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Medical Forum / Diseases and Disorders / Alzheimer's / September 2004

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Eating habits

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Sparky - 05 Sep 2004 05:23 GMT
Forgive me if I mess this up as this is my first time posting--ever.

I have been lurking for a couple of months gleaning advice given to
others. However, I have a question that I don't believe I have seen
addressed. Mom has gradually gotten "tired" of certain foods. Mostly
anything that is healthy. It started a couple of months ago when I had
trouble getting her to eat any kind of meat. She would only eat turkey
and dressing, chicken pot pie and chicken fingers. She still will
occasionally eat chicken fingers if they are cut up into bite size
bits, but only a few bites then. Vegetables she would eat included
corn, baby carrots and yams. Now she will only eat the yams. The
waitresses at a local restaurant have been helping me, and we can get
her to eat cantaloupe, bananas, pineapple and peaches (all sweet
foods)--but again only if cut up into small bite sizes. Of course she
loves sweets--mostly dougnuts and Reeses cups.

My question is: Is this typical of late stage AD? Have any of you
encountered this with your LO and how did you overcome it (or did you
overcome it)? What do I have to look forward to?

A short history: Mom took an "eleven-hour trip" to go to see my aunt
just across town almost 4 years ago. Her trip took her out of state--a
four hour trip one way. As I live just two houses away and am still
single, I have watched over her ever since. Almost a year ago that
meant I moved in and started using sitters during the day so I could
attempt to work part-time. We changed doctors because her former doctor
was impossible to get any information out of. The neurologist she went
to see was a bone-head, and we didn't go back. Aricept and Reminyl kept
her up at night and made my life miserable. She is now on a low dose of
Reminyl and a full dose of Namenda.

Again, I apoligize in advance if I didn't follow proper procedures for
posting here. Any advice will be welcome.
Dennis White - 05 Sep 2004 18:03 GMT
> Forgive me if I mess this up as this is my first time posting--ever.
>
[quoted text clipped - 11 lines]
> foods)--but again only if cut up into small bite sizes. Of course she
> loves sweets--mostly dougnuts and Reeses cups.

    Aside from the obvious neurological reasons, consider these factors:
Are your mothers teeth in good shape?  If she wears dentures are they a good
fit?  Discomfort from either case may cause her to change her eating
preferences.  If she cannot adequately express this to you you'll have to
watch carefully.  Also, as you may have read here, I lost my friend very
recently to dysphasia, the loss of control of muscles in the throat.  If you
suspect she needs "small bites", and it sounds like softer foods, you may
look into having an examination by a speech therapist...they are the ones
who can discover if there is a problem.  Especially if she seems to be
coughing when eating.

Dennis
Evelyn Ruut - 06 Sep 2004 00:52 GMT
> Forgive me if I mess this up as this is my first time posting--ever.
>
[quoted text clipped - 29 lines]
> Again, I apoligize in advance if I didn't follow proper procedures for
> posting here. Any advice will be welcome.

Hi Sparky,

We had something like the same experience with my mother in law, who also
developed a "sweet tooth" and suddenly didn't want to eat meat anymore.
There were many foods she formerly loved and she would sometimes just not
want them, so it got that I just never knew what on earth to cook for her
anymore.

We found that the best way to get a balanced meal into her was to make lots
of very good thick homemade soups.   I would make a big pot of soup and
freeze the portions, so there was always a variety to choose from.
Eventually it became almost the only thing she really enjoyed eating.   You
absolutely could not fool her with soup from a can, either!!!

There are others who post here, and maybe they will have other, better
suggestions, but for us the homemade soups worked out to be the best
solution.

Now that she is in a nursing home, she is doing well for the circumstances,
and she does eat pretty well there.   I think there is something about
getting all the little containers on her tray that she likes.
Signature

Regards,
Evelyn

(to reply to me personally, remove 'sox")

Mary Gordon - 06 Sep 2004 01:19 GMT
Weight loss is a very common occurance with AD -  from loss of
appetite and from difficulties eating - and obviously, a person who is
not eating well becomes very vunerable to all kinds of health issues,
and ends up with no reserves should even minor illness strike. It is
as though they no longer realize they need to eat to live - and they
often don't seem to be hungry, despite loosing so much weight.

