To Reduce Swallowing Difficulties

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185. Plan a regular mealtime schedule. Give yourself at least twice the time it usually takes to eat a meal. Don't allow yourself to feel hurried, because stress can exacerbate symptoms and make swallowing even more difficult. Minimize mealtime distractions by turning off the television and radio and keeping conversation to a minimum. To keep your food warm for a longer period of time, consider using a child's heated plate. 36

If you find that you fatigue quickly when eating a whole meal, plan five or six smaller meals during the day, or snack throughout the day. If chewing is too difficult, but your swallowing is good, drink a food supplement such as Ensure, Boost, or Carnation Instant Breakfast to supplement your diet. Check with your doctor to make sure that the protein content of those drinks doesn't interfere with the absorption of your medications. You might also consider juices or smoothies made from fresh ingredients.

186. Suck on a few crushed ice cubes about 20 minutes before mealtime to reduce any swelling in your throat. If you eat something very cold and sour, like lemon or lime sorbet, before you begin to eat, it may help to improve saliva production for people with dry mouth; it may also stimulate the muscles necessary for swallowing and reduce tongue delay. Although not proven, it may be helpful to eat spoonfuls of the cold, sour food periodically during the meal to continue improved swallowing and to help clear the mouth and throat of food particles.

187. Sit in an upright position with both feet on the floor and stay upright for at least 30 minutes after a meal. Reclining or lying flat while eating can cause food to remain in the esophagus or to back up into it. If you have frequent heartburn, it is important to consult with a good gastroenterologist. Frequent bouts of heartburn can damage the esophagus. In rare cases, food can be refluxed all the way up and into the throat. The major danger when that happens is that some of the refluxed material could get into the airway and down into the lungs. When foreign material gets into the lungs, it can cause pneumonia.

188. Keep your chin pointed down as you chew and swallow. In addition, gently touching or massaging the front of the throat right before or during eating may help stimulate swallowing.

189. Concentrate on each step of the swallowing process.

Make sure you have enough saliva or moisture in your mouth to get the food into your esophagus. Do not try to eat if you are too fatigued to concentrate on chewing and swallowing.

190. Take bite-sized portions (about one-half spoonful) of food. Chew deliberately. Swallow each bite completely before you take another. Chew hard with the food on one side of the mouth, then move the food to the other side and chew hard some more. Take comfortable sips of liquids to reduce the risk of aspiration. If swallowing liquids at the same time as solid foods is difficult, stick to one substance at a time before you try to swallow another.

191. If you have a cough that you can't stop, try eating a spoonful of applesauce. Its cool, smooth texture can help soothe your irritated throat. Applesauce now comes in single-serving cups, so you can carry one with you for instant relief.

However, if your cough persists, food may have gone down into your airway. A cough is your body's natural protective mechanism for getting rid of foreign material in the airway. The signs of silent aspiration (food particles that go into the airway but you do not feel them) may be respiratory problems, fever, chest noises, and then pneumonia. Consult a doctor immediately if you experience any of these symptoms.

192. If you feel that you are choking while swallowing, close your mouth, breathe through your nose, and calm down. Taking that one breath will give you enough air to help avoid panic and allow you to breathe normally again. Ask family members and helpers to learn the Heimlich maneuver in case you choke while trying to swallow. A doctor or other healthcare professional can demonstrate and teach the procedure.

Tips If Drooling Is a Problem

193. When drooling is a problem, chew gum. It helps remind you to swallow more often.

194. Make it a deliberate habit to try to swallow your saliva regularly. To reduce its accumulation in your mouth, close your lips firmly, move the saliva to the back of your throat, and swallow. Swallow any excess saliva before you attempt to speak.

Food Consistency and Texture

195. The texture of food becomes more important when you can taste only sweet, sour, or salt. See which textures work better for you. However, if you have trouble swallowing, be sure to have a swallowing study done, which can tell you if thickened liquids might help and how to experiment with various degrees of thickness.

196. Swallowing can be easier if you stick with foods of a soft, even consistency. An example would be creamy, whipped mashed potatoes (not lumpy and dry or thin and runny, but smooth and somewhat viscous, like sour cream).

197. Avoid foods that easily pose a choking hazard:

# Steak is the number one thing people choke on. Eat ground steak instead.

# Dry foods that break into small pieces like seeds, nuts, or baked goods.

# Foods that irritate your throat (such as vinegar) or cause you to choke (potato chips, etc.).

198. Stick with foods that are easy to swallow:

# Baby foods and cereals. Baby foods have a smooth, easy-to-swallow consistency.

# Strained, thickened soups. Puree a favorite soup in a food processor or blender to remove chunks. Then, thicken the soup with mashed potatoes (or strained, mashed peas, beans, lentils, or chickpeas), blend, and serve.

# Strained, thickened fruits. Use a food processor to combine your favorite fruits with cottage cheese, cream cheese, or yogurt. Strain off excess liquid, blend until desired consistency is reached, and then serve.

# Yogurt. Buy the smooth or blended variety, or puree the fruit-on-the-bottom variety in a blender until smooth.

# Thick puddings.

# Soft bread with crusts removed. Take your time with bread. Eat one small piece at a time. Suck on it until it is soaked in saliva and swallow it with one big gulp.

# Canned liquid diets. Some of these may be too thin; thicken them with cornstarch. Be aware that relying solely on liquid diets can result in low blood albumin, so you might want to add dried egg-white powder to the liquid if you plan to use liquid diets for an extended period.

# Fruit nectars. Thicker than most juices, nectars are less likely to be aspirated when swallowed. Look for apricot, pear, mango, and banana nectar in the ethnic or specialty aisle of your supermarket. Tomato juice is another thicker beverage that can be easier to swallow.

# Thick spreads like hummus or cream cheese. Serve on soft, crustless bread or eat as a snack with a spoon.

# Mashed avocado or banana.

199. Try variations on your favorite food and drinks to make them easier to swallow. For example, if you find regular orange juice irritating to your throat, try orange juice with pulp or the low-acidity kind.

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