This is the most recent episode of my mum’s PSP, she barely chokes, now we are dealing with after a meal cough, she coughs few mins after having her meals(different meals). I got her a cough syrup that helps after a while. Has this happened to anyone or experienced this, any solution?
Her next appointment is till June 10th
Hi, I remember you posting about her getting food stuck before, please be careful as she may be aspirating. I have pasted the below guidelines from an NHS website:Swallowing difficulties are also common in PSP. These include:
Coughing or choking on food or drink
Wet voice quality when eating or drinking
Taste changes – people may develop a preference for sweet food
Eating too fast or putting too much food in the mouth
Because PSP can cause difficulties with downward eye movement, it can be difficult to see food and bring it to your mouth. This means that some people require assistance with eating
Difficulties with eating or drinking can lead to weight loss, repeated chest infections (through small amounts of food and drink being aspirated into the lungs) and increased risk of choking.
The following is some general advice:
Sit upright, facing forwards, chin level or down slightly
Avoid distractions, e.g. turn off the TV and try not to talk during a meal
Take small mouthfuls of food
Take your time, don’t rush
Chew carefully and finish each mouthful before you take the next
When drinking take single sips of fluids slowly, rather than gulping mouthfuls
Avoid mixing fluids and solids e.g. soup with bits in, cornflakes with milk
Avoid dry crumbly foods, moist foods may be easier
Sit upright for 20 minutes after eating and drinking
I am her primary caregiver, I am currently taking all the steps you listed above, I feed her myself, food are given in small quantities and slowly.
I really do not understand the constant cough few minutes after eating.
Thank you for taking out time to reply
Hello again, If this happens after food it is highly likely it is because she has not swallowed all the food completely and/or has aspirated. Here is a .pdf document you may find useful
google.com/url?sa=t&source=...
and this is a guide to pureed food
hcalabtheoryandpractice.pre...
also try water rather than cough syrup, this can contain a lot of sugar which is not good if it gets into the lungs.
Hi Candor8!
First, I agree with Zarachiel. I have collected our experiences and information that I submit for your consideration:
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!.
David750 point out: “I found with my wife (PSP) the food had to be more and more ultra smooth. Gauging this was difficult- not too runny not too thick. Liquidising food I found I had to be liquidised when hot to get the smoothness required. Any "grittiness" in the food caused choking”
In advanced stages of the disease, feeding the patient is a big problem. The patient is so bent forward and cannot tip his head back or move it, so feeding is now very difficult
Our solution (which often works but sometimes does not) is as follows:
1) With the fiber-free part of the head of an electric toothbrush, we massage the outside of the jaw and the inside of the mouth to stimulate the muscles that open the mouth. Also, before feeding the patient, give a circular finger massage for 1 minute just at the top of the jaw and under the ears, she can move her jaw better.
2) Place a big napkin under the chin.
3) With the caregiver's left hand, the head is raised and with the right hand the spoon is inserted into the mouth and it is removed empty.
4) The head returns to the position where the chin is close to the chest (in this position it is easier to swallow) so that patient can swallow better.
5) Steps 3 and 4 are repeated as many times as necessary.
6) When feeding with a small spoon is very slow and difficult, we have used a 60 ml syringe, introducing the pureed food between the teeth and the cheek in small doses (10 ml each time).
It is normal for the napkin to get very dirty.
Note.- On the advanced phase, the patient tends to be frequently drowsy. If he is very sleepy it is useless to feed him. It is preferable that you take something the patient like very much (An ice cream for instance) to entertain the stomach and not force feed. This happens especially at dinner and in the morning our patient eat breakfast very well (generally the easiest and fastest meal of the day). Lunch is usually quite acceptable too.
Scottoppy suggest: "My wife has a similar problem and has been given a "Headmaster" neck brace by the orthotics people. Google it for more info but it is a comfortable, adjustable brace that she tolerates better than the old foam one. Also try a 'V' pillow at night and in her chair this helps to keep the head straight and comfortable.”
pmcdonough1 suggest: “My husband had PSP and when he started to aspirate when drinking his doctor prescribed Donepezil 10 mg (Donezepil is a cholinesterase inhibitor) . After just a few doses his eyes lit up like there was a light turned on in his head. His swallowing improved. After a couple years when he started aspirating again his doctor increased the dose of Donepezil to 20 mg. His speech therapist was amazed at his improvement. In the United States on the NIH website under Progressive Supranuclear Palsy it lists that ”some PSP patients” benefit from up to 20 mg of Donepezil.
Richard33 point out: “Cholinesterase inhibitors are not recommended if severe motor features are present, as any positive effects on memory may be negated by worsening of motor symptoms. That said, everyone's journey is different and it may help someone where they still have good mobility”.
Let doctor know about the article on the NIH website as a resource.“
Feeding thier loved ones they sometimes will cough, sneeze and nose starts running, despite feeding with puree and using a syringe.Dance 1955 and David 750 suggest "the use of an atropine solution that is used as eye drops in ophthalmology. These drops are applied under the tongue of the patient about 15/45 mins before food helps with the secretions".
REOC pointed out: “We were told to definitely not use a straw as can’t control the amount going in. Mum uses a glass or a ‘sippy cup’ which controls the amount (like toddlers use, with two handles and a drinking spout). She’s also on level 4 food which is puréed. If you search for level 4 food you’ll find lots of info and advice on the different stages of foods to eat as well as ideas for meals.”
I hope to be useful. Hug and luck.
Luis
Hi. You’ve had a lot of valuable information from Zerachiel and Luis. Noises and coughing and wheezing after eating or drinking or sometimes just moving become a sound you hear often. It’s all to do with the swallowing muscles in the throat managing flow of food, drink, saliva. It’s an awful sound but in some ways being able to cough is a good thing in at least her body is trying to clear any irritation or blockages. It’s very stressful for us all to hear as aspiration is very dangerous. Cough medicine is just something else she has to swallow and can cause her to cough as the cough isn’t always infection it’s swallow weakness.
Thank you and yes Luis and Zerachiel have been very helpful
thanks for asking about this and many thanks for all the replies which are useful and relevant for me as I care for my husband with CBD and who is increasingly struggling with his swallowing
My husband used to cough after eating (no choking) and he did six weeks of voice therapy that seems to have corrected that. You might want to ask your doctor about whether this would be helpful.
Eating concerns
Eating problems 
Eating is optional for my sister
Cough
