Choking

French

Yesterday was his young son's birthday (20 years old). I had made a roast beef. He made the pieces too big and put two in a row in his mouth. Result' it got stuck in his esophagus. 

This happens often because he eats very quickly. I haven't finished serving everyone and I haven't started eating yet, but he already has emptied his plate. Even when it's very hot and we can't eat, he swallows everything very quickly.

Yesterday evening it started again with a piece of quiche and this lunch with yogurt. So 3 meals in a row. That makes a lot in a short time.

I make him get up and walk to pass it on. I will undoubtedly have to practice the Heimlich method. 

Otherwise, he still manages to use his cutlery and has a very good appetite.

Have you been confronted with that? Do you think it's neuro-physiological or just because he eats too fast? 

We have an appointment with the neurologist at the end of the month, I notes the question to remember to ask it.

 Thank you 

Ed1937

Hi French. I don't know what causes this, but I'm sure it must be pretty scary. We have a son who eats like that, but he hasn't chocked, so I'm guessing it isn't due to eating too fast. Hope you find out what it is.

caberr

My DH has been coughing when he eats. He says he's ok but once said food was getting stuck. He also takes big bites. Maybe that could be part of the problem.

The dr wants to do testing because  it can be a neuro problem which comes with ALZ.   But DH doesn't want to do the test.  We are watching it now but I am bringing it up again when we see the neurologist.  

I don't know maybe your husband is eating too fast but I would bring this up at your appointment.  It can be scary.

Jo C.

Hello French; I am sorry this is happening.  Your instinct to be concerned about this is a good instinct.  With dementia, many times our Loved Ones (LOs) develop difficulty swallowing and as time passes, it can become an inability to swallow. 

It is extremely important to have the doctor order a "swallow test," just as soon as possible.  Perhaps making a call to the doctor to get this done quickly would be helpful.  This test is done easily and is usually performed by a Registered Dietician.  It is non-invasive and nothing touches the patient.

This is usually done in outpatient radiology.  The patient sits on a guerney and a fluorscope is placed in front of the patient without touching him/her; the person conducting the test can then, on a screen, observe actual action of the mouth and tongue chewing; the throat mechanism in swallowing, all the way down.  This will show where the issue is and what is happening physiologically.

In my LOs case; she was given sips of water; bits of applesauce, pudding, and a cracker to eat. I was present in the room and it was fascinating to watch.   The dietician can then prescribe a helpful diet and can also prescribe exercises to help the swallow if that is going to be possible.

When swallowing becomes an issue, our LO's risk is not just choking, it is also a concern for  aspiration and there can even be "silent" aspiration with no choking; even from saliva; the aspiration hazards are there and dangerous.  Very important to get the swallow evaluation done.

Perhaps it might be necessary to cut his food into small pieces for him; serve him last; and put only small amounts on his plate and if he is still hungry; you can cut and serve him a second helping.  It may be that he is not going to be able to handle items such as beef, that can happen; the meat is too firm.  This is a challenge to find the best approach, and it may take a bit of time to find  the right actions to assist him in not harming himself. 

My LO could not handle beef or pork; the consistency she needed was soft foods and we also later had to add a prescribed thickener to her liquids to ease swallowing. It was called, "Thick-It."

So hope that you can get a swallow test done soon and to find a way to adjust your LOs food issues.  Let us know how it goes.

J.

ElaineD

Dear French:

I had the same ideas that Jo C suggested:

Cut his food into small bites.  And perhaps you can control how much food he gets at one time?

I imagine both ideas might be difficult to employ if your DH is resistant, of course.

You have faced so many challenges with creativity and bravery.  I know, of course, that you are just 'doing what has to be done' and might reject that idea that you are 'brave'.  But that's how I see you, French.

By the way, our older son has lived in France for 36 years.  He and his family live in the 7th Arrondissement in Paris, and now have a house on the coast in Brittany.  We used to visit France very often.   My father, killed in action in Normandy in WWII is buried in the large American Cemetery in Normandy.

