Anyone tell me about a SALT assessment/swallowing problems?

[TheSarcasticFringehead]

GM (have POA) has had difficulty in swallowing and coughing. Anyone with advice about swallowing assessments?

Bumping. This sounds stupid, but I thought a SALT (until a couple of months ago) was for children and adults with difficulty talking and so on.

I'm not sure if it's always done the same way but my GM has just been referred for swallowing problems and the first thing that has happened is that she has been to the hospital to do a barium swallow x-ray to make sure thre is no physical obstruction (there isn't in her case, it is a weakness of muscles on either side of her throat). She has now been told to tilt her head to put her chin near her chest and do a double swallow to get food down clearly.

People are referred for SALT assessment if they have difficulty with swallowing. The therapist will listen for any sign of a wet voice, and will ask your GM to eat and drink different foodstuffs of differing textures and thicknesses.

The referrer will probably be concerned about the risk of aspiration, where food and drink can end up in the lungs. Also risk of choking if she cannot clear her mouth of food and drink effectively.

That's our biggest fears wewill if she has trouble getting something down, she won't be able to get it back up again. Grainy food is a big problem but she likes blended soups, thankfully. I am scared of something like aspiration pneumonia.

In the future, I mean.

Do you think this has been happening for a long time, or is it new?

The assessment itself is OK - looking at your face and throat, then you need to try a few different foods and drinks. It can even be just someone sitting and watching while your GM has a meal.

If the speech and language therapist thinks that your GM's swallow is unsafe, they might recommend that she is placed nil by mouth. The doctors should then think about the cause of that - is it a temporary thing, like a chest infection or a urine infection, or something more long-term? Your GM also of course should say whether she wants to try being nil by mouth or not. Do you think she would be able to make that kind of decision? If not, what do you think her wishes would be?

If it's an infection, then it's really sensible not to eat for a little - you've heard the phrase 'starve a fever'. The doctors would think about feeding/drinking another way - so, probably IV fluids and perhaps a nasogastric tube. The SaLT should then review in a few days and hopefully things would have settled down and your GM could have things by mouth again. If not, the doctors have to think what options they could suggest.

It might be that, whatever the cause, your GM can eat and drink safely, but the SaLT might suggest changes to her diet, or to her drinks. She might suggest thickening drinks - this can look unpleasant but sometimes it's not so bad - particularly if it means your GM won't be coughing on every mouthful. Thickening slows fluids down so if your GM's swallow is weak and slow, she has time to drink without it going into her lungs.

I hope all goes well. The SaLT service in most hospitals can take 2 days to assess (usually Monday to Friday) I'm afraid. Don't ever be afraid to keep chasing for assessment or review, or to ask for more information if you aren't sure what's happening.

It seems to have been gradual. At first, she was a lot louder at eating/swallowing iyswim? She has struggled with larger pieces of food but her appetite is very slim too and she has avoided food this way too, and it seems to have started with her struggling with very grainy sort of food though.

She recently had quite a violent episode where it took two support workers to stop her choking, which is a first, which is when her swallowing and coughing problem was more obvious.

given her symptoms she definitely should have an assessment from a SALT.

If she is at home the gp can do an urgent referral, or if she's in a home the staff should arrange it ASAP
aspiration pneumonia is quite common and can be very serious. I'm a nurse in a care home.

Well I had the SaLT team visiting my Mum when she was in hospital. They weren't bad, but really I was the one who got her eating and drinking again it seemed to me, I was there three times a day. They might turn up when Mum was asleep, or reacting to her drugs so obv not able to swallow much, plus she was admitted with severe kidney damage and so on.

Tasty food to get your Mum going again is a must, sweet stuff like delicious creamy yoghurts, Activia maybe or Rachael's Organic. Start with a tiny little plastic teaspoon tilted on her pallate. You do have to use your own judgement and see how compos mentis your mum is before doing this, I mean she has to be awake for starters...

My mother would suck on lollipops (pink sponge on a stick) but I got bollocked for this because if the sponge came off and she swallowed it, it would be curtains. But it did help activate her swallow technique, her suck was stronger than her swallow. Are straws a possibility? You can shorten them with scissors to halt the distance the liquid needs to travel.

The only thing I would say is that if your GM is waiting for a swallow assessment, i wouldn't introduce anything new until she's been seen - straws can be great for some people, definitely ask about them, but for others they are a bad idea because they shoot the fluid to the back of the mouth and it starts heading down the throat before the swallow reflex can kick in.