What I Learned About Swallowing Problems (Dysphagia) in the Elderly

After my mom's first stroke, she not only had problems with her right arm and right leg, but also with swallowing. Apparently, the swallowing muscles on the right side of her throat also were affected by the stroke. Along with the Physical Therapy and Occupational Therapy that she began shortly after the stroke, she also had Speech Therapy, which quickly restored her speech to normal and addressed any potential swallowing problem. The speech therapist explained that she had to be careful when she swallowed, especially thin liquids like water, which was mostly what she drank. She was told that, after a stroke, she was at higher risk for aspiration (having liquid go down her airway when she swallowed instead of down her esophagus).

She was gagging more often when swallowing, but had significant improvement with that problem after purchasing an Alpha-Stim Cranial Electrotherapy Stimulation (CES) device from her doctor to use daily. But within another couple years, it was gradually getting worse and she started a habit of holding liquids in her mouth without swallowing. So we took her for more Speech Therapy to see if they could help her any more with the swallowing problem. The therapist she worked with this time conducted a Modified Barium Swallow test, which showed on a moving video x-ray that foods and liquids were getting caught in her throat. At each therapy session, the therapist attached a Vital Stim device that worked to strengthen her swallowing muscles. This speech therapist told her one very important detail about swallowing safely: Put your chin down as you swallow and you're less likely to gag or aspirate. This made a huge difference as she got into the habit of doing it and was something that I've even begun doing and sharing with others because we were never told this simple solution. In fact, we may even tilt our head back when we swallow, which makes it worse because that angle opens up our airway.

Even though my mom's memory was getting worse, she got pretty good at remembering to put her chin down and swallow. But when she forgot, she would usually gag on the food or liquid, causing choking, coughing, and sometimes even vomiting from it. Over the next couple years, when she started forgetting more regularly, I made a sign on my computer and printed it for her. I posted it as a reminder for her where she could easily see it as she sat to eat:

As she got weaker in her later years, we had to start adding a thickener to her water to help prevent aspiration. We heard of one that wouldn't add a nasty taste to her water that was called Simply Thick, so I bought that for her and we started giving that to her regularly.

For quite a few years, my mom had preferred drinking room temperature water over cold water, mainly because of sensitivity of her teeth. On the last few days before she passed, she was thought to have either a respiratory infection or fluid/congestion in her lungs. So, two days before she passed (which was the last day that I was able to spend chatting and visiting with her), I brought her some Winter Respiratory Tea from Mama Jo's Sunshine Herbals. I had found that this tea works wonderfully at breaking up (and bringing up) congestion in the bronchial tubes and lungs. After two or three cups of this tea, it started working and she began coughing up stuff. She started breathing better and feeling better overall. But the biggest surprise on that day was that she swallowed this hot liquid with no hesitation of holding it in her mouth! I immediately started trying to think of ways to have her drink warm or hot liquids more regularly in the future...but the future for her wasn't meant to be. It was sad to think that I learned one more way to help her, but wouldn't be able to put it into use.

What I Learned About Dealing with Multiple Health Problems in the Elderly

Just over one year after my mom's first stroke and a full year of multiple new prescription medications to "prevent another one," she acquired an intestinal infection that put her in the hospital. Her primary care doctor prescribed a powerful antibiotic, Flagyl, for the infection, but apparently did not check for interactions with the blood thinner that they already had her taking, Coumadin. Shortly after getting home and starting on the antibiotic, she stared feeling very badly, so my younger sister called 9-1-1. By the time she got to the E.R., she was vomiting blood. They found her coumadin level was three times the level that it was supposed to be at! They quickly gave her something to start clotting her blood to stop the internal bleeding so she wouldn't die from this event. The Gastrointestinal doctor who saw her pumped the blood from her stomach, then put a scope down her esophagus and found a tear in the lining of her duodenum (the first section of the intestines after the stomach). He started her on a powerful acid-suppressing drug, Protonix, and planned to have her take that the rest of her life. At the next chance I had, I researched drug interactions online and found that Flagyl had a Major Interaction with Coumadin because the Flagyl prevents the liver from breaking down the Coumadin, leading to high levels of Coumadin in the blood that can cause internal bleeding. That was exactly what my mom experienced! I'm not a doctor, but shouldn't a doctor look this stuff up before prescribing drugs??!!

