NEW Dysphagia Support Group in the Greater Phoenix Area

On Friday, March 11, from 3:00 pm to 5;00 pm, the National Foundation of Swallowing Disorders is kicking-off a support group for those with swallowing disorders.

Future meetings are scheduled for the second Friday of the month from 3:00 pm to 4:00 pm.

Morningstar Senior Living has graciously offered to host our meetings. Morningstar is located at 21432 N 75th Avenue, Glendale, AZ 85305. http://www.morningstarseniorliving.com/communities/morningstar-at-arrowhead/

As this is our first meeting, this will be a planning meeting where we discuss the needs of the community.  Future topics will include:

  1. Feeding tube management
  2. Thickening products and thickening procedures
  3. Oral Care
  4. National Dysphagia Diet
  5. Compensatory swallowing techniques
  6. Social/emotional ramifications of dysphagia
  7. Optimizing reflux management
  8. New advances in Dysphagia Management
  9. Role of nutrition in maximizing swallowing function
  10. Dysphagia, from the eyes of the caregiver
  11. Free water protocol
  12. Understanding Aspiration Pneumonia
  13. Long term effects of radiation therapy
  14. Living with Xerostomia
  15. Naturally thickened liquids. Naturally pureed foods
  16. Customizing dysphagia therapy
  17. Understanding normal swallowing function
  18. Stroke and Dysphagia
  19. Voice and Swallowing…How are they connected?
  20. Dysphagia Diet Recipes
  21. Maximizing outcomes through the interdisciplinary team approach
  22. How are swallowing problems diagnosed

This swallowing disorder support group is open to patients, caregivers, clinicians and anyone who has questions and needs support and resources to live their best lives.

If you need more information or plan to attend, please email Laura Michael at: Laura@dysphagiasupplies.com.SSSC 2016 booth

Hope to see you there!

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Mom & Dad

M, D, L 2006 cropped

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.


Nourishing Independence with Mom’s Meals

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: laura@dysphagiasupplies.com or 480-266-5622.

moms meals


The Perfect Puree Day by Laura Michael

Dysphagia Cafe

Getting proper nutrition can be difficult when you have trouble swallowing. The inability to eat the right foods safely can lead to malnutrition. Maintaining proper nutritional intake is a key to overall good health and a high quality of life1. The National Dysphagia Diet2 defined the standard of what pureed food is, but offers little information on how to incorporate pureed foods into an active lifestyle.

The Challenge: Is it possible to eat healthy and well on a puree diet without using your blender or food processor? Can you still eat out? Yes! Let’s answer that challenge by offering breakfast, lunch, and dinner options for those on a modified diet.

Breakfast. Pre-made smoothies, available in the freezer case at most grocery stores, are a good option. Custom-made smoothies can be found at Whole Foods®, Einstein Bros.®, McDonalds®, Starbucks® or any juice bar. Smoothies that contain…

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Cookbook Review – Part 2

Book 4.1

 

I purchased, read and tested recipes from the four best-selling “Dysphagia Cookbooks” on Amazon.  Each is well written and insightful but there are specifics that are unique to each book. Each is a “labor of love” for the author. If you purchase one of these books, I encourage you to read the forewords and acknowledgements as you will find something of value in each.

As a passionate cookbook reader, collector and author, I currently have more than 100 cookbooks in my collection. I subscribe to every food magazine that is currently published and I can’t seem to part with my 20 year collection of the now defunct “Gourmet” magazine. If you called me a “food-wonk”, you would not be far off. I have developed my own techniques and recipes and have combined them into a guide: “Cooking for Someone with Swallowing Problems”.  This guide teaches the techniques you need to modify everyday foods and beverages. It has recipes and suggestions for eating out and stocking your pantry with pre-made, common everyday foods found in the grocery store. This guide is designed as a reference tool so you can modify the everyday foods you love so you can come close to living the life you had before you developed dysphagia. It is available for purchase for $29.95, which includes shipping and handling. If you want to purchase one, contact me directly: laura@dysphagiasupplies.com.  As part of the purchase of the guide, you will receive monthly updates, articles and new recipes.

The four best-selling “Dysphagia Cookbooks” on Amazon are:

  •  “Soft Foods for Easier Eating Cookbook” by Sandra Woodruff, R.D. and Leah Gilbert-Henderson, Ph.D.  This is “A Complete Guide” to dysphagia management.  The first 101 pages cover everything you need to know about stocking your pantry with food and kitchen equipment, thickening liquids, staying healthy, special considerations and more! If you can, take the time to read the first 101 pages, they are truly enlightening. The approximately 200 recipes follow the National Dysphagia Diet guidelines. The recipes are simple and easy to follow. Each recipe includes nutritional information and offers suggestions for substitutions and modifications. There are also tips for menu planning. The last thirty pages lists support organizations as well as products, manufacturers and distributors of products that make life easier for living with swallowing problems.

 o   This book was written in 2010, therefore it does not list many of the, new or improved products, new suppliers and support groups that have been developed in the last four years and there are many.

