Chewing and swallowing

ImMaggieMae

My DH has a problem lately with chewing food. He chews things a few times and then washes them down with water. We had penne pasta with shrimp, olive oil, and herbs, all soft foods. Even after trying to convince him to chew longer before swallowing and not using the water to wash to food down, he continued. He must have drank 8 or 9 glasses of water. He’s around stage 5, has been to the dentist, but other than a pocket between 2 back teeth that he has to floss a couple times per day, no problems with his teeth. He doesn’t have trouble drinking liquids and can eat sweets like cookies without having to was them down with water. Has anyone else had this problem with their LO? What to do?

harshedbuzz

MaggieMae-

Hi and welcome. I am sorry for your reason to be here, but glad you found us.

I wonder if you should have an SLP come in and do a swallow evaluation/study with your DH. This practice of washing back food with water could lead to aspiration if his epiglottis doesn't react quickly enough. Dad's SLP specifically warned us against this practice (washing food down with water) and also against things like straws, sports-bottles and slurries with mixed textures like lumpy cereal and chunky soups. Alas, her appointment came when dad was already suffering with a case of aspiration pneumonia that would be his cause of death. 

My other thought is that your idea of shrimp as a "soft food" is probably not accurate. My mom recently got implants and her surgeon gave us the list of soft foods- not what I would have expected. She ate a lot of scrambled eggs.

That meal sounds amazing, btw, but I imagine the shrimp you used were large enough to have a nice chew to them. I noticed dad's preferences for food morphed as his disease progressed. He was more drawn to sweets than ever. In 60 years I had never seen dad eat ice cream and in late early stages, it became a nightly indulgence. His diet of grilled meats/seafood and salads went out the window and he leaned towards heavy sauced or gravy laden foods like meatloaf, mashed potatoes, mac'n'cheese, etc. He developed gall bladder issues for the first time in 40 years.

HB

DrinaJGB

He probably needs ot be assessed by a speech pathologist asap. This can lead to aspiration pneumonia. My father was assessed years ago after having trouble swallowing (radiation treatments with subsequent scar tissue)-- and that lead to a G tube for his nourishment afterwards. Too big of a risk.

ImMaggieMae

Thank you so much for all of your replies. I had no idea lung aspiration was a danger of this new behavior. I was more concerned about digestion of food that was not fully chewed. I will try to get an appointment with a speech therapist. 

The behavior is confusing because he’s at home fully able to walk and go up and down the stairs or go for a mile walk with me. He’s confused about a lot of things so explaining to him why he has to chew his food better goes in one ear and out the other. This behavior just started in the past week. 

While we are waiting for an appointment, harshedbuzz, you mentioned a list of soft foods from the doctor. Do you have a link or could you share some of the items on the list? He had been washing down partially chewed hard boiled egg this morning, but scrambled eggs are wetter and may go down without the water. Meatloaf is something he likes but it would have to be chewed at least as much as pasta. Maybe thinner pasta. The penne is thicker. Chunky soups are out? That leaves broths and puréed soups. 

harshedbuzz

Mom's soft food list was much like this one-

17 Best Foods To Eat After Dental Implant Surgery For Quick Recovery (healthsoothe.com)

As I recall she also ate a lot of fish and crabmeat around this time, too.

The neurologist or PCP might be able to get you in with an SLP sooner. Dad's came to his MCF to see him. FWIW, he was ambulatory, ridiculously verbal and knew his people at the time.

ImMaggieMae

Well, a month and a half later and DH’s problems with the swallowing seem less but his symptoms are now more like mid stage 6. Covid rates are very high here right now so waiting on the speech therapist for things to calm down a bit. In the meantime, thanks to all of your comments, I’ve revamped our menus to include lots of stews containing things like vegetables, beans, minced meats and sweet or white potatoes. I make a big pot that lasts for a few days and can also double for lunches or even be frozen. Besides the standard minestrone type stews I’ve come up with some African types with sweet potatoes, carrots, soft canned green beans, diced tomatoes, chick peas, cinnamon, cumin, coconut milk, a couple tablespoons of creamy peanut butter and a bit of curry powder. Another is German style with ground beef or pork, potatoes, cabbage, carrots, a small amount of sauerkraut, caraway seed and dill. There are a few others like eggplant chili that are popular here too. These recipes are great for all 3 of us so it doesn’t require special meals.

I also do a lot of dishes based on minced meats or beans which he can swallow easily. Foods like bread are difficult for him. Brownies puddings, yogurts and cakes aren’t a problem but I try to limit sweets to once a day. Most fruits are ok. He’s eating very well now and doesn’t drink liquids until after the meal for the most part.