[Dysphagia] Gagging

[harmony at bmlug.org (Harmony)]

Thanks for the suggestions. I will definitely look into all of the  
possibilities.
I am wondering how I might increase the sweet taste in her food when  
she is diabetic? I will definitely be working with the dietitians with  
that possibility.
This lady is a wonderful character to work with and I would really like  
to see her enjoying her food!
thanks
Harmony

On 07/07/2004, at 8:33 AM, Beecher, Robert wrote:

> I agree with all of these possibilities.  Her behavior may indicate  
> that she is avoiding tastes and textures that cause her discomfort.   
> There are other factors to consider which include possible GI  
> problems.  She is likely to have reduced motility of her esophagus due  
> to her age and syndrome.  Also, it would not be surprising that she  
> has had long term GER related to her Down syndrome, which may have  
> resulted in chronic irritation at a minimum that now has resulted in a  
> stricture, ulcer, etc. that causes her to gag to clear a food  
> obstruction.  Down syndrome folks are also known for chronic  
> constipation that can affect appetite and also contribute to GER.  I  
> would suggest a thorough GI evaluation if she has not had one in the  
> last year.  Good luck to you and your patient.  Please let the list  
> know what you find as you try all the suggestions.
>
> Robert Beecher, M.S., CCC-SLP
> Senior Speech/Language Pathologist
> Masters Family Speech and Hearing Center
> Children's Hospital of Wisconsin
> Milwaukee, WI
>
>
>  -----Original Message-----
> From: 	dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]  On  
> Behalf Of Marie Isbell
> Sent:	Tuesday, July 06, 2004 8:33 AM
> To:	dysphagia@b9.com; Harmony.Turnbull@dadhc.nsw.gov.au
> Subject:	Re: [Dysphagia] Gagging
>
> Consider looking at the consistency of the food.  The minced food may  
> be
> too dry, scatter in her mouth and make it difficult for her to form the
> bolus, leaving little pieces that trigger a gag.  The foods that she
> likes have a creamy or smooth consistency.  Adding a gravy or sauce to
> the minced foods might make a difference for her.  For instance, add
> butter to the sweet potatoes and mash it in, add a gravy or BBQ sauce  
> to
> meats, spinach could have a cheese sauce added.  All of these could be
> purchased in a grocery and kept in her home area to add to the foods
> when they come up from the kitchen.
>
> Marie M. Isbell, MA, CCC-SLP
> West TN Regional PNM Team
> West TN Regional Office
> 8383 Wolf Lake Drive
> Bartlett, TN 38133
> (901) 213-1847
> Fax: (901) 372-3460
> Marie.Isbell@state.tn.us
>
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>>>> "TURNBULL Harmony" <Harmony.Turnbull@dadhc.nsw.gov.au> 7/6/2004
> 12:26:57 AM >>>
> Does anyone have any suggestions here?
> I saw a client today who is 52, has Down Syndrome and diabetes. She has
> some communication skills and usually answers y/n appropriately to most
> q's. She is a very fussy eater and prefers to eat dessert (dont we
> all?). She feeds herself and needs pretty consistent encouragement to
> eat her main meal (minced consistency). She has little difficulty at  
> the
> beginning of the meal, but when she gets about 1/2 way through she
> starts to gag. Initially we thought she was putting her spoon too far
> into her mouth triggering the gag, but today it looked more like a
> response to the food she was eating (minced spinach, sweet potato and
> meat). She looked like she didnt like the food and only ate with lots  
> of
> encouragement but I was afraid she would make herself vomit if she
> continued. She then went on to eat icecream and puree fruit for dessert
> with no probs. We have given her a shorter spoon so she cant put it as
> far back in her mouth, so it really seemed that it was an objection to
> the food.
> I work in a large residential facility with a limited menu to offer
> clients. Does anyone have any other suggestions since this lady would
> only eat dessert all day long if we let her??
> Thanks,
> Harmony
>
>
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