The ASHA Leader - February 2015 - 72

Fi r s t Pe r s o n / l a s t pag e

From Chop Suey to ...
Chopped Chicken?
Her father's condition makes this SLP think twice about
her dietary recommendations to older patients.
By Kathy Kennard-MacKenzie

How do you tell an 80-year-old
businessman who spends his
retirement fishing off the coast of
British Columbia that he should
drink thickened liquids and eat
chopped food for the rest of his life?
Have you ever tried to thicken beer?
How do you tell this man that he
should no longer eat corn-on-thecob, Chinese food or barbecued
hamburgers?
You deliver this information by
stressing the health consequences
of not following these
recommendations. You describe the
weakness and incoordination of the
swallowing muscles. You discuss the
relationship between aspiration and
aspiration pneumonia. You discuss
the risk of choking. You refer the
family to a cookbook of alteredconsistency diets. You list soufflés,
smoothies, tomato juice, meatloaf
and meatballs as naturally thickened
and chopped products that taste
good.
But what if the patient is your
father?
My father is a cancer survivor.
He was diagnosed at the age
of 76 with acute promyelocytic
leukemia in 2008. He survived the
chemotherapy and the complications
of pneumonia, temporal arteritis and
herpetic esophagitis. He emerged
a significantly weakened man
with short-term memory loss. He

also exhibited intermittent loud,
prolonged coughing during meals. I
asked his physician to send him for a
swallowing evaluation.
The esophogram described a large
amount of silent aspiration extending
down the trachea and into the right
and left main stem bronchi. There
was no cough reflex or gagging
during these episodes of aspiration.
The report concluded that there
was significant risk for aspiration
pneumonia and recommended a
speech pathology consultation.
My family came to me with this
report. I considered requesting a
videofluoroscopic swallowing study.
Should my father be on a chopped
diet and nectar-thick liquids? Would
exercises improve his swallowing
function? I looked at my dad with
his early-stage dementia and little
hope of remembering a supraglottic
swallow or a chin tuck. As for
the importance of good oral care
to reduce the risk for aspiration
pneumonia, I recalled his nightly
habit of soaking his dentures. I then
considered the four glasses of milk
Dad drank every day, the cup of
coffee he loved in the morning, and
the Chinese food and Caesar's (a
Canadian Bloody Mary) he enjoyed
during family visits. I thought of
what his reaction would be to three
mounds of chopped food on his plate
... and I said and did nothing.

So here we are, two years later, and my father still
drinks his milk, coffee and Caesar's, and my mother
still orders Chinese food on Friday nights.
72

FebRuARY 2015 |

THe ASHA Le ADeR

So here we are, two years later,
and my father still drinks his milk,
coffee and Caesar's, and my mother
still orders Chinese food on Friday
nights. He still coughs excessively
and repeatedly during meals.
He came down with a bad cold
and bronchitis once and required
antibiotics. He has never developed
pneumonia.
I work in a skilled nursing
facility and I think of my father
and his swallowing study every
time I evaluate an 81-year-old man
who coughs during meals. I need
to remember always that there is
a balance between quality of life
and the safest diet. I need to use
all my skills and knowledge of the
swallowing mechanism to develop
strategies for my patients to continue
to eat the foods they love. And
sometimes, I need to say nothing.
Kathy Kennard-MacKenzie, Ma, CCCSLP, is a speech-language pathologist at
The Osborn, a senior living community in
Rye, New York. She is an affiliate of ASHA
Special Interest Groups 2, Neurophysiology
and Neurogenic Speech and Language
Disorders; 13, Swallowing and Swallowing
Disorders; and 15, Gerontology.
kkennard@optonline.net

·

This column presents the views and
experiences of communication sciences and
disorders professionals in their own voices.
The ASHA Leader - February 2015

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