Many people with dementias also have perceptual problems, and thus are
easily distracted. My MIL had to take her meals on the ward, sitting
alone at a card table, since the bustle of a dining hall was too much
for her. Colour and patterns were also confusing to her - so she did
best of all at a plain table with no patterns on cloth or china, and
only one thing on the plate at a time. She needed coaxing, lots of
time, and a very relaxed atmosphere. She also had trouble with
utensils, so simple and fewer is better. In the last few years of her
life, she did much better eating with her fingers (knives and forks
were beyond her, and even a spoon became iffy). It was very messy, but
the important part was getting as much into her as possible. We did a
lot of hand feeding as well in the later part of the illness, since
even though she would stop eating a meal on her own and just sit there
as though she was done, she would open her mouth if you came at her
with a spoonful of pudding.

Have you tried feeding her lots of small meals and snacks instead of
fewer large ones? You might be able to get more calories into her that
way over the course of the day. I'd also try to make every bite count
in terms of high calory, high nutrient foods. Let her eat anything you
think will tempt her, even if its wierd and wonderful like rice
pudding for breakfast or cheesecake midmorning. Put lots of butter on
her food. Make her milkshakes or egg nogs. Use cereal cream instead of
milk. Try out some of those high calorie supplement drinks like Boost
or Gain (you can buy them at most pharmacies) instead of a mid
afternoon cup of coffee and a biscuit. Give her puddings.

You might also want to contemplate giving her softer textured foods -
the fact that she likes
yam so much suggests to me that the mushy texture may be easier for
her to handle. Many people with AD develop problems with chewing and
swallowing fairly early in the game, even if this isn't apparent to
you - it is related to coordination problems. They have trouble
manipulating things in their mouths, and mixed textures can be a real
problem (i.e. they do better with oatmeal porridge than with
cornflakes with milk, since the combination of a liquid and a crunchy
solid can be difficult). Even thin liquids can be a problem for
swallowing. Often they do better with thicker liquids, and they
actually sell products to thicken ordinary liquids like milk or juice.

Good luck with this.

Mary G.
Lee - 06 Sep 2004 01:36 GMT
Re: appetite supplements like Boost and Ensure... we use them with my MIL...
and she'll take them without issue as long as we offer them as MILKSHAKES...
if someone slips up and suggests it's a meal supplement or good for her or
whatever, it'll be a couple of days before she forgets and is happy to have
her milkshakes again

> Weight loss is a very common occurance with AD -  from loss of
> appetite and from difficulties eating - and obviously, a person who is
[quoted text clipped - 46 lines]
>
> Mary G.
turkey in the straw - 06 Sep 2004 03:37 GMT
My mom has to have all her liquids thickened.She had a swallowing test
and liquids were getting into her airways.After her last hospital stay
they now have me pureeing all her food.If these things get into there
lungs it sits there and grows bacteria causing aspiration pneumonia.
      The thickener we use is "Thick It".My mom is a type 2 diabetic
also so i have to be sure to count the carbs in the thickener.There are
7 carbs in 2 tbsp.That thickens 4 oz.
        Watch for coughing when eating or drinking.Thats a sign of
aspiration pneumonia.
       Good Luck,Barb
Glenfiddich - 06 Sep 2004 01:42 GMT
>Forgive me if I mess this up as this is my first time posting--ever.

Hey, even the oldest inhabitants here were once virgins like you.

>I have been lurking for a couple of months gleaning advice given to
>others. However, I have a question that I don't believe I have seen
[quoted text clipped - 13 lines]
>encountered this with your LO and how did you overcome it (or did you
>overcome it)? What do I have to look forward to?

More of the same - and some entirely new problems!

Just a thought for the future - try any of the 'complete food drinks'
such as Ensure.   They're sweetish and nourishing and also come
thickened as puddings.
They come in cheaper versions sold as own-brand in bigger pharmacies.

>Again, I apoligize in advance if I didn't follow proper procedures for
>posting here. Any advice will be welcome.

Your posting was fine.

Others have warned of chewing or swallowing problems behind your Mom's
change in habits.

I'd add that you must think like a detective, always looking for the
*real* reason for any change, since she will become less and less able
to tell you what's really wrong.
Of course, often there won't be any 'real reason' - it'll just be
yet another side effect of AD.  
But don't forget that people with AD can and do get all the other
diseases...

