Starting to have trouble swallowing. Any suggestions?

Dear Old Sailor, please call her doctor and make an appt as soon as possible. Then when there ask for a speech/language pathology referral for a dysphagia evaluation.

After an evaluation is done, usually including a modified barium swallow study, the therapist can do some short term therapy to determine textures, strategies and whether different methods will work. There are different strategies that really help-for example chin tucks, head turns, and some positioning strategies also. But you really need a professional to determine how to protect her airway, and also how to help her be more comfortable when eating.

The gagging, trouble initiating a swallow, and trouble handling secretions are red flags. She is at a very high risk for aspiration pneumonia or malnutrition.
I have treated people with swallowing problems for over 20 years.

There are also some special cups and eating utensils that can help. But first, you have to know exactly what the problem is.

You are a great husband, and it sounds like you are excellent at problem solving. A professional can work with you to make it safer for your wife.

My mom kept shoving too much food into her mouth at once. We started using teaspoons instead of tablespoons. And a child-sized (not baby) fork. She has two meds that can't be crushed so we keeo canned whipped cream on hand. A squirt onto a spoon, drop the pill into the middle, and she usually swallows it with no problem. We follow up with another squirt or two so she wikl swallow a few extra times to make sure the pill goes all the way down.
Regarding straws, sucking through a straw uses the mouth muscles differently than swallowing. It can be too hard for people with swallowing issues to remember to alternate, suck, swallow, suck, swallow. It leads to sucking too much and gagging or swallowing but not getting anything through the straw.
Applesause is great for taking pills. But boring to my mom. So we will put canned pears or peaches into a blender and pour in just enough of the liquid to get it to the right consistency.
One last thing, the consistency that she is able to swallow will change so watch for any struggling. Sometimes mom can eat regular but soft food like tuna sandwiches. Other times she needs food like pea soup consistency. You should be prepared to set a meal aside to try again tomorrow and give something else. We keep pureed soups for those days in single serving plastic bags in the freezer. Not every day will be the same.
I applaud your efforts to make sure your wife is eating suitable healthy foods. It's not always easy.

Be sure to find out if the pills can be crushed...some can't be if extended release kind. Yogurt, applesauce, ice cream...foods like that. Let Dr know the swallowing issues ASAP. Diagnosis Alzheimer's? This is a symptom

Hello there fellow caregivers .. I have some swallowing tips that i do with my 92 yr old mom that is late/end stage with contracted arms and legs just not quite to fetal position. Last year it hit hard within a month she lost all of her movement and now only grunts. Neurologist confirmed not a stroke but infact dementia.
My mom always had taste for hard candy even at bedtime she would take some to bed. About a year before her transition she developed sundowning issues and slow speech and a very annoying calling out or rather a ah..ah..ah..ah..ah sound non stop.
On a 1300 mile car trip she started that. I had a bag of trip candy and decided to give her a blow pop. And she stopped until the gum stuck to her dentures lol..
So i bought a bag of dum dums YES I SAID DUM DUMS SUCKERS.
Eventually i had hospice come to the house. They have been here 9 months what a god send.
They were concerned of her choking. Sugar intake.. Like hello you just approved her for hospice.
Comfort care...
Every morning i wake her for nourishment usually a Enterex strawberry diabetic shake. They are hands down the best tasting skake..But i stick a straw into her mouth and nothing.. Doesnt even close her mouth... I wet a dum dum and stick that into her mouth and wait a few minutes and she is working that dum dum over. I just pull the dum dum out and insert the straw and she off to the races on that shake.. Hospice workers thought it was crazy but they have come around. Maybe the constant eating of suckers keeps her muscles in memory mode and that helps swallowng too. Needless to say sams clubs sells a bag of (small head pops for about $13 )
Small head means the pop head is smaller than the traditional size.
Dum dum of ohio heard of my moms love of their product tjey sent us a whopping 60lb case.
My mom is on seroquel ( decreasing dosage from the intial dose). Baclofen for muscle pain. Xanax, fentynal patch and morphine for break thru pain. I have been thru a lot with my mom i view this as a journey.. I am a sole caregiver with worthless older brothers. I consider us fortunate.
Day by day. .. Never never never...
Give up.
A final thought... I see commercial s on tv about what smoking does to a body. Not many people (except medical people) know exactly how bad dementia diseases can affect a person
Its like no one wants to talk about this insidious final stages of the disease ,at least until it happens to their loved ones. I just didnt know about it myself... No one should have to go through this.. Caregivers you are special. Please tell the world about this disease .please educate.. And then maybe more will be spent on research. And caregivers only truly know the sacrifices this disease takes .. Im done ... Lol hope this helps. I have lots of tips that i do ... For my mom . lm always eager to share and learn
Have a peaceful day..
Also pills are crushed and mixed with applesauce.
Sweet is last taste to go.
There is a product that some hospitals have by Hormel called " magic cup" google it about 300 calories.
Ninja smoothy maker is good for puree foods. $60 at walmart..
You can buy pureed dinners in bulk
But they will cost a bit.
Let hospice help you when its time.
Sometimes we want our loved ones to eat a lot however when a swallowing incident happens . aspiration is a real serious reality. So when that almost happened to us. Now we tend to be less robust in the amount of food . but taste and does it have a great amount of nutritional value.. As disease progresses more of " thick it" is needed in liquids .. Antibiotics do not try to crush them . they taste awful and you cannot mask the bitter taste with anything ask for the liquid form and put it in a half full shake..
God bless ..

