Silent Aspiration? Chest Infection

[PMPL]

My mother is 86. She began exhibiting PSP symptoms in 2015 and now has a PEG tube to receive all medicines and nourishment. She appears to be very uncomfortable much of the time when fluid is introduced via the PEG.

Recently she has been treated with antibiotics for a chest infection because she is coughing and appears to be choking on the secretions which can be heard clearly in her upper throat/ chest area. Her lungs appear to be clear and her oxygen saturation 96-98% which is fine. She has no temperature but is very distressed by the coughing and inability to clear whatever is there.

My question to the forum is ...does anyone know or have experience of fluid being refluxed up a PEG tube that may cause the coughing and sound of "alot" of phlegm ( which may actually be the fluid put through the PEG?)

I feel.this is happening but have no precedent for it ...can anyone enlighten me...I'd be grateful for any insight/ informed opinion. Thank you. PMPL.

[Zerachiel]

Hi,

Please try to ensure she is sitting up at at least a 45 degree angle when feeding and for 15 minutes afterwards to prevent reflux.

My wife is also coughing alot with phlegm in her throat, as she cannot swallow very well or invoke a cough on her own it is very difficult to clear; try to help her when she is struggling to cough by sitting her up, quickly if possible, as this will create pressure on her Diaphragm and aid the strength of the cough, also when she is wheezing and you can hear her throat rattle get her to take big deep breathes in and out to to help provoke the cough.

Botox injections in the saliva glands can help reduce the amount of saliva produced.

[PMPL in reply to Zerachiel]

Thank you so much for your feedback, I do appreciate it .Doing all you advise already

Recently she has not been able to lie lower than 80 degrees without issue .

I always sit up at 90 degs to administer via PEG , even the slightest quantity of fluid.

I am aware when we give via PEG it causes her to push backwards, cough, make tasting movements of her mouth and more recently gag before coughing which is what has prompted my query.

Thanks again for your support.

[Zerachiel in reply to PMPL]

If you can lay her back a little it may reduce the pressure around her abdomen. Sorry to state the obvious but is her feed at room temperature and is it administered very slowly? It might be worth having a word with her dietician.

[PMPL]

I appreciate all you offer as advice.Again , all you say is addressed and more . Temperature, speed , duration, positioning, antacids, anti emetics, mucus thinners, secrerion inhibitors...

I have contacted dietician, SALT, District Nurses, St Giles palliative team, GP's and now "you" via this amazing forum.

All Advice has been followed to the letter, always in hope but there has been no improvement.

I also like to understand "why" aspiration/ reflux is happening ? Is it sphincter weakness, inhibition ? Position of the PEG ( if M herself is upright) , the size of the stomach ??

I will keep enquiring and will share anything I find..

In the meantime, bless you for taking time to help.

LPMP

[Cello8274]

Hello, PMPL. I sympathize with your struggle! A few things that have helped us: smaller amounts of formula more frequently. Higher calorie density requiring less formula required, absolutely nothing by mouth except water, glycopyrrolate 1 mg 3x day, guaifenesin 400 mg 3x day. Be sure she doesn’t raise her knees up…it’s amazing how that interferes with formula flow and digestion.

[PMPL]

Hello, thank you so much for your time and personal feedback, I am so grateful. We are according to the dietician already on highest calorie, lowest volume feed - I addressed this issue months ago yet we still struggle to give the quantity of fluid / food advised.

I have since posting my dilema and asking for insight determined that reflux/ regurgitation is the issue and I have also researched possible causes ...decreased gut motility , incorrect PEG tube placement, intolerance of type of feed, type of drug , hiatus hernia , ineffective sphincter activity.

All other causes , bolus delivery too fast, head lower than 45 degrees, poor postural positioning have been accommodated from day one of PEG feeding so I am able to eliminate these.

I also had ultra sound scan of abdomen and tube 6 months ago and all was in order re position of tube.

I am revisiting scan on Monday to check position and will then be seeking advice re the other causes.

I will feed back to this forum the outcome.

I extend deep and sincere thanks to you and everyone who has reached out to me and I send support to everyone having to travel this tumultuous PSP path.