What made you choke?

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Al

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PALS
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CA
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NW of Toronto
Had 2 incidents lately. First was cinnibun second was rye toast with butter. Question is for ALS patients who have choked bad enough to change color or needed Heimlich. Just wondering if we need a list of stuff to avoid. Thanks. Caregivers are welcome to jump in too.

AL.
 
I choked bad enough to change color but it was about 10 or so years ago so can't be ALS. I choked on mashed potatoes. Scared the restaurant staff and my sisters to death! Probably doesn't help you though since it was when I was a still in bloom.
 
I choked eating popcorn and my ALS CLINIC SAYS THAT IS BAD....even normal folks sometimes inhale a oiece of kernal...I choked and it went on and on and I thought I was dead. But mashed potatoes?They told me that was good but to put gravy on everything. I think it is anything that is little and will not mash up with chewing that puts you at risk. So if I eat popcorn now I chew it up until ther is nothing left of it and spit out the kernal peices.....that's how much I love popcorn!
 
Sorry Al, crumbly stuff like toast or crackers is bad news as swallowing ability deteriorates. I can't remember exactly what caused me to choke except that when I choked on scrambled eggs covered in cheese sauce I knew it was the end of solid food for me.
Be careful buddy and never eat alone!
 
Hi Al,
I choke on bread, crackers, chicken, donuts, cake, chocolate, mint anything that is dry or gummy. I have a hard time with some spices if they are not ground up. Lettuce can be hard sometimes also. I have to coat my food in gravies or cream sauces to be able to swallow. If I have broth soup I can't swallow the liquid and the vegetable at the same time. Have to eat it separate. When swallowing anything I have to tuck my chin down and that helps me get it down. I see my neurologist on Monday and I will be scheduling my peg tube surgery. Not looking forward to it but eating is getting to be a very big challenge. I should have done it 3 months ago like they suggested. I hope my lung volume isn't too bad.
Anyway, I hope that answers some of your questions. Be careful, aspiration is not a good thing.
Linda
 
I've just started to choke from time to time. What gets me choking is trying swallow two different textures at the same time, for example: thin broth soup with solids, like meat and veg; salad with oil and vinegar ( the oil seems to slip down my windpipe when I'm chewing the lettuce): juicy fruits that explode juice when bitten, like grapes. I wonder in your case with the toast and butter, maybe some butter slid down while you're chewing on the toast? So far, if I keep my textures consistant, don't talk while eating, and pay attention, keeping the chin down while swallowing, it all helps to avoid choking.
 
I agree with Forever. My hubby first started to choke on mixed textures like chicken noodle soup. My advice would be that if you have started to choke at all, schedule the PEG. Eric went from not choking at all to choking on everything in a matter of 3 weeks, so you never know. It is just safer to have the PEG.
 
I ended up in the hospital with aspiration pneumonia. It's not worth it. I now have a peg, I miss food bit not the choking. I take a little taste now and then but get my calories from the peg.
 
Many things like bread, crackers, toast and such that get chewed to a pasty consistency, cannot be Heimlich-ed! They just get stuck in the throat. My mom had her most serious incident last July, when she snuck a pizza roll off of a plate I had hidden in the pantry. It was the perfect consistency to get stuck in her throat. I did the Heimlich over and over. She was not able to breath, and was turning blue. I called 911--twice, because it felt like it was taking them forever to get there. This was truly one of the scariest experiences of my life. I thought she was dying right in front of me. There are so many foods that can result in the "first" serious episode. As said above: never eat alone, avoid the most common culprits, and (I know this is a big one as far as the many losses caused by ALS), stop eating when it just gets too dangerous.

On top of how utterly horrific the experience was, I got balled out by her neurologist the next week. He said, "This was an entirely avoidable situation, and an unnecessary expense." (meaning the ambulance, and ER visit).
 
Sadiemae, that ALS chocking article was great. and so was the bipap story which I am going thru right now...made me laugh til it hurt! Wonderful site. Thanks!
 
dry or stodgey food with me,though i do notice i choke a bit on liquids and saliva.
had a couple of bad choking epidodes...........life flashing before your eyes and thinking this is it.
 
