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Dysphagia - Symptoms and Treatment

dysphagia

The danger of swallowing disorders is that they can lead to aspiration pneumonia and poor nutrition. Both conditions contribute to declining health and increased length of hospital stays. Symptoms of difficulty swallowing include:

  • coughing
  • choking
  • food "sticking in the throat"
  • drooling
  • nasal drainage while eating
  • weight loss
  • fever from pneumonia

The Diagnosis of Dysphagia

When the above symptoms are noted by physicians, nurses or therapy staff, a speech-language pathologist (SLP) is consulted. Patients hospitalized for neurological disorders such as stroke, brain injury, Parkinsonism, or ALS likely are on the SLP caseload.
Swallowing requires timely and effective coordination of many muscles. When these do not operate efficiently, ingested substances can enter the airway and endanger patient health.

After the referral, an evaluation takes place. The SLP offers different food textures to assess difficulty swallowing them separately. Liquids, pudding, crumbling foods such as crackers and sometimes more complex foods containing mixed textures are introduced. The SLP assesses the patient's ability to:

  • chew (masticate) food thoroughly
  • clear food from pockets in the mouth
  • form a bolus (food ball)
  • use the tongue to project the bolus toward the pharynx
  • maintain timeliness and coordination of oral and pharyngeal movements to keep food on track
  • maintain timeliness of elevation of the larynx (Adam's apple area)
  • clear residual food from pockets around the airway (valecula)
  • move the epiglottis to cover the airway
  • effect travel of the ingested material down the esophagus

Assessments begin at bedside with behavioral observations. In addition to bedside evaluation, the SLP can perform tests such as a modified barium swallow study (MBSS) or a fiberoptic endoscopy study (FEES). The MBSS uses barium, a white substance that shows up on X-ray, indicating the path of ingested material. The FEES uses a camera above the vocal cords and color-tinted food, so the SLP can assess efficiency of food transfer.

These tests also help determine whether there is "silent aspiration." Liquids especially can penetrate into the airway, without coughing, in serious cases of impairment. When patients say they have no trouble at all with liquids, there can still be a dangerous problem.

Treatment of Swallowing Disorders

After determining the nature of the problem, several approaches may come into play. With silent aspiration, or in very severe cases of dysphagia where management is not immediately possible, feeding tubes may be necessary. A nasogastric tube (from the nose to the stomach) or a PEG (percutaneous endoscopic gastrostomy) tube may be placed to provide nutrition until the patient's condition improves.

The following treatments may be appropriate for specific patients:

  • Diet: easy to chew if oral problems occur
  • Thickened liquids when thin consistencies are difficult to manage
  • Sit upright for at least 20 minutes after ingesting anything
  • Small bites and sips to make it easier to manage
  • Slowed intake
  • Provide assistance when needed, especially if the patient is fatigued
  • Oral exercises to increase strength and range of motion (ROM) of the tongue
  • Lip strengthening exercises to improve lip seal and avoid leakage
  • Exercises to increase laryngeal strength

Swallowing Improvement

The good news is that swallowing often improves with therapy. This depends on the nature and severity of impairment. It is important to report these symptoms to one's physician and to follow recommendations. Avoiding aspiration pneumonia also means avoiding severe health complications.

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A Snacking Revolution


healthy snacks

The website Graze.com delivers healthy snacks and fruit to people's desks and homes weekly for a low price. The site enables the customer to choose and rate their favourite munchies so the buyer can snack with pleasure and no guilt.

Benefits of Snacking

Believe it or not, there are benefits of eating between meals, provided the snacks eaten are healthy and nutritious. It gives busy people energy throughout a tough working day, helps to prevent overeating at meal times, and provides people easy opportunities to achieve the tough goal of eating five fruit and vegetables a day.

Graze.com was conceived by managing director Graham Bosher, also the man behind Lovefilm.com. The aim of his company is to improve the working person's eating habits, so to avoid that horrible post-lunch slump at the desk. Their are over 150 snack packs to choose from, and the firm is delivering over 80,000 boxes per month.

Range of Snacks

The range of snacks the website offers is extensive. There are the unusual packs of fruit and desserts, ranging from delicious oily olives and earthy nuts to the sweet and sugary crystalled ginger (one for acquired tastes and developed taste buds).

The basic dried fruits -- raisins, bananas, and apricots -- are there in abundant supply, and juxtapose nicely with the salty pistachios, slightly bitter almonds and moreish cashews, and even the occasional cheeky dark chocolate buttons.

Customer Service

Like most successful franchises, Graze.com is customer driven and focuses on the clientele's needs and wants. Each snack box is delivered first class in compact cardboard boxes with each snack tightly sealed in its own plastic, clear container. The boxes can comfortably fit through letter boxes and are easily recyclable.

In a week of postal strikes, Graze still has the customer at heart, offering a four snack pack as opposed to the normal three until the strikes abate, and restricting the delivery of fresh fruit to avoid wastage if the fruit goes "off."

At £2.99 for each weekly delivery, the service offers great value for money as dried fruit can often be expensive in major supermarkets. The boxes can be delivered to workplaces as well as the home, and buyers can choose which weeks the packages can be sent.

An introductory offer means that snack fans can have their first pack for half price, and the consumer can "rate" each individual snack on the website. If they don't like a certain food, the low rating given will mean that Graze will not send the food in future, and people can even design their packs according to their lifestyle needs.

The fun, healthy and succulent choice of snacks and treats means that office workers need never slump at their desks again.
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Diabetes Food Pyramid

diabetes food pyramid
This diabetic food pyramid functions in a similar way to the regular food pyramid. One of the main differences is that the diabetic food pyramid focuses on limiting sugar intake.

Diabetes is a disease that prohibits people from eating sugar at the same levels that they used to. This does not mean that all diabetics have to avoid sugar like vampires avoid the sun! Some people have mild cases that enable them to eat sugar once in a while. Others have to avoid it at all costs.

The diabetic food pyramid is a lifesaver to many people. Just by looking at the pyramid they can tell which foods to eat and which ones not to. It also suggests serving sizes and suggestions for planning whole meals.

The diabetic food pyramid has six categories of food groups. At the bottom the main group is grains, starchy vegetables, and beans. The second grouping on the diabetic food pyramid includes vegetables and fruits. The third includes diary products, meats and other sources of protein. At the top the list of fats, oils, and sweets should be consumed least of all.

The latest version of the diabetic food pyramid was rolled out by the United States Department of Agriculture in 2005. Not only does it describe what to eat, but it also makes recommendations on calorie intake!

If you want to find out more about the diabetic food pyramid you should begin your search with the diabetic organizations that serve people with diabetes. There is so much information floating around about diabetes and nutrition that in only a short time you should become somewhat of an expert on the subject. Remember, the pyramid might not be as exciting as the one at Giza in Egypt, but it’s still something to marvel at. Good luck and happy eating!
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