Aack, tablets....

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MupstateNY

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PALS
Diagnosis
11/2022
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NY
I've been taking Mucinex to liquify my mucus because of my mucus problems, and because the ALS Center only wants to order things when you're scheduled to come into clinic, and because my primary is a wimp. I've been asking Center and primary for cough assist and suction gadget for three weeks.

Today the Mucinex got stuck in my throat. I know from my swallow study that part of what I swallow stays in a certain spot because my swallow isn't complete, or something like that. Usually when a tablet or gelcap gets stuck, I can spit it out, calm down, and try again. But today I couldn't get it up and I couldn't get it down. My spouse tried to Heimlich it out but that didn't work either. I don't think I was aspirating it exactly. At first I couldn't even swallow water because the fat Mucinex tablet was blocking my esophagus. I was sipping, sipping, but then the water all came up again -- without the darned tablet.

Tomorrow I am going to buy the liquid form.

But also, can someone tell me what we should do it if happens again?

My clinic visit is coming up on Wednesday and I want to put cough assist, suction and feeding tube on the table.

Also I'm set up to see a pulmonologist Monday (day after tomorrow). That was suggested by my virtual support group. Is it reasonable to ask him to order these things?
 
If the table has a groove in the centre you can snap it in two. If this is the long release table you can't really crush it and you shouldn't cut it in more than half as it will impact how quickly it is absorbed (making it fast release).
This also really indicates to you that you need to be very careful eating - cut all your foods up fine and tuck your chin while swallowing.

Heimlich is about all that would work if it is stuck, and it takes a surprising amount of force, albeit very fast.
It sounds like it was quite wedged, so aspiration is unlikely. If it had been stuck there a long time and started dissolving the risk of aspiration would have increased.

That must have been very scary, I remember choking incidents so clearly.
 
affected, did you ask someone to teach you Heimlich? Who could we approach? I could go to a walk-in with my spouse tomorrow if I think they would teach us how.
 
There is a site that seems good. heimlichheroes [ dot com ]
Sadly it's a hard one to practice as it isn't comfortable to have done to you!
 
Most everything you take or a close substitute can be crushed in warm water or buried in applesauce/yogurt (check the Do Not Crush List, drugs.com if an item is not on the list, and the instructions relative to food first) or is available in liquid form.

Please note: not every scored tablet can be crushed. Exceptions include Toprol XL and Sinemet CR. These can be halved to swallow, but not crushed. Likewise, sublingual and enteric-coated tablets should not be crushed, nor opioids.

Conversely, the filling of some capsules can be sprinkled for swallowing without chewing or crushing, including some opioids.

As you have read, you will want to ask about having your feeding tube placed by an interventional radiologist if that is not at first offered.
 

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Please note I checked online about crushing this medication and the advice I received was that if the tablet is scored you can break in half but no further. I then indicated that it could not be crushed and it is on the list provided. I sure didn't advise crushing the scored tablet.

Just in case my words were not clear.
 
I tried the applesauce idea for my Riluzole at bedtime and it worked. I was kind of scared to try after the earlier crisis. Now I'm planning to use the applesauce until I get a feeding tube.
 
Mupstateny. I am sorry you are having mucous issues. Are you on nuedexta? It is helping Tom.
When you see your clinic i suggest talking with them about their ethical responsibility for your care. They must respond to your requests for help in-between visits. Otherwise what is their purpose?
Our clinic at NYPresby Columbia is very busy, and they take days or weeks to respond, but they eventually do respond. We have gotten rx in between visits with pestering.
Your wimpy PCP is concerned with conflicts in care and malpractice.
 
Did you get the liquid form today?
 
My spouse is combining the 24-hr pharmacy and Lowes. Thanks for following up! I also spoke with a covering neurologist by phone and he said to increase the guaifenesin, keep drinking lots of water, and use a personal humidifier in addition to the one we use for the whole house. Also he said he would send a message to his colleague who saw me previously.
 
The 24-hour pharmacy was out of liquid guayfenesin. He bought scored non-extended release tablets. I've successfully taken some with applesauce. Today my normal pharmacy is open and they are ordering the liquid for me -- hopefully ready tomorrow.

Today I saw a pulmonologist for the first time. He prescribed a rescue inhaler. When I'm having a cough attack or am aware of phlegm I'm having trouble getting up, I'm supposed to do two puffs. Maximum frequency every 4 to 6 hours. (Note - I've never had asthma.)

He wants me to go to a musculo-skeletal clinic in the same city as the ALS Center (90-min drive from home). My spouse thinks maybe they are competitors. I am hoping I'll like it better than the center. Wild fantasy: I'm able to switch my care over!

He said he can't order a cough assist yet because he measured my peak flow (of air) at 250. He said insurance won't cover until I'm below 200. However, I convinced him to order the suction thing because I have so much trouble spitting the mucus out when I finally manage to get some up. Also, I had a better night last night than the previous one.

I managed to get some phlegm up while I was there, and did my wipe-out-my-mouth with the paper towel thing. He looked and acknowledged that it's very sticky.

He listened to my lungs and said he heard a little bitty crackle on the left which he said is to be expected because of the proximity to the heart. I had never heard of that before. I had pneumonia when I was 30, after a mishap with a canoe outing (which my canoeing instructor had badly organized!). I have had a pneumonia vaccine for what it's worth, and every COVID shot possible.

My bed has an electric thing that raises the head area. I slept as upright as I could last night. It's hard because one tends to slide down in that bed.

When does one request a hospital bed?

I have big hopes for the inhaler.
 
Some steps forwards for you.
I'm glad you got a crushable alternative til you get the liquid, that's great news.

The inhaler is designed to hold open the airways. It may give you some relief in the short term while you are in the early stages and still have a reasonable cough strength. It's not a long term solution, but if it helps at this point then use it!

The vaccines are wise, but just be aware that aspiration pneumonia is often caused by other bacteria than Streptococcus pneumoniae that get carried into the lungs with the particles of food/fluids aspirated. Everything you can do helps of course!

You could talk about a hospital bed right now - it will be far more comfortable for sleeping semi upright.
 
Yes, having ALS is enough justification for the hospital bed. You will be able to position the legs so you don't slide down.

Be sure to get an order for a bed that has a "cardiac chair" (reverse Trendelenburg) position to help stretch your back and use a urinal, among other things. Some DMEs will presume this but some not.
 
I'm working on the hospital bed.

I couldn't handle the liquid robitussin because the flavor was sooo intense. So currently my spouse is using utility scissors to cut all the medium-sized tablets into four pieces. I've eliminated all the large ones. The swallowing of the little pieces is going well, as long as I don't get the piece stuck under my tongue, or take too big a gulp of water.

Tomswife, I looked up Nuedexta but it talks about crying and laughing episodes when it doesn't match what one feels. I cry when I feel sad. True, my crying is weird now -- I have a high-pitched long wail that I never had before, but I think the inhaler will help when that happens.

I replaced the big Calcium and magnesium gel caps with medium-sized tablets that combine both minerals. The PEG was supposedly ordered but I can't figure out how to schedule myself for the first step. I think tomorrow I might just start phoning, e.g. intervention radiology, hopefully someone will tell me what to do. I don't want this dragged out.
 
is that robitussin safe to cut into four? if it has a groove you can cut in half only, if no groove you can't even do that. this is because it is supposed to be slow release
have you tried putting it in a spoon of apple sauce?
 
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