First get the swallow study done and follow their advice. A lot of us mix the pills in applesauce or pudding but Teepa Snow recommends using jam because it is ultra sweet to mask the flavour plus the texture isn't smooth so the pills are less noticeable. And as has already been mentioned you might need to change some of her meds to similar ones that can be crushed.

And sure the ensure can be given with a straw if that works better!

If you do decide to get Ensure or Boost, contact your local Meals on Wheels center to see if they offer it. I got 2 +/- weeks' supply through MOW, at about 1/2 the cost of retail price.  Vanilla, butterscotch and I believe chocolate come in cans; strawberry comes in a soft pouch.

10.   Fish is good b/c of its nutrients, and its effect on emotions.    I eat fish when I need to calm down.     Avoid the fried; the little crumbs can cause coughing.   I would try baked or steamed as you suggest (probably the best choice); I used to add orange juice as fluid, so the fish wouldn't dry out and would have a touch of Vitamin C.  

I'm not sure about tuna from cans; it's stringy, and would have to be pureed a lot - I found that stringy foods (such as roast beef) took much more time to puree.    OTOH, the rehab facilities pureed them as well as ham.   The food definitely wasn't appetizing, but for Dad it was edible.

11.    Cold foods and gagging:  I don't have any input on this other than juices that Dad drank.     The pathologist did point out that drinks should be altered with softer food, but in sips and not gulps, to help flush food down and out of the mouth pockets.   

Actually, Dad had no problem with ice cream, and it was refreshing, so cold foods might be a good idea, as long as they're thickened (like yogurt is).

But don't let her keep the ice in her mouth long enough to become unthickened liquid.

12,  Thick mucous:   During his last months, Dad had a scopalomine patch applied behind his ear to allegedly thin the secretions.  I couldn't determine if it actually did any good, and it can have side effects.   

Suctioning was used as well; that was more effective.    The rehab/PC/hospice facility provided a bedside machine for suctioning.    The doctor who orders the swallow study might be able to order a suctioning machine, if appropriate, through a DME supplier.

13.   Straws.  No, not for anything.   That's what we were advised.  

Caveat:  my father's dysphagia progressed from a manageable level to more complex; that's when the restrictions became so much more limited, i.e., no straws.

14.    There are charts for different levels of dysphagia; your speech pathologist who interprets the swallow study could probably give you copies.    If not post back; I'll dig out my dysphagia material and see which institute published them.

15.    Lastly, don't worry about being a pest.  It's not the number of questions you ask, it's the approach, the research you do, your concern for your wife and the interaction between you and the staff that are important.     You're obviously very intelligent, do your research, and have a good grasp of what's happening.    Med pros like that - they can interact with you on a higher, more specific level.

In my experience, if you're educated and knowledgeable on the subject you're more likely to be treated professionally than if you don't know anything and take a hostile approach, like some of these people who have very negative preconceived notions about interacting with professionals. and approach in a defensive manner.

16.   Lastly, thickening in general.   The swallow study will help the speech pathologist determine whether liquids need to be nectar or honey thick.    Or your wife may just need mechanically soft foods.

Thik-it and other brands are fairly easy to find.  I was surprised that the major chain store carried them.  Pharmacies do as well.  

17.   And, finally, I suspect that you'll do all the food prep yourself.   You'll want a processor that has speeds for blending and pureeing.    You'll also find that some foods require additional liquids to reach a pureed stage. I used different gravies, OJ and cider.   

I'm P'M'ing you with the brand of processor I used after doing research on a variety of them.

Out of space again.

Ch. 3.   Hope you have a nice cool glass of lemonade while you're reading.

18.  I haven't addressed vegetables or fruits; they require more fluids to process, but corn and peas were harder b/c of their "soft skin".   Cooked peaches, pears, and other soft skinless fruits were easy to puree.

19.    While I don't like to criticize someone else's suggestions, I think the idea of "shooting" pills into the throat of anyone, let alone someone with dysphagia, is an unsafe suggestion, and is asking for trouble and a trip to the ER.  

If your wife does have  compromised swallowing ability, food and liquids need to be prepared in an easy to swallow form.    Whole pills do not fit into that category.   Nothing should be poured or "shot" into anyone's throat unless given by specific medical advice.

And, first, swallowing muscles need to be used to maintain what strength they have.   Second, a pill "shot" into the throat could get stuck (as some pills did with my father) and cause emergency level choking.

20.   And another "lastly"...There are exercises that can be done to strengthen the swallowing muscles, as did swallowing exercises (the "Shaker" exercises) the first time around.  Dad was given easier exercises years later when dysphagia again became an issue.  

You can ask the pathologist who performs the study about these.

I use a nutribullet to purée my mom’s food and then add seasoning and spices everything must be soft

I crush her meds with a pill crasher ( the doctor said it was ok) and put it in a small amount of ice cream or vanilla pudding to make sure she gets her medicine.
I add fruit to the vegetables and vegetables to her oatmeal or cream of wheat , or fruit to her cereal than add seasoning after I put it in the nutribullet
she will only eat if She likes the food
I had to make my own recipes and changed her meal times to get my mom to eat

The most helpful tests I found for my husband were by a Speech Therapist. They are specifically qualified to do swallow tests. And they are essential. Ask her doctor to recommend/order such a test. Arrange to be present when it is done. She (and you!) will then learn tips and tricks to help control the choking, understand why it is so very dangerous, and how to prepare and present safe, but nutritional and tasty foods for her.

You can also research dysphagia diets and see recommendations. However, the first and most crucial step is getting the evaluation.

My mother had her throat dilated to make swallowing easier. Speech therapist may make an evaluation. One friend had a problem and it ended up being ALS. Throat cancer? Dementia confusion? Lots to consider.