Although the hospital saved her life, the clotting intervention that stopped the bleeding also caused a second stroke. This stroke damaged the part of her brain that was responsible for recognizing letters and numbers and also created a "void" area in her peripheral vision where "phantom images" would appear (the brain projects these images to fill the "dead space" in the visual field). So this avid book reader and math whiz could no longer enjoy the reading hobby she had for the majority of her life, nor could she make sense of her checkbook and bills that arrived or count out the various vitamins and supplements that she had been taking for years. This was a serious loss of independence, so my siblings and I had to start taking over things for her. One of my older sisters and I took over the vitamins and supplements, counting and putting them in the pill organizer she had been using, which made it easy for her. And since she had already put me as a second person on her checking account, I eventually took that over along with the bill-paying after my younger sister had taken it over first (up until she started forgetting to pay bills and was obviously getting tired of helping our mom, claiming "caregiver burnout"--I'll have much more on dealing with sibling problems in a future post).

Two months after this bleeding event/second stroke, she was scheduled to have her gall bladder removed due to inflammation there. It was starting to be risky for her to have surgery with general anesthesia. She told me before the surgery that, if she survives, she wanted me to find another primary care doctor for her, since the one she had nearly killed her. She had previously mentioned not being happy with him because every time she would start to tell him about some new ache or pain, he was reaching for his prescription pad before she could finish, so she was hesitant to tell him things any more. This was the only way he knew how to practice medicine and, as I learned later, was the worst possible type of doctor for anyone over 65. Over 100,000 people die every year from prescription medications taken properly and it's partly due to doctors like this one.

I didn't know of any good doctors in her part of the county, which is almost an hour from where I live, so I went to the independent health food store in a town near her to ask the owner for recommendations. She mentioned a chiropractor, a doctor an hour away, and a female doctor in that same nearby town who was an MD but also practiced alternative medicine. I discussed the options with my mom and we decided to schedule an appointment with the alternative MD. Two months after her gall bladder surgery, I took my mom to her first appointment with the new doctor. As we left the appointment, she and I discussed how we were both very pleased with her new doctor. Thanks to the health food store owner, we had found a doctor who was friendly, caring, intelligent, had common sense in dealing with an elderly person, and was capable of helping my mom go off unnecessary prescription medications, while also recommending vitamins and supplements that would help her. What a blessing it was for my mom to have this new doctor!!

Her new doctor asked about each prescription medication, vitamin, and supplement that she was taking and why she was taking each of them. After explaining the intestinal bleeding event to her, the doctor felt that the powerful acid-suppressing drug she was on "for the rest of her life" was no longer necessary and would negatively affect her digestion. This drug is only supposed to be taken for two weeks to heal a digestive ulcer, which should have been healed by then. The new doctor contacted the G.I. doctor who started her on the drug and his explanation was that "she's in such bad shape" so the drug was necessary. My mom's doctor described to him what good shape my mom was in, so he hesitantly agreed that she could take a less powerful acid-suppressing drug. Her new doctor put her on one that's even available over-the-counter. A couple years later, I heard Julian Whitaker, MD, discussing using DGL (licorice) chewable tablets as the only form of maintenance for duodenal ulcer that he uses at his clinic. With guidance from her new doctor, my mom started on DGL, chewing two tablets twenty minutes before each meal, and was able to eventually discontinue the acid-suppressing drug entirely. I'll have more on what I learned about the successes of her natural and alternative treatments in a later post.

What I Learned About A "Secret" Cause of Memory Problems in the Elderly

My mom always had a pretty sharp memory and, working as a bookkeeper with numbers most of her life, she stayed sharp and wasn't one to easily forget things. She had her first stroke at age 75 from very high blood pressure that her cardiologist told her was okay, as long as she didn't have chest pain (he became her cardiologist after her open heart surgery 4 years earlier). After this life-changing health event, she was prescribed multiple prescription drugs which are supposed to "prevent" another stroke. About six months later, she had an episode of what I learned later was called Transient Global Amnesia.

