Most of us take eating for granted, a necessary and enjoyable part of life. But when you have trouble swallowing, mealtime can become difficult and frustrating.
Swallowing problems, or dysphagia, can be the result of a number of conditions, including multiple sclerosis, Alzheimer's disease, cancer of the throat, head injuries, or dental disorders. As many as 30% of stroke patients experience dysphagia. Although dysphagia can occur at any age, it is more common among older people -- as many as 45% of people over age 75 have trouble swallowing.
Dysphagia is a two-part problem for dialysis patients. First, you need to learn tricks and techniques to improve your ability to swallow. If possible, work with a speech therapist to get recommendations specifically designed for your condition. Second, you need to understand what foods you can eat that will also fit into your dialysis diet.
Choking is a real risk for people with swallowing problems. Learn to do the Heimlich maneuver on yourself so that you know what to do if you start choking when you are alone. Ask your family and friends to learn the techniques so they can help you.
Information about the Heimlich maneuver is available in many places, including the Learn2 web site.
No list of general recommendations will work for everyone. Your specific swallowing problems aren't exactly the same as anyone else's. You'll find that some of the following recommendations work well for you, and others are less effective.
Many people find it helpful to eat in a quiet, relaxed atmosphere, with few distractions. Others prefer to have the television or radio on during the meal, because it helps them to relax and feel less anxious.
Take more time on meals. Although you shouldn't hurry meals, try to keep them 25 minutes long or less.
The following general recommendations can help with your swallowing problems:
Some therapists suggest alternating food and drink to help clear the mouth of food. Discuss this approach with a speech therapist before you try it.
Try these methods to facilitate swallowing:
Nutritionists and therapists have defined five levels of diets to handle the dysphagia patients' needs.
At all levels of dysphagia diets, foods should be moist. Patients are advised to drink plenty of fluids, which can be thickened to make them easier to deal with. The general recommendations are designed to add enough calories to keep patients at a desired weight, by adding instant mashed potatoes and powdered milk to foods like creamed soups and sauces.
However, many of these recommendations don't work well for dialysis patients. For example, dialysis patients must avoid potatoes, bananas, and milk products because of the potassium and phosphorous content. Canned soups are often high in sodium. Fluids, which include those in soups and sauces, are usually restricted to four to six cups a day.
Check with your renal care provider to find out what changes you can make in your diet. You may be able to temporarily increase the amounts of potassium and phosphorous.
Depending on your Diet Level, you will need to adjust the texture of these foods by chopping, mincing, or pureeing.
Dialysis patients must be careful to get enough protein. Mixing meat and chicken in a casserole adds moisture and makes it easier to swallow. The Non-Chew Cookbook, by J. Randy Wilson, is a good addition to your cookbook collection. The recipes include full nutritional information, so you can select recipes that meet the requirements of your dialysis diet.
Experiment to find the flavors that work best for you. Some dieticians recommend flavoring foods with a sour flavor such as lemon, to trigger swallowing. Others believe the acidic flavor can cause problems on an irritated esophagus.
You might be able to use soy milk and other soy-based products to add protein and increase your food options. For example, you can use a meat analog in a casserole, or make a pudding with soy milk. Check the labels carefully, because some brands have significantly higher levels of phosphorous.
Adjust the texture of these foods as needed:
Your dialysis diet restricts a number of foods because of potassium and phosphorous content. Now, you need to avoid other foods that can cause trouble with swallowing, including the following:
You may be tempted to use baby food, but it does not contain enough nutrition for an adult. Use baby food only as an emergency solution.
Some people live to eat, and other people eat to live. But no matter what your attitude toward food is, when you have trouble swallowing, eating can be difficult. Learn which swallowing techniques work best for you. With careful choice of foods, you can make mealtime an enjoyable part of your life again. Remember, you need to eat a balanced diet, to replace the inevitable losses from dialysis.
ALS SLA Society of Canada. Living With ALS. Pp 48-50. http://www.als.ca
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Dysphagiaonline.com. Welcome to Dysphagiaonline.com. www.dysphagiaonline.com/main_p_eng.htm
Karalis, Maria. The Benefits of Soy Food (Part 1 - Meat Analogs). http://www.ikidney.com/wolancmnt/anitem.cfm?AnnID=67
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