Tuesday, November 20, 2012

Choking, Swallowing, Dysphagia - my father's case

Nov. 2006 - from my book, Living and Dying With Dignity

Dad greets me with a kiss today. Three times he tipped over in his chair. I think his equilibrium is gone. He juggled right-of-way with another resident, Tom, in the doorway as he tried to leave the sitting room. They are crashing about with wheel chairs, running into one another. He became angry, “I can never do anything well, dammit.” How do I recall for him the home repairs he had done, the work he did over the years, the care and love and the attention he lavished on his family?

He chokes on his milk and he cannot swallow properly. He recites “555”, the first three digits of his home phone number. I leave to get his third cup of milk and when I return he is surprised that I am here. He says, “Oh. Look who’s here!” As if I hadn’t just fed him two cups of milk. He insists on spearing his own meat that day. He manages to get three pieces into himself. He had much trouble doing it.
“Shit. Nothing’s worth a shit.” as he misses the small piece I had cut for him. He drank four glasses of milk that day. He is quite thirsty but I fear that he will choke to death and the newspaper will say, “Daughter stands by while father chokes to death on milk”.

Swallowing difficulties are called dysphagia and they are a common result of neurological or neuromuscular damage. At the time I had no idea that it is something to be expected. Large percentages of people with strokes, Parkinson’s disease, MS have this symptom. Those with structural damage include people like my Dad who have tumours. Swallowing is a complex process that involves 26 muscles. It is uncomfortable and frightening, as well as life-threatening because dysphagia interferes with the oral intake of food and medications. Long-Term Care Best Practices says that up to 70% of residents on LTC have signs of swallowing problems. This can result in aspirations, choking, suffocation, dehydration, malnutrition and decreased quality of life.

Dysphagia – choking and swallowing issues <=read more.

Signs of Swallowing Difficulties
• Coughing when eating or drinking
• Food or liquid spilling from the lips when eating or drinking
• Trouble moving food or liquid around in the mouth
• Prolonged chewing
• Trouble starting to swallow once food of liquid is in the mouth
• Clearing throat shortly after a meal
• Has a wet or gurgly sounding voice
• Complains feeling that something is “stuck” after swallowing
• Shortness of breath during or right after mealtime
• Has frequent heartburn or bitter taste in the mouth
• Unexplained weight loss
• Recurrent chest infections
• Refusal to eat or reluctance to have food in the mouth
• Pocketing food or liquid in the cheeks or holding food in mouth
(Reprinted with permission)

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