Bearable Asked January 2016
My Dad coughs sometimes now and has been put on a puree diet. Anyone else experience this?
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My Dad's favorite thing is food. He no longer enjoys his meals & he still coughs. Since the pureed food isn't helping with the aspiration and he hasn't gotten pneumonia only once and that was 6 months ago, can't he continue eating the mechanical soft diet he was on? Since Dad is now in a facility, it appears I have no choice in this, or at least the memory care is resisting this idea and the same with the speech therapist. But I am his proxy and want to do what is good for his quality of life. And I think his doctor would give me an order for the mechanical soft if I asked for it. Anyone have any experience on this topic?
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Has he seen a pulmonologist or PCP for referral to a specialist to determine if there are other issues causing the coughing?
From my own experience, I know that foods with crumbs (such as toast and crackers) as well as chocolate and other similar foods can cause coughing. I've seen it happen repeatedly.
Another issue could be that he adds more food to his mouth before the previous food is completely swallowed. That was one caution a speech pathologist warned about.
Dad could eat a soft poached egg (with a runny yolk) but couldn't swallow scrambled egg at all. He could eat casseroled liver but not minced or even pureed chicken.
He could eat rice pudding but not boiled rice
He could eat cauliflower cheese but not macaroni cheese.
When we got to the puree stage he couldn't taste food very well so I tried to make each item as flavourful as I could.
One thing I would check is how they are serving the food to your Dad I have seen it all in a sort of slop that resembles the way it comes out some hours later and that has to be unappetising. I used to make sure he had very very soft masse potato and that it was separated from a carrot puree which was separate from the mushed peas and that the meat was separate so he got a variety of tastes in his mouth.
Always a dessert usually very soft with pureed bananas which he loved, stewed apple and cloves which he really liked and I used to mix it with yoghurt or ice cream too for that added zing.
His dysphagia was caused by being intubated for months. The speech therapist who eventually solved the problem prescribed exercises, Shaker exercises I believe they were. They were the key to strengthening the swallowing muscles.
You might want to ask the speech therapist about these exercises, if the barium swallow test shows aspiration. I don't know whether they're appropriate for all situations though.
GardenArtist, I will ask the speech therapist about the Shaker exercises next time I talk to her. She is visiting with Dad today so I expect she will call me afterward.
Thank you also GardenArtist, The speech therapist is all about safety. Of course safety is important, but it is not the only thing in life (I tell them) You can be so safe that you no longer enjoy life. He will be having a barium swallow test soon. Speech therapist seemed to think this would give more info. Dad had a chest x ray last night so he has no sign of pneumonia. Yes, the therapist worked with him on taking small bites, eating slowly and tucking his chin before swallowing. None of which will stick without reinforcement. Maybe after I take him out a few times it would help me know whether to push for a return to mechanical soft. Very grateful for you time and kind attention.
Sadly I cannot eat more than a quarter of a slice of bread but I can eat a full slice of toast. Unfortunately memory care wont have the time (and if I am honest the inclination) to establish what he can and can't eat.
Mum is moving towards limited eating (basically because she is too bloody lazy to chew I might add unless of course it is sweets - she will chew a toffee quite happily!)
I make a lot of chunky soups so the veg is there but nearly cooked to death but it doesn't matter because all the goodness is in the liquid, when she is having one of her moments I make it a smooth soup otherwise I leave it chunky but I used minced meat in the soup not chunks. I find a cooked gammon on the bone (Boiled) will give you a great stock to base a soup on or the boiled bones from the chicken and while Mum hasn't a clue I do it I often use an oxtail and make a really good broth from that too.
When she wants pureed food I make sure I have lots of colour in separate piles on the plate so she know she has the various veg etc. It's like I said earlier I can't think of anything worse than having a pile of brown slop on the plate and that does happen a lot although not so much these days.
The other thing you need to think about is order of eating. I like to eat my vegetables first meat last always have always will. Mum likes a little bit of everything on the fork each time - if you alter that and care homes sometimes don't ask this you sometimes find that appetite disappears because that is not the way they LIKE to eat their food.