Dysphagia Soft Diet
What is a dysphagia soft diet?
A dysphagia soft diet is needed for people who have trouble chewing or swallowing.
On a dysphagia soft diet you may eat foods that are soft and moist. Foods that are not soft or moist enough may need to be diced, finely shaved, or minced. Foods that need to be diced should be less than 1 cm (1⁄2 inch).
Example of 1 cm:
Eating well
Canada’s Food Guide recommends choosing a variety of foods from all four food groups each day. This includes: Vegetables and Fruit, Grain Products, Milk and Alternatives, and Meat and Alternatives.
Vegetables and Fruit
Adults (over 18 years) - 7 to 10 servings a day Teens (14 to 18 years) - 7 to 8 servings a day Children (2 to 13 years) - 4 to 6 servings a day
Foods to choose:
• soft cooked, diced or mashed vegetables • mashed potatoes or other well-cooked potato
side dishes (such as scalloped potatoes) • canned creamed corn • diced or mashed, soft cooked, canned or ripe
fruit, with skins removed • fruit cocktail without pineapple or grapes • canned crushed pineapple • vegetable or fruit juice
Foods that need to be minced:
• lettuce, tossed salad, or cabbage • cooked vegetables that are fibrous or stringy
(such as broccoli stems, wax, or green beans)
Foods that need to be pureed:
• cooked dried fruit • fresh fruit mixed into a smoothie
Foods to avoid:
• hard, raw vegetables, even if diced • potato skins • whole kernel corn, even in soup • fresh or canned fruit or vegetables with
membranes or tough skins (such as citrus
fruits, whole apple, grapes, whole tomatoes • fruits with hard seeds (such as raspberries,
blackberries) • fresh or dried coconut
Developed by Registered Dietitians Nutrition Services 605565-NFS
Examples of 1 serving before dicing:
• •

1 medium size vegetable or fruit 1⁄2 cup (125 mL) fresh, frozen, or canned vegetables or fruit 1⁄2 cup (125 mL) vegetable or fruit juice
Grain Products Milk and Alternatives
Adults (over 18 years) - 6 to 8 servings a day Teens (14 to 18 years) - 6 to 7 servings a day Children (2 to 13 years) - 3 to 6 servings a day
Foods to choose:
• soft breads, buns, or buttered toast • soft baked items (such as biscuits, muffins) • pancakes, waffles, or French toast with apple
sauce or syrup to moisten • hot cereals (oatmeal, cream of wheat, oat
bran, cream of rice) • cold cereals softened in milk (such as
cornflakes, bran flakes) • wheat bran or ground flax seed stirred into
cereals • bite-sized pasta served in a sauce • rice, couscous, or barley in a sauce, casserole,
or moist sticky rice • rice pudding, bread pudding, or soft and moist
bread stuffing without nuts, seeds, dried fruit,
or any other hard particles • soft crackers (such as soda crackers, Ritz®) • soft cereal bars (such as Nutri-Grain® bars)
Foods to avoid:
• dry, crusty or chewy breads (pitas, crusty buns, bagels, English muffins, soft tortillas)
• pizza crust • grain products or cereals with chocolate chips,
dried fruit, nuts, or seeds • dry, loose rice (steamed, wild, brown) • hard or chewy granola or cereal bars
Adults (over 18 years) - 2 to 3 servings a day Teens (14 to 18 years) - 3 to 4 servings a day Children (2 to 13 years) - 2 to 4 servings a day
Foods to choose:
• plain or flavoured milk, buttermilk, soy milk, or smooth milkshakes
• smooth yogurt (such as plain or vanilla) or those with small soft pieces of fruit or seeds (such as peach or strawberry)
• smooth custard or milk pudding (such as tapioca and rice pudding)
• all cheeses (hard or soft), diced, cubed, or grated
• cottage cheese Foods to avoid:
Examples of 1 serving: • 1 cup (250 mL) milk or fortified soy
beverage • 3⁄4 cup (175 mL) yogurt • 1⁄2 cup (125 mL) pudding or custard (made
with milk or fortified soy beverage) • 11⁄2 oz (50 g) cheese • 1 cup (250 mL) cottage cheese
Examples of 1 serving before dicing:
• • •
3⁄4 cup (175 mL) hot cereal 1 slice of bread 1⁄2 cup (125 mL) cooked pasta or rice
• •
cyogurt, custard or puddings with large fruit pieces, dried fruit, nuts, seeds or granola crispy, melted cheese topping
Meat and Alternatives
Adults (over 18 years) - 2 to 3 servings a day Teens (14 to 18 years) - 2 to 3 servings a day Children (2 to 13 years) - 1 to 2 servings a day
Examples of 1 serving before dicing: • 21⁄2 oz (75 gram) or 1⁄2 cup (125 mL) • cooked meat, poultry, or fish • 2 eggs • 2 Tbsp (30 mL) peanut or nut butter • 3⁄4 cup (175 mL) cooked beans or lentils • 3⁄4 cup (175 mL) tofu
Dysphagia Soft Diet Page 2 of 4 605565-NFS
Foods to choose:
• minced meat formed into another product that is tender and made with allowed ingredients (such as casseroles, lasagna, shepherd’s pie, meatloaf, meatballs, if diced)
• tender, boneless fish that flakes easily • canned fish with bones removed or mashed • cooked eggs or egg substitutes including quiche
and omelets, made with allowed ingredients • sandwiches with finely minced fillings (egg,
chicken, tuna salad) or cheese, without
lettuce or raw vegetables • smooth nut butters (such as peanut butter)
used in cooking • soft cooked beans, peas, or lentils • tofu • broth or cream soups with tender diced meat
Foods that need to be diced:
Foods to avoid:
• hard candy, toffee, licorice, gum • baked desserts with chocolate chips, dried
fruit, nuts, or seeds • crispy or hard dry desserts and snacks • chips, popcorn, pretzels, or Cheezies® • whole, sliced, or cut pickles
Condiments, Sauces, and Dressings
Foods to choose:
• sugar, syrup, or sugar substitutes • jam, jelly, and marmalade • finely ground seasonings, herbs and spices
without hard seeds • condiments that are smooth or have small
pieces (such as ketchup, BBQ sauce, relish,
horseradish, mustard, chutney) • smooth gravies or sauces (such as white
sauce, cheese sauce, hollandaise sauce) • non-hydrogenated margarine, butter,
mayonnaise, salad dressing, sour cream
Foods to avoid:
• herbs, spices, and seasonings with hard seeds (such as coriander, whole pepper)
• condiments with larger pieces (such as chutney, salsa with corn, cranberry sauce)
• spreads, gravies, or sauces that are not smooth
* Sticky foods, such as cream cheese, cheese spread, and honey are allowed if mixed into cooking or thinly spread on allowed foods. These foods are not allowed to be eaten alone.

