# swallowing/phlegm in elderly man



## Use Less (Nov 8, 2007)

Dad, almost 86, has a lot of health stuff going on. He gets so much phlegm in throat that he is spitting all the time. Foods and meds don't "go down". Last night he gagged over soft grits, and that was it for supper. He takes nystatin 3xday against thrush and to lubricate. He's a fussy eater at this point, anyway. Calling the doc (again) later for more advice, but it seems to be the same thing over & over. He drinks Boost, eats some pudding, applesauce, oatmeal, yogurt (reluctantly), ice cream. At least he's getting calories, but obviously not balanced or interesting. Any ideas that have worked for you or yours appreciated. Sue


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## bluesky (Mar 22, 2008)

Has your dad had a swallowing evaluation? That might be something to consider as difficulty swallowing solids and liquids and handling secretions can lead to aspiration pneumonia. You can try having him tuck his chin down to his chest when swallowing, which can help prevent aspiration, but a formal swallowing eval should probably be done.


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## mare (Aug 31, 2006)

i agree with bluesky---my dad was having issues swallowing and found out he is in the end stages of esophagial (SPELL) cancer. he is also 86 and i was told its very common in people his age. i would have his doctor check. good luck


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## Alice In TX/MO (May 10, 2002)

This is what we just went through with my friend, Lonnie. It got to the point that he wasn't interested in ANY food because of the gagging issues.

Your dad needs a swallowing evaluation, and he needs to be checked to see if he's overall healthy enough to tolerate installation of a feeding tube.... if he wants to do that. 

At 86, balanced nutrition isn't as important. If he's interested in living, jut getting enough calories is enough.

As our gastroenterologist said, "This is the course of your disease." Options are limited.


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## springvalley (Jun 23, 2009)

Yep, had a friends Dad having the same problem at 93, he ended up in the hospital from ingesting to much into his lungs. They put in a feeding tube, and is now fed that way. He thinks maybe he will be giving up riding horses for good now, but his daughter is trying to get him back in the saddle once more. Get the testing done, has so much life left. > Marc


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## Use Less (Nov 8, 2007)

The eval is already scheduled for two weeks from now. Makes for a very long two weeks, though.


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## clovis (May 13, 2002)

And you are sure that your dad is getting enough water on a daily basis? Could this be a dehydration issue?

Dehydration happens so easily, and tends to hit the elderly and young.


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## mekasmom (Jan 19, 2010)

Both strokes or AD can also cause swallowing problems as well as enlarged thyroids, aortic aneurisms, etc. He really does need to be evaluated. 
I personally wouldn't have a feeding tube implanted unless he has a really good life quality that will continue. Once they are in, they don't come out in most cases. And that is just cruel to prolong suffering if the person has a poor quality of life anyway. Thickening liquids does help as does feeding the types of things you are feeding like pudding, applesauce, milk shakes, blended soups, etc.


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## SteveD(TX) (May 14, 2002)

I think dairy products tend to increase phlegm, so he might want to limit his intake of ice cream, etc..


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## Michael W. Smith (Jun 2, 2002)

My father-in-law had the same issue. But his was due to a cracked neck after a fall. Tucking the chin (putting chin down towards the chest) does help - if the patient remembers. Throw in a bit of dementia, and anytime he went to swallow you had to remind him.

Start discussing NOW what the plans are for whatever the swallow evaluation shows. If it's a swallowing problem due to age (or dementia is making them forget HOW to swallow) what are you willing to do? A feeding tube is about the only solution, and unless your Dad is in excellent health , I'm not so sure I would suggest it.

A feeding tube prolongs life. If the life they currently have isn't worth prolonging, think long and hard before going that route.

After seeing my father-in-law in assisted living for a year, and in regular nursing home care for 6 months . . . . . . I've come to the conclusion - there ARE worse things than death.  

The hospital was kind of pushing a feeding tube. Thank goodness my wife and brother-in-law had the sense to say "No."

Good luck with whatever your decision.


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## Joshie (Dec 8, 2008)

I'm glad the swallowing study is scheduled. They can help tell if he's refluxing. They can also tell which textures are best for him. Sometimes you need to basically eat food from a grinder. Other times thin or nectar thick things. 

While waiting for the study experiment to see what's better for him. I sometimes have problems taking pills, for example. The doc said to drink first then take pills. I also need to eat something after taking the pills to get them from coming back up. At times I have to drink before I eat.

Try some apricot nectar. It's a little thicker so that might help. The docs may suggest something like Thick-It. If he's not bothered by milk, Carnation Instant Breakfast (CIB) tastes a million times better than Ensure and doesn't have the nasty aftertaste. Our DD's feeding therapist told us that it provides most of the same nutrients. She recommended mixing CIB with ice cream when extra calories are needed. 