I think that doctors dealing with AD should have to spend a couple
of years as veterinarians, so they can get used to doing diagnosis
with zero input from the patient!
Sparky - 06 Sep 2004 04:27 GMT
Thanks for all the replies. I didn't mention before, but I do get her
to take an Ensure each morning. And, yes, I call it a "milkshake" as
well. I found early on that she had problem drinking the Ensure and
eating cereal. She takes her pills, then washes it down with the
Ensure. I found that if I switched her cereal for an oatmeal cookie,
she would need something to wash the cookie down with. This is how I
got her to finish off the Ensure. In the beginning, she would holler
out to me to take away the unfinished Ensure. I would "pretend" to not
hear and leave the room. Then she would finish the cookie and need
something to drink and would finish off the Ensure. Sometimes I think
it helps being an artist because I am always having to come up with
creative solutions to current situations.

The sitter is with her Monday through Thursday, and she does get Mom to
eat small snacks during the day. She is wonderful. She also comes up
with creative ideas like putting two sugar wafers in a cup of yogurt
and telling Mom that it is ice cream (like the ice cream parlor does).
I forget this on weekends because I am not geared to think about snacks
during the day. The doctor is aware of how the sitter feeds Mom and is
OK with it. He thinks anything we can get into her is OK as long as she
doesn't begin adding weight due to the sweet stuff.

You may be right about the loose dentures. She grinds her teeth
sometimes when not eating. I thought that early on, but don't have a
solution for it. She wouldn't sit still for a refitting. Color plays a
part in food as well. She always reaches for the strawberry shortcake
as a dessert although I know she hates strawberries.

The soup sounds like a good idea to try. She was eating the thicker
Campbell soups but has turned against them now. Maybe a homemade soup
with softer ingredients would work.

I agree all doctors would do well to spend some time as a vet. Mom
gives them a fit. She SCREAMS when they take her blood pressure. Of
course this makes getting an accurate count impossible. Normally this
will bring all the nurses running to see what is going on. Blood work
takes me and two nurses. Anyone remember the A-Team from TV? Everytime
they had a mission that involved flying, they would have to sneak up on
Mr. T and knock him out for the trip as he hated flying. We had to do
that to Mom to take her to the hospital to give her a CAT scan. She was
complaining of stomach pains, and they knew no other way to check her
out. Turned out to be nothing, but she gave the anesthesiologist a
right hook when she woke up.

Thanks for all the ideas.

--
Sparky
Dennis P. Harris - 06 Sep 2004 07:27 GMT
> The soup sounds like a good idea to try. She was eating the thicker
> Campbell soups but has turned against them now. Maybe a homemade soup
> with softer ingredients would work.

campbell and most other canned soups are loaded with salt, so
homemade soups are always better.  my mom used to like them too,
expecially chicken soup with rice or noodles.  i used the no salt
swansons chicken broth as a base --- there are other brands, too.
i saw an organic no-salt chicken broth in a health food store
when i was in california a couple of months ago.

if you know what her favorite veggies are, you can put them in a
homemade soup, and avoid the ones she doesn't like.

liver problems can also make foods tase horrible, usually bitter
or metallic.  is she jaundiced?

and i echo the others --- aspriration pneumonia can be a real
danger.  have her dec refer her to a speech therapist for an
evaluation, since they are experts in mouth and throat problems.
medicare should pay for it as long as you get a referral.

our biggest problem right now is getting her to eat anything at
all.  she's still hypomanic, and the brain chemistry seems to
work like amphetamines:  very little appetite.  meds were just
upped and she's finally sleeping now, and i'm hoping that her
appetite improves.  most of these meds take several weeks to
build back up in the blood, and she was off them for at least 3
weeks, and probably more.

when she was in better mental shape, she had acid reflux and a
hiatal hernia, partly due, i believe, due to her long time
tendency to wolf down her food.  her mental state didn't seem to
make any difference in her eating habits.

and with all of us kids together for the first time in 10 or so
years we decided that we would expedite her transfer from the
small group home where she is now to the juneau pioneers' home,
where she will be at the top of the waiting list when we activate
her this week.  for once, a unanimous decision, the only one we
made all day.

she seems to feel confined in the group home,even though the
dining room and residents' lounge are spacious. the pioneers'
home has very good security (doors lock when residents wearing a
triggering device come near) and some large indoor spaces as well
as smaller rooms and hallways with garden and wetland/mountain
views.  

she put herself on the waiting list ten years ago, and at the
time was quite adamant about wanting to go there if she required
long term care.

first, though, we just need to get her stabilized, and get her to
stay on her oxygen more.
 
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