Our last visit to France was in 2019.  But now I fear my disability will make future visits almost impossible.  And perhaps the progression of my DH's dementia would also be a factor. 

Our 27 year old French grandson will probably marry in the next 3 years at most, however,  and I so hope we can attend.   

Love to you, French.   ElaineD

amicrazytoo

I have learned to change up our menu to reflect easy to swallow foods, my DH has dentures and only wears the top one. He tends to put much larger chunks of food in his mouth than he should, I used to tell him to cut it up smaller. Now I just serve everything smaller, if we have steak, I pre-slice it for him into more manageable bites , the same with other meals that are not user friendly. Bonus, it keeps the mess on the counter in the kitchen instead of on the table and I don't have to watch him as closely while he eats. Just about every menu can be fairly easy to convert to a casserole as long as you have all the flavors.

star26

Hi French, When food gets stuck in the esophagus it is not choking. It hurts and is very uncomfortable but the airway is not blocked. If this is DH's issue, it is probably due to both eating too fast and his esophagus not clearing the food at its normal quick pace because of age and/or neurological dysfunction. (There's a long list of esophageal disorders that can happen on their own but I'm guessing this is neurological/dementia related.)  A PWD that is eating way too fast will even continue to eat once they start to feel this pressure building, which of course makes the problem worse. The risk of choking comes if the food comes back up into the throat instead of eventually going down to the stomach.  That's when you'll hear coughing and choking. 

The heimlich maneuver is for clearing a blocked airway. Sitting/standing up straight and giving it some time with no more food/liquid coming in (as you have been doing) will help an esophagus clear. Sometimes telling someone to raise their arms straight up towards the sky can help achieve the straight up posture that helps. 

If he's coughing while he's eating (and before the esophageal issue starts), as caberr's DH is, that's a separate issue (swallowing). It would not be unusual for a PWD to have both issues. 

The modified barium swallow study that Jo C describes, or a full barium swallow study that shows the digestive tract as well, may show the issue. I say "may" because depending on what the problem is, and how bad it is, it may only happen when DH has eaten a certain amount of food in a certain way (too fast). Because this test exposes a patient to radiation, they cannot watch him eat an entire meal nor would he likely want to eat a bunch of food covered with barium. A gastroenterologist would likely recommend an "EGD" test if the swallow study shows food coming back up or otherwise not clearing the esophagus in a timely manner. 

Obviously, slowing down his eating should help a lot. (Good luck. I find this very unpleasant and nearly impossible with strong-willed PWD). Hot water or hot drinks also speed up esophageal clearance (avoid alcohol and caffeine). If you have any luck with him following direction while eating you might have him take a sip after every few bites, in addition to slowing down.  

If he also has GERD (reflux: food coming up from stomach into esophagus), there are a list of dietary and other recommendations you can find online. 

French

 Thanks to all of you. I didn't know swallowing tests existed. Interesting and harmless indeed.

We have an appointment with the neurologist in 2 weeks. In the meantime, I observe how it evolves and adapt if necessary.

The neurologist is very young and I'm afraid she has very little practical experience. But she is also a very good listener and has confidence. She compensates for her very natural inexperience by listening and that is very pleasant.

My companion also regularly coughs, not much but regular. He never complains because it doesn’t harm. I had posted a topic almost 6 months ago and some of you had told me about some kind of allergic reactions. He tells me it's like a feather tickling his throat, which is also consistent with an allergic reaction. It reminds me of my asthma attacks at the time of my divorce. We did a lot of tests to find out what I was allergic to until one day I realized it was every time I saw my ex-husband or he called ! That day I realized that you can create asthma attacks from stress and treated the source (with not seeing him and answering his calls). From this days I have stopped the meds and never had asthma again.

I have the impression that it's also at particular moments but I can't find the causes.

