mucus (phlegms). It will have to be tested if the patient tolerates pineapple juice without coughing or choking. (Red1990 indicates that: the pineapple juice enzyme complex is available as a supplement called Bromelain. For people taking anticoagulants, bromelain and melatonin have the same risks of gastrointestinal bleeding as aspirin).

There are some foods to avoid…. things like grapes, rice, couscous, lentils, peas etc anything small was problematic as were spicy foods. Foods that crumble easily, cookies, crackers, stringy foods, sticky foods, etc.

• There is a suction machine which seems to help with the very sticky phlegm. We have NOT used it.

• A steam atomizer to keep the air in the room moist helped, too. (40% - 52% moist advisable.)

• The physiotherapists have exercises reinforcing trunk muscles to improve the cough response to choking. Engage a good speech/swallow therapist to learn swallowing techniques.

• Avoid dairy products, especially before bedtime, this seems to prevent the increase in phlegm viscosity.

• Raising around 15º a 35º (9” to 12”) the head of the bed also helps.

• Excess salivation - drooling: In our case and at the moment it is working:

• Drink plenty of liquid. In this case we use juice of “mango” and the juice of 1/4 lemon (*) for each 250 c.c. of mango juice, adding thickener until it reaches an adequate viscosity so as not to have choking problems.

• After hydrating with the mango fruit and lemon juice, the patient nibbles the remains of lemon Pulp (*). The pure lemon (*) is astringent and makes it easy to control excess salivation.

(*) It is necessary to test the use of lemon as there are cases that produce the opposite effect.

• Some caregivers have mentioned that the physician has prescribed Botox for drooling problems. In addition, the doctor who does the injections also prescribes pill, glycopyrrolate, that seems to extends and enhances the effect but on a recent paper of Dr. James Rowe (2021-07) points out that it primarily aids chest secretions and may have systemic side effects.

• Others have described the use of a sublingual drop in the morning and in the evening of Atropine (used in ophthalmology) to significantly reduce excess salivation.

• On our case, excessive salivation is a PSP symptom which decrease but not disappears as the illness progresses.

• Caregiver “key4u” pointed out: “Travel sickness patch called Scopdern blocked the choking on saliva which gave more energy for swallowing.”

• pspaireland.ie/quick-index/...

Prevent solids or regular liquids from reaching the lungs to avoid eventual “aspiration pneumonia,” (Besides falls, this is another very important risk.)

• Add thickeners (eg, Resource from Nestle, Thick-it, Simply Thick-Easy Mix, CVs,etc.) to drinks (soups, water, Aquarius (*) orange or lemon or similar without gas, etc.) till obtain a sufficient glutinous liquid. To drink, it is advisable to use a special cup (Ornamin 815) with the chin as near as possible to the chest. Some mango and peach juices have an adequate consistency.

(*) Isotonic drinks are interesting to help maintain blood electrolytes at the correct level.

• The food must be moderately doughy and in small pieces, around ½”-3/4” if solid.

• The speech therapist has insisted that she should not take meals that "deceive" the mechanism of swallowing that is damaged. The foods that “deceive” are those that have liquids and solids in the same bite (eg, some beans with soup or a soup with pasta).

• Check the patient is sitting fully upright to eat and try not to have distractions around while he is eating.

• Making a puree with a hand blender is always a solution, but it is preferable to crush with a fork until a homogeneous paste without liquid and so as not forget the function of chewing. What is not used is lost!