Chew, Swallow, Choke and Cough

 

Fellow Parkinsonians: Do you daydream of a dinner of steak with unsalted butter dripping from the top, baked potatoes with soured cream and chives mixing into the granular potato held in by the crusty potato’s skin, green beans with almonds, and a glass of Malbec wine? Let’s pause to savor. Then remember how this dream meal first smelled, then tasted, and how the flavor came out as you chewed. I’m with you, for such a meal is from my good old days, pre-PD. Now, if this meal were set in front of me, at best, I might taste the salt, but no smells; no richness of the butter. My anxieties about chewing would set in as soon as I sat at the table. Will this be the time when food will lodge in my windpipe and the Heimlich fail?

My sense of smell left me before my PD diagnosis in 2005. Two formal “smell” tests confirmed what I feared. For many years after the diagnosis, I still had a fine sense of taste, but with smell gone, so went some of the sweetness in life. A walk in the woods no longer brought me the fragrance of dried leaves or the surprise sweetness from a spring flower. Now, even taste is slipping away. I’ve become a fan of those chili peppers that most people set aside, for spicy, salty, and sour are what I’ve left. Is this Parkinsonian or advancing age? I don’t know.

A side effect is I lost 40 pounds, a healthier weight for me. I now leave restaurants taking half my meal home or order two appetizers. My closet contains oversized suits, pants, shirts and belts. I hold onto my fat wardrobe like the old days when my weight fluctuated. Either I or my wife can’t accept this as permanent. All is not lost though, for my two great food loves: ice cream and pizza, still bring satisfaction. From earliest childhood, I have adored ice cream with its coldness and smooth texture.

 

We Parkinson’s patients eat with caution. As the disease advances, we lose dexterity in our hands and fingers, so cutting food challenges. It requires the performance of three tasks simultaneously: (a) hold the food steady with a fork; (b) press down on the food with the knife; and, (c) saw back and forth to cut the food. Not easy when your muscles fight against the actions.

Eating is further complicated by the degree of hand tremor, if any. I have shared meals with Parkinson’s patients who shake so much that moving food from the plate to the mouth becomes as difficult as docking a transporter to a space station. My heart goes out to the person. His or her task is complicated by self-consciousness. Odds are people with shaking hands that impede eating stay away from restaurants. Good news is technology has led to smart silverware which stabilizes the Parkinson’s tremor and gives back dignity at meals. You can read about it here: http://www.medgadget.com/2013/08/smart-spoon-new-apps-help-people-with-parkinsons-essential-tremors.html Or buy it here: https://store.liftware.com/

Third meal problem: We PD patients must cut our food into tiny bites and then chew slowly and thoroughly. If we try to take big bites and eat fast, we risk choking, a constant danger. For me, choking is partly physical and partly psychological. Sometimes I can, for example, swallow all my medicine from small tablets to large capsules without a problem. However, at other times I gag on the smallest pill. My throat constricts such that swallowing water is an effort. I used to focus my brain and try to visualize my throat as a huge open empty tube compared to the tiny pill. While this technique worked occasionally, it mostly failed. My solution, very early on, was to take my pills with yogurt, gelatin, applesauce or ice cream. I swallow the bulk of my non-PD medicines and/or vitamins with breakfast and take advantage of the yogurt I eat. Of course, if given a choice, I prefer ice cream. If you find that swallowing pills is hard, I hope this method works for you.

Meal eating with people requires patience from friends, family and associates. We Parkinson’s sufferers take forever to eat, and that is a good thing. We must not talk and chew. This is hard for me, because as a business man, I learned how to master the art of eating and talking at the same time while at dinner with clients or business prospects. Now, I remind myself chew or talk. Just like, I must talk or walk. With food, if I violate this rule, I choke.

The natural reaction to choking is to try to expel the item. This means coughing it up and clearing the throat or windpipe. Most of the time, this is easy, for the body wants to rid itself of the intruding bit. But sometimes, the food morsel is lodged, and fast action is required. The “Heimlich maneuver” is critical for it forces the item from the throat passages. This technique is named after its inventor, an American thoracic surgeon and medical researcher.  Read about him here:

https://en.wikipedia.org/wiki/Henry_Heimlich

Most restaurants train personnel on how to perform the Heimlich. It would be bad form to have a restaurant customer choke to death, and the technique is simple. I have endured the Heimlich maneuver seven or eight times in restaurants when I went into a severe coughing spell that had nothing to do with choking. I will put up with it, for at least once,  I really was choking, and a man came to my rescue. (My awareness of choking led me to perform the Heimlich on a young child when he was suffocating from a wayward grape.) A few times, and this point is crucial, I’ve been alone and performed it on myself.

To learn how to perform it on another person, study the following:

http://www.wikihow.com/Perform-the-Heimlich-Maneuver

To learn how to perform it on yourself, study the following:

http://www.wikihow.com/Perform-the-Heimlich-Maneuver-on-Yourself

When you practice the Heimlich on yourself, be sure to study the chair method; I have found this method the most reliable.

Here are my rules for eating a la Parkinsonian:

1. Avoid talking with any food in your mouth; this is more difficult than it seems because people are always asking questions and PD patients take forever to chew and swallow food. Remember, DO NOT TALK AND WALK AND DO NOT TALK AND CHEW. Most important, NEVER WALK, TALK AND CHEW at the same time.
2. Cut your food into small bites and do not stuff your mouth with food.
3. If you have a lot of trouble eating, try sticking to soft foods like pasta, rice, and soups. Fish is generally better than steak, but fish bones can be dangerous.
4. For swallowing medicines, try taking the difficult pills with applesauce, yogurt, gelatin, or ice cream.
5. Learn how to perform the Heimlich maneuver on others, and most importantly, on yourself. It could save your life.

 

Bon Appetite.