hyperextended neck and eating

[desperate07]

my sister had a stroke in 2008 and now she hyperextends her neck.  problem swollowing water and sometimes holds food/water in her mouth.  what could it be and what do i do?

[caregiver222]

You will eventually come to a decision about a"peg".

The answer is by no means clear.

Some people do not tolerate a peg well at all.

In the case of my 105 year old she tolerated it well.

And she expressed a definite desire to live.

Maintaining a peg requires constant attention. You have to learn bolus feeding.
And once in, it cannot be removed without a court order. The quality of life with a peg must be evaluated. At the age of 103 I took my little one (with her peg) for bus rides and out to the park. It is no means a sentence to a bed.

[caregiver222]

She has a problem known as dysphagia, which is a serious swalowing disorder. Hyperextension of the neck is one of the compensatory mechanisms. It is caused by damage from the stroke.

This is a very serious problem, and sometimes it improves and other times it does not.

Easting small amounts (perhaps a half teaspoon) every few minutes may be necessary to prevent choking. My little one was 99 years old when she developed this problem, and it was solved by careful patient feeding. She had a peg when she was 103. She is now 105, going on 106.

The disorder is often circadian. That is to say at certain times of the day (often late at night) swallowing becomes much easier. I would often schedule feeding at nine P.M. for this reason.

Highly flavored foods (such as with a bit of hot sauce) can stimulate the swallowing reflex. Pureed foods are usually necessary.

The key thing to remember is that it will take a long time to feed a meal. At times I would feed my little one a teaspoon every ten minutes. Patience is required.

If she can feed herself, letting her feed is the best thing to do. Force-feeding is absolutely the way to cause death. Unfortunately many health care aids have been taught to do this.

Keeping the teaspoon level with the head while bringing it to the mouth helps a bit.

So-called "thickeners" are available at the drug store. These can be added to thin liquids. Often a thicklened liquid can be ingested without choking. Soups can be thickened with corn starch. Avoid unthickened broths. Pea soup makes an excellent meal. Other thickened heart soups will be appreciated. Soft cook boneless fish such as tilapia make a good meal. Scrambled eggs flavored with different things each day. McDonalds pancakes (which are very soft) are nice with lots of butter and maple syrup.

Holding food in the mouth is called "cheeking". Do not force her to swallow this food or you could cause her to have a layangospasm, blocking her airway,  and choke to death. This means she has been putting too much food in her mouth at one time.

There are specialists in this area, but they usually don't have much to offer except to suggest you get a peg. Nevertheless, it's worth a consult.