  •  “Down Easy: A cookbook for those with swallowing difficulties” by Judy Best. This book is especially helpful for someone recovering from cancer. The author, Judy Best, a graduate of a Le Cordon Bleu cooking school, was inspired to write this book as her husband was recovering from throat cancer.  If you want to learn to eat again after you’ve been on a feeding tube, this book offers great tips. The recipes are simple, easy to follow, use whole foods and natural ingredients.  Each recipe also has a complete nutritional breakdown and addresses whether it is gluten-free. This cookbook would appeal to someone who is transitioning to “regular” foods.

o    The author has assigned her own “Down Easy Swallowing Levels”, so the recipes don’t follow the standards set by the National Dysphagia Diet. If you have been given a care-plan for the National Dysphagia Diet, it may be a bit confusing if/how you use the recipes.

  • The “Easy-to-Swallow, Easy-to-Chew Cookbook” by Donna L. Weihofen, R.D., M.S, JoAnne Robbins, Ph.D., CCC-SLP, and Paula A. Sullivan, M.S., CCC-SLP. Part one of the cookbook covers information about how we swallow, and gives tips for managing some of the conditions that occur with swallowing problems. Part two contains approximately 150 recipes that will appeal to someone who enjoys the basic American diet. Each recipe includes a complete nutritional breakdown. This book is written for someone who is on a “Mechanical Soft” diet or who just needs foods that are easy to chew. It doesn’t completely address purees and how to modify each recipe for a “Puree” diet.

o    Written about the same time the National Dysphagia Diet was developed, it does not use the same terminology.  This book was published in 2002, so it can be a bit hard to find.

  •  “The Dysphagia Cookbook” by Elayne Achilles, Ed.D.  In this cookbook, most of the recipes are written for someone who can eat soft foods.  The author offers good advice on how to stock your refrigerator and pantry with foods that are easy to prepare and eat. The book also offers tips for traveling and eating out. The approximately 150 recipes will appeal to a wide variety of people.

 o   The recipes do not use the standards set by the National Dysphagia Diet, so you may need to read carefully and adjust the final dish.  This book does not include nutritional breakdowns of the recipes.

 


Eat Safely, Eat Well and Stay on Budget

“So what’s this going to cost me?” is a question I hear a frequently. 

The answer may be surprising.

For less than the cost of a “$5 foot long”, you can have a nutritious pre-made pureed meal that includes: a meat, a fruit or vegetable and a dessert.

Do you hate pre-made food? Do you want to eat your “normal” food? Then the cost of modifying “regular” foods and beverages adds about 10¢ – 20¢ to a portion.

An in-home cooking class and complete care instruction is $125 an hour. Training in your home takes about an hour and a half.

You’ll need a mini food processor. They cost about $40.  I can supply it or you can purchase one yourself.

Many care-givers are overwhelmed and under prepared for managing dysphagia at home. Help and solutions are not expensive…you just need to know where to look. 

I am here to help.

Contact me: laura@dysphagiasupplies.com

 

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Life After Aspiration Pneumonia

To my dad, food was love. Dad was a passionate gardener and loved to bake bread.  He was a child during the Great Depression when food was scarce. Simple things, like a good meal shared with family, mattered to him. As a “daddy’s girl”, I learned to cook because of my affection for him and because I liked eating good food.

When my dad returned home after his first bout of aspiration pneumonia, life at home changed drastically for both Mom and Dad. Like most people with dementia, Dad’s swallowing problems started a few years after his diagnosis. And like many people with dysphagia, the subtle changes went unnoticed until there was a real problem. Once his doctor and speech therapist prescribed a pureed diet and thickened liquids, life at home had to change. Dad’s food had to be pureed for safe swallowing so food particles didn’t get into his lungs. The beverages he drank had to be thickened so liquids didn’t leak into his lungs.

Mom had been preparing food for Dad for 45 years but she needed to make adjustments to her old cooking habits. Like Mom, many of my clients have been cooking for their loved-one for many decades but the “same-old-same-old” needs to be tweaked.

Many people don’t know where to start but I can help!

There are simple cooking techniques for modifying “regular” foods.

There are delicious, pre-made pureed meats, vegetables and fruits that are simple to prepare and are affordable.

There are thickened supplements and desserts that taste delicious.

