From Chop Suey to … Chopped Chicken? Her father’s condition makes this SLP think twice about her dietary recommendations to older patients. First Person/Last Page
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First Person/Last Page  |   February 01, 2015
From Chop Suey to … Chopped Chicken?
Author Notes
  • Kathy Kennard-MacKenzie, MA, CCC-SLP, is a speech-language pathologist at The Osborn, a senior living community in Rye, New York. She is an affiliate of ASHA Special Interest Groups 2, Neurophysiology and Neurogenic Speech and Language Disorders; 13, Swallowing and Swallowing Disorders; and 15, Gerontology. kkennard@optonline.net
    Kathy Kennard-MacKenzie, MA, CCC-SLP, is a speech-language pathologist at The Osborn, a senior living community in Rye, New York. She is an affiliate of ASHA Special Interest Groups 2, Neurophysiology and Neurogenic Speech and Language Disorders; 13, Swallowing and Swallowing Disorders; and 15, Gerontology. kkennard@optonline.net×
Article Information
Swallowing, Dysphagia & Feeding Disorders / Special Populations / Older Adults & Aging / First Person/Last Page
First Person/Last Page   |   February 01, 2015
From Chop Suey to … Chopped Chicken?
The ASHA Leader, February 2015, Vol. 20, 72. doi:10.1044/leader.FPLP.20022015.72
The ASHA Leader, February 2015, Vol. 20, 72. doi:10.1044/leader.FPLP.20022015.72
How do you tell an 80-year-old businessman who spends his retirement fishing off the coast of British Columbia that he should drink thickened liquids and eat chopped food for the rest of his life? Have you ever tried to thicken beer? How do you tell this man that he should no longer eat corn-on-the-cob, Chinese food or barbecued hamburgers?
You deliver this information by stressing the health consequences of not following these recommendations. You describe the weakness and incoordination of the swallowing muscles. You discuss the relationship between aspiration and aspiration pneumonia. You discuss the risk of choking. You refer the family to a cookbook of altered-consistency diets. You list soufflés, smoothies, tomato juice, meatloaf and meatballs as naturally thickened and chopped products that taste good.
But what if the patient is your father?
My father is a cancer survivor. He was diagnosed at the age of 76 with acute promyelocytic leukemia in 2008. He survived the chemotherapy and the complications of pneumonia, temporal arteritis and herpetic esophagitis. He emerged a significantly weakened man with short-term memory loss. He also exhibited intermittent loud, prolonged coughing during meals. I asked his physician to send him for a swallowing evaluation.
The esophogram described a large amount of silent aspiration extending down the trachea and into the right and left main stem bronchi. There was no cough reflex or gagging during these episodes of aspiration. The report concluded that there was significant risk for aspiration pneumonia and recommended a speech pathology consultation.
My family came to me with this report. I considered requesting a videofluoroscopic swallowing study. Should my father be on a chopped diet and nectar-thick liquids? Would exercises improve his swallowing function? I looked at my dad with his early-stage dementia and little hope of remembering a supraglottic swallow or a chin tuck. As for the importance of good oral care to reduce the risk for aspiration pneumonia, I recalled his nightly habit of soaking his dentures. I then considered the four glasses of milk Dad drank every day, the cup of coffee he loved in the morning, and the Chinese food and Caesar’s (a Canadian Bloody Mary) he enjoyed during family visits. I thought of what his reaction would be to three mounds of chopped food on his plate … and I said and did nothing.
So here we are, two years later, and my father still drinks his milk, coffee and Caesar’s, and my mother still orders Chinese food on Friday nights. He still coughs excessively and repeatedly during meals. He came down with a bad cold and bronchitis once and required antibiotics. He has never developed pneumonia.
I work in a skilled nursing facility and I think of my father and his swallowing study every time I evaluate an 81-year-old man who coughs during meals. I need to remember always that there is a balance between quality of life and the safest diet. I need to use all my skills and knowledge of the swallowing mechanism to develop strategies for my patients to continue to eat the foods they love. And sometimes, I need to say nothing.
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February 2015
Volume 20, Issue 2