• •
moist and tender meat or poultry, shaved or diced canned meat sausages or wieners with soft casings
Foods to avoid:
• crispy or dry meat, poultry, or fish • bacon, bacon bits, or beef jerky • wieners or hamburger in a bun • fried eggs or egg substitutes
• nuts and seeds, whole or chopped • processed luncheon meats, sausages, or
wieners with hard casings (such as salami,
Kolbassa, garlic sausage) • crunchy nut butters or smooth nut butters spread
on food
Desserts and Snacks
Foods to choose:
• ice cream, sherbet, popsicles • Jell-O®, Bavarians • soft baked desserts (such as moist cakes, pies)
made with allowed foods • soft, moist or easy to break cookies (such as
shortbread, Peak Freans® Digestive biscuits) • cheese puffs or popcorn twists
Dysphagia Soft Diet Page 3 of 4 605565-NFS
Making diced food No mixed consistency
Some foods, such as meat, poultry, or fruit need to be diced to be a safe texture. Other foods such as canned salmon need to be mashed to be a safe texture.
Foods that need to be diced should be less than 1 cm (1⁄2 inch).
Foods can be chopped or mashed with a knife, pastry blender, potato masher, or fork. If you need more information, ask your dietitian or swallowing team.
Vegetables and Fruit
guidelines
If you are not able to eat both thin fluids and solid foods at the same time (in one mouthful) or if you have been told by your healthcare provider to eat foods with no mixed consistencies, here is a list of foods to avoid: • canned fruit in liquid • jellied fruit • juicy, fresh fruits that release juice when
chewed (such as watermelon) • creamed corn • diced stewed tomatoes or baked tomatoes • dry cereal with milk • soups with pieces of vegetables or meat • crackers in soup • more than 1 oz (30 mL) of gravy pooling
around the meat
*Try not to take pills with thin fluids. Instead, take with applesauce, pudding, or yogurt. For more information, talk to your doctor or pharmacies.
• •

Drain vegetables or fruit before dicing. Cut into small pieces about 1 cm cubed or Chop or mash until you have small, even-sized pieces.
Meat
• Cut meat into small pieces about 1 cm cubed or • Finely shave the meat with a meat slicer or
knife so that it looks like thinly-sliced deli meat.
Dysphagia Soft Diet Page 4 of 4 605565-NFS
This is general information and should not replace the advice of your health professional. Alberta Health Services is not liable in any way for actions based on the use of this information. This handout may be reproduced without permission for non-profit education purposes. This handout may not be changed without written permission from [email protected]. © Alberta Health Services (Feb 2011)
 
watermelon...yeah don't really know how I managed that one but it happened. Heimlich and everything. I think it is less of what it is and more on concentrating to chew it up real well so you don't choke.
 
Lettuce, any kind! Soft breads. (Strangely, if I toasted the bread it was OK.)

He's gone through the "soft" diet and now is on pureed foods and Jevity. Water is a no-no, but he still tries to drink it (scary) and he still tries to eat toasted cheese sandwiches!
 
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