Now I tell myself that it could be linked with swallowing and that I should be more careful and also ask the doctor. 

It's really difficult to take care of someone's health when they can't express accurately  if it's going or not and exactly what they feel.

I'm going to try to keep letting him cut his food because I notice that when I do something for him, shortly afterwards he doesn't know how to do it anymore (I just noticed that he can't close the windows anymore). However, I will serve him after everyone else to keep an eye on him and stop him if he eats too much or too fast.

ElaineD, we are at the entrance of Brittany and I am from Normandy. You can imagine very well that the kitchen is the center of my house. Lunch and dinner is a ritual. Forget about blanquette de veau, bœuf bourguignon, trout with fines, leg of lamb or coq au vin ... impossible. Make mincemeat out of it, as a last resort . I hopE you will be able to come for your grandson marriage. For the moment we are the losers in the vaccine race but we have the curfew at 8 pm (6 in some parts of France) that reminds the war to my grand mother, and we will certainly have a third lockdown in few days. I would never have imagine that would be possible in France a year ago !

ElaineD

Just a note:

I have several neurological conditions, and one of them causes my esophagus to 'stop moving' the food down, so the food backs up.  Eventually my esophagus moves the food again.  It really doesn't help me to add liquid to the mix, as it as my esophagus has stopped moving and liquid doesn't make a difference.  This problem is indeed diagnosed with a barium swallow.  My problem was diagnosed in 1996.  And last I understood what is happening.

The second neurological problem in my esophagus is that the valve at the bottom, which opens to allow food into the stomach, doesn't open!  The condition is call Achalasia.  The valve is stuck shut.

This is the result of nerve damage.  This is a much more difficult problem for me as the food stops at the bottom, and since I don't feel it has stopped, I keep on eating until the last bite cannot go down.  Now my entire esophagus is full.  Again adding liquids is counter productive.  No more eating and waiting can take, literally, hours, since the nerves that control this valve are damaged and keep it closed.  Achalasia is diagnosed with an esophageal endoscopy, which isn't quite as 'patient friendly' as the barium swallow.

There is a treatment for achalasia, which is an outpatient treatment.  There is a balloon-like instrument introduced into my esophagus to stretch the valve open.  And then, BOTOX is injected into the muscles all around the bottom of my esophagus, to relax them so they will not cause the valve to close.

Well, at least my esophagus is beautiful and wrinkle free!  However, the Botox injections do not last forever, and I'm almost three years out from my first treatment, and the Achalasia is beginning to reappear.   In the time of COVID, I'm waiting until I'm vaccinated to consider this elective surgery.

By the way, you'd think with these two problems I'd be skinny from them.  No so, I always manage to eat enough, and sugary things don't have the fiber and bulk that cause my problems.  Ice-cream and cake never 'get stuck'. Alas.

ElaineD

ElaineD

Dearest French,

The vaccine will come to you, rest assured.  And the central place of 'la table' and 'la famille' in French life is very beautiful.  My lovely and talented daughter-in-law (belle fille) cannot cook at all.  My son is a marvelous cook, creative and masterful.  Everyone is in awe of his skill.  He must always begin with basic ingredients and many herbs ands spices, no shortcuts for him.  Now his daughter is an accomplished cook and she also bakes!  The son is asking for help in learning from his father.

The family has spent many weeks in Brittany during the curfews, but now the daughter, son and his girl friend are in the Paris apartment.  My son and daughter-in-law return this week after many months in Brittany, because he  must attend to his very large apartment.  My daughter-in-law, with a Rothschild bank in Paris, is still working from home.

I love Paris, and France.  My son says Paris is 'not the same' as much of the property has been bought by Russian oligarchs and the very wealthy Chinese.  The neighborhoods are losing their charm, I guess.   Or perhaps my son is just 'getting older', and at 56 I suppose that is so.

