Atul Gawande’s marvelous book “Being Mortal: Medicine and What Matters in the End”, is a must-read for anyone who plans to age in the USA. Dr. Atul Gawande is a surgeon, a professor at Harvard Medical School and the Harvard School of Public Health, a writer for the New York Times, and the author of three bestselling non-fiction books on science and public health. He makes difficult subjects interesting and understandable. You don’t have to be a scientist to understand and enjoy his books.
In “Being Mortal”, Dr. Gawande writes eloquently about the history of how we care for our aging population and the importance of retaining the dignity and freedom to be the “authors of our own lives.” In the end, when all else is said and done, that is what matters.
This book has inspired me. This month, I spoke at the Arizona Geriatric Society’s Fall conference. My topic was “Managing Dysphagia Beyond Acute Care”. Once read this book, I reworked my presentation. I made sure to address the joy of eating, the social aspects of sharing a meal and the cultural significance of food. The medical professionals who attended this conference know the science so I shared with them my thoughts on the art and soul of eating.
“Being Mortal” is a call to action for doctors and other medical professionals to expand our responsibilities beyond trying to “fix” what is wrong and embrace the final years of living. This time period should be about living as fully as possible and having the best possible day (week/month/year); it should not be focused on dying. As we reach advanced age or fight a terminal illness, much of what happens to our bodies can’t be “fixed”. Yes, we can eat right and exercise but there is nothing we can do to stop time.
For many of us, as we age, our ability to swallow can become impaired. Illnesses like oral cancer and dementia can rob us of more than our vitality; they can steal from us our ability to eat and enjoy food. According to the National Institutes of Health, one in six Americans over the age of 60 is having trouble swallowing. In 2013, over ten million Americans had a swallowing assessment.
In “Being Mortal” Dr. Gawande builds the case that “as our time runs down, we all seek comfort in simple pleasures – companionship, everyday routines, the taste of good food, the warmth of sunlight on our faces”. Not being able to eat and drink like everyone else can interrupt our everyday routines, be isolating and can lead to depression. Food and eating is basic to our survival, but is even more important to our quality of life and our joy of living. How we eat and with whom we eat feeds the spirit.
Caring for someone with swallowing problems is about more than the mechanics of feeding. Doing it right is science combined with art. With the right tools, creativity and information, it may be possible for those with swallowing problems to share and enjoy a meal. Diagnoses and food modifications help to sustain the ability to nourish the body but we should acknowledge that we need to feed the soul, as well.
Gathering at the holiday table is one way we share our love, show our humanity and honor our cultural traditions. For manyof us, holiday feasts like Thanksgiving and Christmas don’t feel like a holiday without certain well known and loved dishes. Traditional foods and recipes are handed down from one generation to the next, keeping alive our memories and honoring those no longer at the table.
For most of us, feasting with friends and family is basic to our humanity. But when you are having trouble swallowing, the act of eating can be scary, difficult or even dangerous. Needing to be conscious of every bite you take, how you position your head and thinking through the swallow is no picnic! It can create anxiety, prevent you from being in the moment, taking part in the conversation at the table and enjoying the occasion like everyone else. Those who are recovering from a stroke, are having treatment for cancer or who are living with dementia may already feel isolated. Not being able to share traditional family meals in a “natural” manner may be frustrating and challenging and can make matters worse.
It is understandable when those with swallowing problems may be tempted to “cheat” during the holidays and eat foods that are not part of their eating plan. Sharing traditional foods with family and friends is how we celebrate! Platters get passed and everyone takes a little bit of this and maybe a whole lot of that. Traditional foods have a special place at the holiday table but if those foods are the wrong texture, they can be a problem for someone who is at risk for aspiration. Aspiration is when a small particle of food or liquid enters the trachea (a.k.a. the airway or windpipe). Aspiration can cause choking and aspiration pneumonia, both of which can be life-threatening.
Whether your family celebrates a holiday dinner with roast beef, turkey or ham, it is possible for someone with dysphagia to eat almost everything on the dinner table with a few modifications.