We were at a family gathering and my younger sister was showing everyone a small stuffed cat that she had bought for an opera-singing friend of hers. It was animated and sang "O Sole Meow," which was a funny twist on the 19th century Italian song, "O Sole Mio." Since my mom's parents were from Italy, she loved this rendition and laughed at this singing cat, along with the rest of us. But two days later, when my sister mentioned going out of town to visit her friend and give her the singing cat, my mom was baffled as to what singing cat she was talking about. My sister described it to her, but she still had no recollection of what she saw and heard just two days earlier! It was a transient amnesia episode.

My younger sister immediately talked about wanting to take our mom for Alzheimer's testing. But, because I remembered that my mom had many problems in the past from prescription drug side effects, so I was concerned with all these new drugs that she began taking. I immediately went online to research each one she was taking. That's where I found the cause of her amnesia episode: a cholesterol-lowering statin drug. These drugs affect memory function in many people, but doctors and pharmaceutical companies are hesitant to share that "secret" with the public.

Our liver makes cholesterol because so many areas of our body depend upon it (especially our brain's memory synapses and our muscles), so I learned that this idea of taking a drug to lower cholesterol wasn't as great as the doctors and pharmaceutical companies have everyone believing. In my research, I found a website that was created by a former NASA astronaut and MD named Duane Graveline. He described the similar amnesia problem that he experienced and even wrote a book on the subject, titled, "Lipitor: Thief of Memory."

My mom was pretty organized and always saved her lab test printouts in a health folder for each year, so I looked through them to see what her latest cholesterol reading was, as well as what it had been over the past few years. I found that her total cholesterol was typically around 180 to sometimes, just over 200. So those numbers don't warrant going on a medication to push that lower, but after a stroke, doctors mistakenly believe that "lower is better" with respect to cholesterol. Her latest total cholesterol reading was 135, which I learned later was too low for the brain to function properly in most people. But in order to "prevent another stroke," doctors routinely put people on these harmful drugs, regardless of what the total cholesterol reading is. So I mentioned to my mom that she should ask her primary care doctor at her next visit if she can discontinue this one, which she did and he agreed to with no hesitation.

I learned recently that, a study showed that between 10% and 25% of people on statin drugs get new muscle pain after they start taking them. And, for the majority of people who are taking a statin drug and develop a memory problem, once they discontinue the drug, their memory function returns to normal. But for a small percentage of those people, the memory problem is permanent. Unfortunately for my mom, she was in the permanent memory damage group. I later learned from Jan McBarron, MD, ND on her Duke and the Doctor national radio show that she believes that it's no coincidence that there is a dramatic rise in people being diagnosed with Alzheimer's Disease that parallels a rise in people being put on statin drugs. The brain needs cholesterol!

After discontinuing the statin drug, my mom didn't seem to have another amnesia episode, but her short-term memory did decline continuously until it was apparent that she had dementia. For what I learned about that, please read my post on Dealing with Memory Problems in the Elderly.

Why did I create this blog?

As many people in my age group (50-something) are finding out, our aging parents are no longer as independent as they have been for most of our lives. From health conditions to memory problems to making sense of what their doctors tell them (or don't tell them), they may have challenges that they're no longer able to keep up with. So, just as we were dependent upon them in our early years, they are becoming more dependent upon us "youngsters" in their later years. This blog is intended for any adult child who is either at the beginning or in the midst of caring for a parent for whom he or she cares deeply. I will be sharing the caretaking situations that taught me things that I could have never learned without having gone through them, including housing issues, diet and nutrition concerns, health challenges, and sibling problems, to name a few.

Virginia Northrup (July, 1930 - July, 2012)

This blog is dedicated to my mom, Virginia Northrup, who was my hero throughout my life, as well as a wonderful source of knowledge, inspiration, compassion for others, and emotional support, especially through all of my challenges. At age 75, she suffered a stroke that not only changed the next 6+ years of her life, but dramatically changed mine then and will affect me forever.

She left us on July 17, 2012 to reunite with my dad, as well as her parents, her brothers, and our beloved dogs. My life was blessed to have her as my mom and her legacy will be carried on through the examples she set for me for the remainder of my life.

- Howard