Love, ElaineD

harshedbuzz

Hi French-

I would encourage you to call his neurologist today rather than waiting until his scheduled appointment. Choking in dementia could lead to aspiration and pneumonia. It could be an emergency.

When my dad developed some choking and sputtering the director of nursing at the memory care facility addressed it with urgency and scheduled a swallowing evaluation the next day. I happened to bring him lunch that day- some friend chicken strips, pomme frites (the extent of my French) and a milk shake. His evaluation was done by a speech and language pathologist who specializes in feeding issues using the foods I had brought and some other things as Jo C. described. She determined that dad's epiglottis had become "sluggish" as a result of his damaged brain which didn't close the structure over his windpipe. He was also holding food and saliva in the back of his throat- giving water to wash it down was a special risk to him because it sped the food down faster than his epiglottis could react. This is why PWD often have their liquids thickened. 

After the evaluation, she discussed a balance of feeding dad as safely as possible while keeping food appetizing to him as he was losing weight. She felt he was safer eating pieces that weren't too small and having liquids thickened a bit. She also banned straws and sports bottles as too dangerous and had the staff offer food and liquids at different times rather than together. We were also told to encourage him to clear his throat and verbally prompt him to swallow. I was not expecting dad to have this swallowing issue as early in the disease progression as he seemed; he was still quite verbal and knew how my mom and I were. 

Unfortunately, by the time we put these measures into practice, dad had already developed aspiration pneumonia. The director of nursing also ordered a chest X-ray because dad seemed more fatigued than usual. It was positive for pneumonia and dad died later that evening. 

HB

Lills

My DH also ate at a super fast rate.  Sometimes, I was just sitting down and he'd be done eating!  Funny, when I first told his doctor, he suggested buying a table 2 minute (timer) hourglass.   Ja, right.  I knew right then that this doctor didn't understand!

Cutting up what was on his plate into smaller pieces meant that he could eat faster!  I tried everything to make him eat slower.  At first, I used to remind him to use his manners (this was before I 'knew' of the FTD).  I bought weighted silverware...nope.   I then used to gently hold his arm down until I knew he swallowed.  In desperation, I would pick up his plate and place it next to mine and out of his reach.  I'd give it back to him after he swallowed.  The latter became our 'normal' routine.  

DH also had a swallowing test.  Everything was fine. 

Now, I'm feeding him...

Lorita

Hi,

 My husband, Charles, also had trouble swallowing near the end.   He developed aspiration pneumonia before I knew he was having problems.  After he was hospitalized he had a swallowing test - not the whole kind Jo described - and the dietitian decided he needed to use the thickening agent.  This did seem to help.  I was told the older you get the muscles in your throat lose the strength or ability to adequately push the food down.  He finally got to the point he would pocket his food so we had to be really careful when he was eating.

 I'm having some problems with swallowing, too, if I eat too fast. The food just won't go down and kind of stacks up until I can get rid of it.  I got in the habit of eating fast when I was working and would ran errands on my lunch break and had to eat at the same time or at my desk.  I don't have problems unless I eat too fast - but it's hard to slow down.

 Lills - I'm glad you found a solution to the problem for a while even though now you're feeding your husband.   Sorry it has gotten to this point but it almost always happens - doesn't make it easier but at least you know he's not eating too fast.  Watch for pocketing his food in his cheeks - they can be good at doing that.

French

What happens is exactly what star26 described. He still can breath. It isn’t an aspiration.

At diner I controlled everything. His eating speed, what he put on is fork, and everything went perfectly. I will continue.

Mary Farquhar

https://alzconnected.org/discussion/comment/82764#Comment_82764

Hi Jo: I am new at this chat feature and this appears to be an old post but I found the discussion helpful. My husband is in MC and recently has been eating so fast; he is choking. They asked me if I wanted a swallow test and said, yes. A speech therapist came out and asked if I wanted to do a video fluoroscopic test and am waiting for the referral. Thanks for the encouragement.