And the LORD appointed a great fish to swallow Jonah, and Jonah was in the stomach of the fish three days and three nights. Jonah 1:17 KJV
Some people find the story of Jonah and the whale hard to swallow (Sorry for the pun). Others find it hard to swallow anything— literally.
My mother fell a few weeks ago requiring stitches on her forehead. The fall wasn’t off a motorcycle or a skateboard, but from bending in the bathroom to pull up her slacks. Landing head first required a trip to the hospital, x-rays, CAT scan, lab work, and finally stitches.
Seven days later, she was in the doctor’s office to have the stitches removed. The physician asked what seemed a strange question, “Does she have trouble swallowing?” She does have some difficulty swallowing pills, so they are crushed and put in yogurt.
He then ordered a few tests which indicated she was aspirating some thin fluids. This simply means some fluid goes down her trachea when she drinks thin fluids like water, tea, or coffee. This would also include foods that turn to liquid in her mouth such as gelatin, ice cream, and sherbet. So, she was referred to a speech therapist for educated about the condition.
I learned, older people, especially those with dementia, can get weak causing falls. The general muscle weakness can cause swallowing problems resulting in some fluids or food getting in the lungs. Fluids or food in the lungs can cause pneumonia, which is a major reason for hospitalization of older people. The doctor estimated she fell because she is frail, and, therefore, may have weak muscles in her throat and tongue, too.
Good call Doc! The speech therapist explained dementia alone can cause swallowing problems because of the damaged brain. Many muscle movements in the mouth, throat, and tongue are involved in eating and swallowing. The commands, to and from the brain, are both voluntary and involuntary for chewing and swallowing. The commands may be interrupted by Alzheimer’s disease resulting in one or more disfunctions in the process.
Because of my mother’s swallowing issue, we were instructed to use commercially available liquid thickener. We thicken her fluids to about the thickness of nectar, so she can properly swallow.
One swallowing dysfunction my mother has is frequent spitting. She spits in tissues throughout the day. The therapist explained, she probably isn’t recognizing the need to swallow her saliva. Saliva is tasteless, is at body temperature, and has no texture. So, she isn’t realizing it is there until it builds up. When the saliva collects, her brain won’t let he swallow it, so she spits it out.
Another swallowing dysfunction is her difficulty swallowing mixed-texture food liked diced canned peaches. While she is trying to handle the peach in her mouth, the fluid runs down her throat. So, we must separate the fruit from the juice. The juice can be thickened with commercially available thickener that she can drink later.
We also observed, she would chew some food and spit it out rather than swallow it. This was typically protein rich foods like meat. She would even chew and spit soft meat like meat loaf or hot dogs. We were instructed to puree the meat along with gravy, barbeque sauce or milk. When served warm this worked. For some reason, her brain wouldn’t allow her to swallow the meat she chewed, but it would allow her to swallow it when it was the consistency of thick soup.
Fortunately, we discovered our mother’s condition before she was hospitalized with pneumonia. Typically, the dysfunction is discovered in the hospital with the patient fighting for their life. In fact, my mother’s neurologist once told me Alzheimer patients more commonly die from pneumonia than from the actual disease. Fortunately, I’ve learned how to prevent her from spitting out food, unlike the big fish that spit Jonah on dry ground.