Is your dad even hungry? Sometimes people just don't have much of an appetite as they age or when they're really ill. 

As meckasmom suggested, it's time to have a discussion about what your dad wants to happen if he gets really ill. Does he have a living will? Would he want a feeding tube? Personally, if I wasn't hungry I wouldn't want one (as an elderly person). I think that they prolong death more than they prolong life. That's been my experience caring for people on hospital medical floors, nursing homes, and as a hospice nurse.

I really hope that this is nothing serious and that your dad can be easily helped by modifying his diet.


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## Jan in CO (May 10, 2002)

I'm sorry about the situation. I'm glad to get the information, tho as my 90 year old Mom has been having 'choking' issues frequently when she drinks liquids. I plan on contacting her doctor before her next appointment and ask her to bring it up during the exam. Hope you get a good report and some solutions.


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## Grandmotherbear (May 15, 2002)

A speech therapist told me some years that sucking ice before starting to eat helps the swallowing coordination. 
Before you talk about about feeding tubes stop and think first about the whole ritual of eating. It's very important in our culture- and helps us delineate our days. Breakfast, lunch, supper. Eating is so important that my old infant care books from the 50's suggested that infants who had swallowing problems and shouldn't eat because of digestive difficulties have surgical diversions from their oral-esophageal tracts to their necks- so they could "eat" food- chew, taste, interact with families- then have it evacuated into a pad of gauze on their neck. When you get a feeding tube, you may be increasing calories for a short time, but you are robbing a very important ritual that we carry out 3 times a day for the rest of his life.
Also- as far as aspirating into his lungs- feeding tubes don't prevent that. You can aspirate saliva. Most of us produce a quart and a half a day of saliva. I've seen a LOT of aspiration pneumonia in tubefed patients. Besides, even lung-aspirated food eventually breaks down and absorbs into the body. It just 1. takes a REALLY long time 2. is a breeding ground for microbes while degrading and 3. sets up an inflammatory response in the lungs.
That said, my father would NEVER have had a feeding tube. He was NPO (nothing by mouth- niles per oscum) for 10 days while recovering from an attempted disembowelment and he suffered more over not eating than over the despair that drove him to attempt suicide. And he was quite with it ( depressed, but not demented or braindamaged) but all the time he was in the hospital recovering, all he could talk about was eating. 
Not to say that tube feeding doesn't have it's place- one of my friends in scouting had parotid cancer in his forties, and the radiation destroyed his other gland. He had NO saliva. In his case, tube feeding kept him an employed, taxpaying, volunteering husband and father. 

But most of the time, I have heard from families when Mom or Dad finally signs onto Hospice that no doctor ever talked to them about what life would be like AFTER the tube feeding. I think most of them truly believed it would only be a stop gap measure, discontinued when the parent got stronger, returned to his or her "old " self. Doesn't happen. Mostly the tube feeding maintains them at the level they were at when the feeding started. And I can't tell you how many dementia patient rip out their tubes- over and over again. Like they are making a non verbal plea to be rid of it for good. 

This is a good time for the whole family to sit down and discuss medical treatments and get everyone to understand what all everyone wants. And after the discussion, wishes should be set in writing, signed, and given to family members and doctors. This is just as important for those who believe that they should be relentlessly subjected to the rigors of modern medicine- they want "everything" done for them. Get it in writing, that way, when push comes to shove, you know that you are carrying out your loved one's wishes and should have no guilt about it.


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## Use Less (Nov 8, 2007)

Thanks for all your thoughtful replies. Much of what is suggested is already in place, including quite a lot of choices already outlined a while ago. Dad's dementia is such that he is able to discuss things and give opinions (sometimes strong ones), but then forgets the conversation. He now regularly needs prompted verbally to do simple tasks he's done his whole life, but can converse intelligently on the ramifications of his condition. Curious how the brain works indeed. // We know about the problems of dairy, but milkshake, frappe', ice cream are things he will almost always relish. Calories in and some enjoyment trump phlegm production most days. Yes to MORE fluid. He always has a mug or glass of something to hand, but he can also take all morning to sip 6-8 ounces of tea. I'm trying to cheerily prod him to "drink all of this", but sometimes he objects. I don't see a feeding tube in his future. Our mother had that for a bit while hospitalized. Her deterioration was so fast after a botched surgery it was like we needed time to realize she couldn't recover. Dad doesn't have much appetite, and loss of smell/taste and limited activity certainly part of it. Today I marched him in a square throough the house 4 times just to move some muscles and help his digestive tract.


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## fransean (Dec 21, 2002)

Give him something thicker when trying to swallow pills. Ask a speech therapist..........water is one of the hardest things to swallow.

Balanced and interesting are not as important as calories in. Survival depends on calories getting in.


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