A person can develop swallowing difficulties (dysphagia) due to medical conditions such as:
- Motor neuron diseases such as ALS (Lou Gehrig’s disease)
- Stroke which affect part of the brain controlling the swallowing reflex
- In some cases of end stage dementia/Alzheimers
- Due to certain cancers or from the side effects during treatment
My mother has dysphagia due to end stage Alzheimer’s. I have written blog posts and published videos related to to learnings of my experience in placing her on nasogastric tube feeding. As dysphagia is the same between an Alzheimer’s and someone with stroke or motor neuron disease, I would like to expand on this topic to help others who have this condition. This would be based on a person with dysphagia who have been placed with a feeding tube.
You may watch the YouTube video I have made on this or read the article further:
Choking is a real danger and hazard that come with dysphagia. Often, they choke on their mucus, saliva, phlegm and aspirated food.
For the food portion, we can manage by ensuring that they remain in an upward incline of minimum 30 degrees (it is preferable if they can remain in a fully seated position) for at least 30 minutes. They can be seated to watch TV or their favourite programs to help pass time.
We also should make sure we do not overly feed them and adhere to the feeding schedule and amounts per feed as provided by qualified health care providers.
For example, in the case of my mom, the senior nurses and dietician said that my mom is to be feed 4 times day, at 6 hours intervals. Before feed, we need to aspire the stomach contents via a syringe to ensure the food from the previous feed has been digested. If there are any undigested food, it should not exceed 40ml. Return the stomach contents gently (do not draw out the contents as it may upset electrolyte balance in the digestive track). Each time, the blended food should be about 300 ml plus 50ml of clean drinking water to rinse off the tube after the feeding. If there are any medications that need to be given, it is as per instruction but before the final 50ml rinsing of the tube. You can watch this YouTube video published by a hospital in Singapore which provide useful information and tips on nasogastric feeding:
With those precautions, we can minimize the danger of choking from aspirated food.
Next, we will address the danger of choking on their own saliva, phlegm, mucus and secretions. This is the REAL HAZARD as I have known of 2 cases of persons on nasogastric tube feeding. They were placed on nasogastric tube feeding due to their compromised ability to swallow as the result of stroke.
Both died suddenly from choking on their own phlegm and saliva.
When a person has dysphagia and increasingly could not swallow, we have to remember that they have difficulty to get rid of secretions in their mouth and throat. For most of us, if we have phlegm and saliva, we would either swallow it to our stomach or spit the secretions out. However when a person is no longer able to swallow well or lost that ability all together, they could neither swallow to the stomach or spit it out. Any attempts to move the secretions may cause it to aspirate into the lungs.
There are things that we need to buy and do to help manage the situation:
1. Purchase a MOBILE PHLEGM SUCTION MACHINE
As caregivers, you would need to get used to doing phlegm suction. You can seek advice from nurses to teach you how to perform phlegm suction. I have a video on phlegm suction which I did based on my own experience.
2. Purchase a Oxygen concentrator
During choking, my mother’s lips would turn grey as she struggled to breathe due to the phlegm that got stuck in her passageway. The supplemental oxygen is very important to help them recover their energy.
3. Change to a hospital bed
If a person has limited mobility (not able to move on their own), a hospital bed is very useful because we can adjust the incline (from lying down to seated position) as well as the height of the bed and to adjust the position of their legs. With the railings it also reduces the risk of falling off the bed. In cases of bedridden patients, we can place them on a upward incline position for at least 30 minutes after each feed.
What to do during choking:
My mother had choked a few times and each time it happens, I immediately get her seated upright, hit her back with my curved palms and perform phlegm suction, aiming the suction catheter towards her lungs passageway . I also put on oxygen straight away via the oxygen concentrator. Both the machines are located in the room and within reach and handy in case of such emergency.
There is usually someone else to help me raise my mom to a seated position. We would need help because their body would usually tense up when they choke making them very difficult to lift up as they would seemed to be very heavy.
In future, I would be writing more posts and publishing more videos to help those who have to care for someone with dysphagia due to stroke, ALS or side effects from medical treatments.