Monday, November 28, 2011

dysphagia, yes / dysfunctional meals, no

Written from my perspective, the caregiver’s view, Patti has MS related chewing and swallowing challenges. Memory loss and cognitive impairments act somewhat like an eraser on Patti’s ability to relate her own experience.

How something is defined versus how it affects someone are really two different things.

A meal centered holiday like Thanksgiving literally and figuratively brings dysphagia to the table.

This year was the first year I needed to feed Patti at the table following years of her increasing struggles to try to feed herself.

Amplifying this year’s focus on the challenges of chewing and swallowing I found myself the following day in an enlightening though poignant conversation with a cousin about her own and her son’s challenges with dysphagia associated with muscular dystrophies.

In Patti’s case it’s about the central nervous system in theirs it’s muscular. Nor is dysphagia exclusive to MS or Muscular Dystrophies – Alzheimer, Parkinson, and strokes to name a few. Even some medications and aging itself can complicate the complex combination of voluntary and involuntary muscles we know as chewing and swallowing and that most of us take for granted.

However none of us started out by taking it for granted. Any parent fondly remembers their time spent teaching a baby to eat from a spoon or chew solid food.

Do we fondly or alarmingly view the reverse?  How many people at the table can actually recognize choking and assist?

In Patti’s case, MS related, for example she may appear to be choking. Yet if familiar you would know that if a person appears to be choking yet talking (yes, even cursing and swearing) or coughing a dramatic interference such as Heimlich maneuvers might actually make things worse.

Speaking of the Heimlich maneuver how many at the table actually know when and how to do it? What about with special circumstances, such as a wheelchair?

Perhaps it should be about eating comfortably. Sharing a meal with people you do not have to educate or explain why you eat the way you eat and knowing they’ve ‘got your back’.

Caregivingly Yours, Patrick Leer 


  1. This is the procedure we use here at the hospital in case anyone would like it.

    How to perform the Heimlich Maneuver on a Person in a Wheelchair
    Step 1 Ask, "Are you choking?" to a person who is coughing, able to speak and not turning blue. A person who is choking will likely not be able to reply verbally.
    Step 2 Remain calm and encourage the person to do the same. Try speaking to him or rubbing his back or arm to calm him.
    Step 3 Look for signs that the person is suffering from total airway obstruction. These signs include the victim being unable to make any sounds above a wheeze, the face turning blue and hands clutching the throat in the universal symbol for choking.
    Step 4 Engage the wheelchair's brake if it's not already on, or turn off a power chair.
    Step 5 Try to perform the maneuver from the back, standing behind the person's wheelchair. If the back of the wheelchair is too high, do the maneuver from standing in front of the person (with him or her still sitting in the chair).
    Step 6 Lean the person forward, moving her head and torso down at a slight tilt.
    Step 7 Make a fist with one hand.
    Step 8 Place your fist just above the person's navel with your thumb in contact with his body.
    Step 9 Grab hold of your fist firmly with your other hand.
    Step 10 Make a quick in-and-up thrust against the person's diaphragm. You may need to repeat thrusting several times before the object is expelled.
    Step 11 Repeat until the choking person can breathe, the object is expelled or the person loses consciousness. If necessary, lay the person flat and do the maneuver as pictured above.
    Step 12 Call for medical help using 911 or another emergency number if necessary.

  2. Thank you oklhdan! You helped immensely without me having to exceed my self imposed 350 word limit per entry. :)

  3. The word Noble keeps coming to mind reading your blog...but I don't like all the separate meanings it has come to encompass. So just take it the best possible way. :-)

  4. A balancing act, I'm sure Patrick. I wouldn't know or not know if someone was experiencing dysphagia, choking, not choking, etc. But I do like the comment Oklhdan left (plus Mary's comment was a good one too!)

    Its just sad with dysphagia that it often takes away one of the fine things we enjoy about holidays and life in general. Eating foods we like and trying different ones. I'm sure it is a struggle for Patti in both endeavors!

    (all in all though I hope Thanksgiving was a nice one for you, Patti and Megan!)


  5. Very useful thanks Patrick and oklhdan

  6. That was an interesting thing. I guess, that was really good and I would like to check more materials like that. Hope I'll hear from you soon.


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