If you are on a Mechanical Soft Diet, remember to take small bites of soft, well-cooked foods. Add gravy and sauces to your foods to make them moister and easier to chew and swallow. Dark meat turkey is often more moist and tender so choose thigh meat and cut it into small pieces. Be mindful when eating foods with mixed textures. Avoid foods that aren’t easy to chew like nuts and raw vegetables. Stick with roasted vegetables and stay away from the crudité plate. Have the pumpkin pie instead of the pecan pie.
If you’ve been prescribed a puree diet, you’ll need a make a few additional modifications to many foods to make them the right texture for you. To puree a single serving or two, you will find that a powerful mini food processor will become an invaluable tool. Full-size food processors and blenders won’t work because they are too big to efficiently puree one or two portions to the correct texture. You will also need an instant food thickener like ThickenUp Clear® or ThickIt®.
Here is a puree plan for most traditional foods:
- In a mini food processor, place cooked a 2 – 3 oz. portion of cooked meat and process until finely chopped. Add 2 tablespoons of broth and process again until very finely chopped. Add 1 scoop instant food thickener and puree until smooth. The texture should be as thick as mashed potatoes. For visual appeal, place the meat in the corner of a quart-size zip-top bag and seal. Snip off the corner with the meat, and pipe the puree onto a plate in the approximate shape and size of a serving of meat.
Mashed Potatoes & Gravy
- No modifications needed, just make sure the potatoes and gravy are lump-free and the potatoes are firm (not soupy).
- Avoid stuffing. Try slurried dinner rolls (below) which taste a lot like stuffing.
- Mash with lots of butter.
Green Bean Casserole
- No mushroom soup allowed. Instead, puree a portion of well-cooked green beans and fried onions in a mini food processor with a small amount of cooking liquid. Add 1 scoop of Instant Food Thickener (I like ThickenUp Clear) and blend until smooth. You are looking for a texture like smooth mashed potatoes.
- Use only soft dinner rolls. NO SEEDS OR WHOLE GRAINS! Make a slurry with ¼ cup of chicken broth and ½ scoop of Instant Food Thickener (ThickenUp Clear) and mix until it thickens. Pull apart the roll and cover with the slurry. Set aside for about ten minutes, until the roll has absorbed the slurry. Reheat as needed.
- Canned smooth, jellied sauce is okay.
- Filling only. No crust.
- Puree the filling in a mini food processor. No crust.
If you crave apple pie a la mode, check-out the archived recipe on this blog.
With a few modifications, you or someone you love can safely enjoy a holiday feast!
When you are a caregiver, it is easy to feel alone and overwhelmed. If you are a family caregiver, it may feel even more challenging because of family dynamics and family roles. Even when you are doing your best, you can’t seem to “fix” what is going wrong. Often, family caregivers are thrust into the role without much preparation. Whether you are caring for an aging parent or a spouse or child with an unexpected illness, switching gears and roles can be HARD.
When you are in the thick of it, please remember to “take the oxygen mask for yourself” before you assist the person you are caring for. “Taking the oxygen mask” means looking after your own basic needs. Take time to eat, rest and care for yourself. You need to do those things that rejuvenate you. Doing so does not make you selfish, it makes you smart. If you can’t breathe deeply or if your body, mind and soul are not nourished, you will no doubt fail. There is only so much of you to go around.
When my mom was in the thick of it, when Dad had more bad days than good, I would remind/nag/cajole her to take time for herself. Many, many times I told her: “I’m losing Dad to Lewy Bodies; I don’t want to lose you as well”. She listened. She asked for help and assistance within the family, from her friends, in the community and through support groups. As the old saying goes: “Many hands make the burden light”.
My parents had always been the first to volunteer when there was an emergency or need whether it was in the family, within the community or among their friends. I am grateful that their community responded when Mom and Dad were in need. Both of my parents taught me the true meaning of grace and courage.
Dad has been gone five years now and Mom continues to move mountains.
In my next blog post, I will share some of the great support groups and online communities in which I have found strength and support. In the meantime, if you would like to contact me, please visit my website: http://www.dysphagiasolutions.com.
Recently, I worked with a client who had just returned home after six weeks in hospital and rehab. “Irene” had been a vital, active 78 year-old woman before her stroke. More than anything, Irene and her husband “Bob” want to get their lives back to normal.
