Choking

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.

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

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. 

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

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

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.

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.