MANAGING SYMPTOMS( continued)
• Carbonated beverages may be easier to swallow than still, clear liquids and may result in less residue in the throat after the swallow.
• Try cold liquids versus room-temperature liquids.
• It may be easier to take medications with a spoonful of a puree, such as pudding or applesauce, instead of with liquids. Do not use gelatin. Do not crush medications unless approved by a physician. Take one medication at a time.
• Consider smaller, more frequent meals.
• Use the less-affected side for self-feeding( CBD).
• Consider that some foods melt at body temperature, such as ice cream and gelatin, and may increase the aspiration risk.
• Consider using yogurt for smoothies to maintain consistency.
Any other suggestions?
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• It is important to maintain good oral hygiene to minimize the risk of aspiration pneumonia and to enhance ease and enjoyment of oral intake.
• Minimize use of dairy products, which may make secretions thicker, thereby interfering with swallowing.
• A portable suction machine may be of value to assist with clearance of secretions, particularly at mealtimes. Both electric and manual oral suction pumps are available. Your physician can provide a prescription.
• Drinking more water, or sometimes carbonated beverages, may help break up secretions. Your physician may have suggestions for over-the-counter or prescription medications to thin or reduce secretions. Generally, try to avoid decongestants, as these dry up secretions, making them thick and ropey and more of a challenge to manage.
• It is important that the caregiver be educated in the use of the Heimlich maneuver. Ask your physician, nurse, or therapist for instructions.
• Monitor for unintentional weight loss.
• Evaluate prescribed medications because some of them may cause the swallowing problem( or make it worse) or cause dry mouth.
• It is important to be alert to the signs of aspiration pneumonia, including increased chest congestion, chronic low-grade fever, increased cough( particularly with mealtimes), and change in sputum. Does the affected individual cough more at mealtimes than at other times of the day?
• The use of nutritional supplements, such as Ensure, Carnation Instant Breakfast Drink, Boost, Sustacal, Benecalorie, etc., may be beneficial to increase caloric intake quickly and easily. Consider the“ plus” version of these products for more concentrated calories and nutrition.
• Supervision during mealtimes is always a good idea.
• Consult with a dietitian to ensure that your meal plans contain all the nutrients that you need.
Thickeners
Thickening liquids are sometimes used to slow the rate that liquids move through the mouth and throat, improving airway protection. These thickeners are selected because they are readily available or can be obtained through most local pharmacies within 24 hours. These products do not require a prescription. However, you should consult your physician and speech pathologist as to whether these are appropriate. There has been some concern that thickeners, when aspirated, are not well tolerated by the lungs. In addition, some experts believe that thickeners may further reduce liquid intake, as regular thin liquids are generally everyone’ s preference.