There are new  instant food thickeners to thicken liquids are clear and tasteless and cost effective.

I offer it all: cooking lessons, equipment, thickeners, premade purees, pre-thickened beverages and desserts.

There are easy, simple and delicious solutions, if you just know where to look.

Please contact me if you need help: laura@dysphagiasupplies.com or 480-266-5622.

 

dinner table with food

 

 

 


Instant Food Thickener Review: the Good, the Bad and the Gloppy

For people living with swallowing disorders, it is unsafe to drink “regular” liquids. Mixing an instant food thickener into beverages is the most common, but unsatisfying, way to make liquids safe for swallowing.

Getting proper hydration is critically important to health, recovery and living. Implementing a care plan for thickened liquids is challenging but possible, even at home.

Starch-based instant food thickeners like ThickIt®, Thick & Easy® and ThickenUp® tend to be the most affordable options but they add a noticeable “starchy” taste to liquids. Starch-based thickeners react differently to different liquids. Liquids high in acid, like juice and coffee, thicken quickly and may continue to thicken as they sit. Starch thickeners also make milk look unappealing because they thicken the water component, separating the milk fat, protein and minerals making the milk look almost curdled. They work great for making a slurry but you can’t thicken carbonated beverages (or wine) with them.

Liquid xanthan gum-based gel thickeners, like SimplyThick®, are a better tasting option for thickening liquids but these gel thickeners don’t mix easily into liquids with a spoon. You need to either shake or whisk it into a liquid or it will not be completely smooth. Xanthan gum-based gel thickeners are about three times more expensive per serving than both starch-based and xanthan gum-based powdered thickeners.

Fortunately, powdered xanthan gum thickeners are becoming more widely available. The first xanthan gum powdered thickener on the market is ThickenUp® Clear. I am so excited about this product! It is a convenient powder and it mixes easily into liquids with just a spoon. Best of all, it has no flavor. When I it mixed into water, I could taste nothing but water. I mixed it into orange juice and milk and the results were smooth and tasted just like orange juice and milk. When I mixed it into hot tea, it thickened more than expected but it was easily remedied by add a little more water or milk. I didn’t try it in a carbonated beverage but I did try it in wine and it was the perfect consistency and added no flavor.

The only downside I see to powdered xanthan gum-based thickeners is that they are slightly more expensive than starch-based thickeners but think they are worth the slightly additional cost.

Like all thickeners, you must allow the both the gel and powdered thickeners to completely disperse and thicken into the liquid before you drink it. Those five minutes can seem like a very long time when you are thirsty so I recommend mixing liquids in bulk and keeping them in the refrigerator. Make sure to mark the container and drink the beverages within 24 hours. Shake or stir the thickened liquid before serving. If, the liquid had become is thicker than you need after it has been refrigerated, add more liquid to make it the proper consistency.

In the meantime, if you are living with a swallowing disorder, you now have better options. If you want to thicken your own beverages you have a choice of thickeners.

The texture of thickened liquids is tough to get over, though you do get used to it. Drinking thickened liquids that have a starchy taste is really tough. Pre-thickened beverages taste better and are convenient.  Drinking a beverage thickened with a “Clear” thickener is a revelation!

 

Happy older man with glass of juice


What is dysphagia and why does it matter?

Dysphagia means having trouble swallowing.

When you think about it, we swallow unconsciously all the time; normally about 500 times per day. Swallowing is one of the most complicated tasks performed by the nervous system. The swallowing mechanism is centered deep in the brain in the cerebral cortex, medulla oblongata and with the cranial nerves.

In the first stage, about fifty pairs of nerves and muscles work together to process the food we put into our mouth, chew it and prepare it for swallowing. Everything we swallow is in the form of a liquid, puree or has been chewed to the right texture.  Once food is chewed it is called a “bolus”.

In the second stage of swallowing, the tongue pushes the food (bolus) or liquid into the back of the mouth which triggers the swallowing response. During this stage, the epiglottis closes and breathing stops which prevents food from entering the trachea (wind pipe) and lungs. Swallowing is one of the only actions that human’s perform during which must stop breathing!

The third stage begins when the epiglottis is closed and the food (bolus) enters the esophagus, the tube that carries food and liquids to the stomach.  The whole process takes about 3 seconds.

When swallowing doesn’t happen correctly, the results can lead to serious problems. People with swallowing disorders are at risk for dehydration and malnutrition. Food or liquid that leaks into the lungs may cause a serious illness called aspiration pneumonia.

Without proper hydration, our bodies cannot survive. Without proper hydration, our bodies cannot process the foods and medicines we consume. Dehydration often leads to mental confusion and depression.