Since Irene has arrived home, Bob has been working overtime managing all of the activities that come with recovery from stroke including: scheduling doctor’s appointments then going to the appointments, ordering and receiving a hospital bed and wheel chair, juggling therapy visits, picking-up prescriptions, making the house wheel chair friendly and opening all the mail that accumulates while you are occupied away from home, just to name a few.
Bob asked me to help him learn how to cook for and feed Irene. Before the stroke, cooking was Irene’s job in the family but Bob will do anything it takes to care for his wife, including learning how to cook at 78 years-old! Being a bit overwhelmed, Bob has no time to cook for himself, let alone cook and then puree meals for Irene. I’m glad that there are foods like Mom’s Meals – Purees to recommend to him.
Mom’s Meals is an online supplier fresh-cooked, ready-made refrigerated pureed meals. Each meal has a main dish, vegetable and dessert. Their menu consists of comfort foods like:
- Scrambled Eggs with Brown Sugar Pork Loin Bacon, Bread and Applesauce
- Roast Beef with Gravy, Mashed Potatoes, Brown Sugar Glazed Carrots, Vanilla Pudding and Applesauce
- Pork with BBQ Sauce, Cheese Mashed Potatoes, Green Beans, Fruit and Chocolate Pudding
- Roasted White-meat Chicken with Gravy, Mashed Potatoes, Green Beans and Carrots, Fruit and Vanilla Pudding
- Pasta with Marinara Sauce and Broccoli, Blueberry Applesauce and Pudding
You order online (or by phone) and Mom’s Meals ships directly to your home. The meals have a 14 day shelf life and are easily reheated in the microwave.
I sampled four meals and I found them delicious and hearty. At between 600 and 700 calories per meal, they are ideal for helping to rebuild your strength. With four breakfast menus and eight lunch/dinner choices, you have some ability to eat a variety of foods. If you like home-cooking, Mom’s Meals purees will appeal to you, as they did to Irene and Bob.
Each full puree meal is $7.49 plus shipping. Shipping is $14.95 regardless of the size of your order.
And if you are too busy to cook, like Bob, check-out their regular meals, as well!
To order from Mom’s Meals purees visit their website: http://www.momsmeals.com/independent-at-home/pureed-menu/.
If you need advice, please contact me: email@example.com or 480-266-5622.
Years ago, when I brought home my newborn son, I stumbled as I tried to find my “new normal”. Major life events mean that life has to change in a big way. The “normal – normal” seems to no longer exist.
Those first few weeks of caring for a totally dependent new life were exhausting, scary, “real” and totally overwhelming. Days were measured by feedings, naps and diapers. Since eating is such a basic part of living, I expected that feeding my son would come naturally. It didn’t. We had challenges. I met with Lactation Specialists in the hospital. I read everything I could get my hands on. What helped me most was reaching-out to other moms and getting advice. Slowly, as I became more comfortable and confident in my role as mommy/care-giver and after my son started eating regularly, the days started to make sense.
I like to compare my experience as a new mom to what families go through when a loved-one is sent home from the hospital after a stroke or other debilitating illness. Care-givers are thrust into roles they’ve probably never before navigated or at least have never practiced on their wife or husband or parent. Many people are often unprepared for the realities of managing the demands of cooking for someone with a swallowing disorder. Unfortunately, the “old way” of preparing meals won’t work anymore and the transition can be difficult. There are no “pureed diet” cooking shows on the Food Network. No famous chef has written a book about how to make pureed foods and beverages safe, nutritious and delicious…but I have.
I have dedicated my life to helping people eat, drink and return as close to “normal” as possible, as they navigate the road to recovery at home. During the ten years I spent working with staffs in hospitals, rehabilitation units and long-term care facilities, I taught many people how to properly manage foods and beverages for their patients with dysphagia. What I teach isn’t difficult or expensive but it can be critical to caring for someone who is living with a swallowing disorder.
The “new normal” will come with time and with a little instruction, a dose of creativity, and the right products. You can help restore the joy of eating and drinking to someone who is living with dysphagia.
If you need help or assistance, please contact me: firstname.lastname@example.org