Without proper nutrition, our bodies cannot heal.  Without proper nutrition, we have no energy to handle the tasks at hand. No one can live, let alone thrive without proper nutrition.

Aspiration pneumonia is the leading cause of death for those suffering from dementia.

Dysphagia is common in people who have had a stroke, Parkinson’s disease, head-neck-throat cancer, dementia and other motor neuron diseases.

If you have a concern or questions about swallowing, see your doctor. Your doctor will refer you to a Clinical Speech Language Pathologist for a swallowing test.

The good news is that once diagnosed, dysphagia can be managed and treated.  Management of dysphagia is usually accomplished by modifying foods and beverages to make them safe for swallowing.

There are delicious, premade pureed meats, vegetables and fruits that are simple to prepare and are affordable. There are simple cooking techniques for modifying “regular” foods. There are thickened supplements and desserts that taste delicious. There are new instant food thickeners to thicken liquids are clear and tasteless and cost effective.

If you have questions, need advice or recipes, please contact me:

laura@dysphagiasupplies.com

 

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“Hydration, Hydration, Hydration!”

 


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Water is an essential element for sustaining life. The human body is composed of more than 60% water. Without water, we won’t survive for more than a few days.

Summer’s warm temperatures and increased humidity can cause dehydration more quickly than during other seasons. No matter what time of year, it is important to stay properly hydrated!

10 Warning Signs of Dehydration:

Thirst. If you are feeling thirsty, you are already dehydrated!

  1. Dry Mouth. Some medications can add to the sense of dry mouth, reduce saliva production and exacerbate the problem.
  2. Fatigue. If you feel tired after activity or in the afternoon, you may be dehydrated.
  3. Dizziness. Feeling light-headed or having vertigo is signs of moderate dehydration.
  4. Depression or Irritability. If you are feeling a case of the blues or find yourself snapping at people for no reason, you may be dehydrated. Dehydration can cause unwanted behaviors in people with Dementia.
  5. Dark or Cloudy Urine. If your urine isn’t clear, you are dehydrated. The darker the color of your urine, the more severe your dehydration.
  6. Difficulty going to the bathroom. Constipation is a common symptom of chronic dehydration.
  7. Changes in Skin. Flushed, or slightly red, skin is symptom of acute dehydration. Dry skin can be a symptom of chronic dehydration.
  8. Nausea. Often, if you feel nauseated, you won’t feel like drinking anything BUT it is necessary for treating and preventing dehydration. If you feel nauseated, take small sips of cool, not cold, water.
  9. Rapid Breathing. Rapid breathing is a sign of severe dehydration and is often accompanied by a rapid heartbeat. If you are experiencing rapid breathing and an increased heartbeat, seek medical attention.

If you experience any of the warning signs, drink sips of cool water to avoid nausea and vomiting.

When you have trouble taking foods and liquids by mouth, it can be especially challenging to get enough hydration. People who must consume thickened liquids are often put-off by the flavor and texture of older, starch-based thickeners. New xanthan gum-based food thickeners like ThickenUp® Clear taste better, mix easily and don’t continue to thicken on standing.

Convenience is also important factor in getting enough to drink. It is easier to just “grab and go” water, juices and other beverages that have been thickened in bulk and are kept readily available in the refrigerator. Commercially prepared pre-thickened beverages provide a consistent supply of thickened liquids but can be a bit more expensive than thickening liquids at home.

Individuals who have limited mobility and who have Dysphagia are at high risk for dehydration because they must depend on others to meet their need for liquids. Keeping cool thickened beverages within “arms-reach” is essential but can be a challenge. One solution is to make ice cubes with water that has been thickened to the proper consistency with a xanthan gum thickener like ThickenUp® Clear and then using the ice cubes in drinks in kept within easy reach. You cannot make ice cubes with starch-based thickeners because they break-down into particles as they melt, causing an unsafe texture.

Eating foods like soups, pureed fruits, yogurt, pudding and other foods that have a high liquid content can also combat dehydration.  Another way to get an even more refreshing hydration is to enjoy popsicles made from fruit juices, sweetened drinks or products like Gatorade® or Pedialyte® that have been thickened to the proper consistency with ThickenUp® Clear. Popsicle molds are inexpensive and are available at stores like Target and Wal-Mart.

Dehydration can be exacerbated by the use of diuretics, laxatives, antidepressants, certain antibiotics and other medications. Please consult your Pharmacist about your specific medications if you have questions or concerns.

Dehydration can be very serious. Severe dehydration can lead to hospitalization.

The key to preventing dehydration is simple: avoid it. Be aware of what you are drinking and consume more liquids!

If you want more help and advice, please contact me: Laura@dysphagiasupplies.com