Speech and language therapist

Discussion in 'ARCHIVE FORUM: Support discussions' started by DeborahBlythe, May 24, 2007.

  1. DeborahBlythe

    DeborahBlythe Registered User

    Dec 1, 2006
    9,222
    My mum has finished the course of antibiotics she was put on last week. On Sunday she was still finishing the course and I noticed that her forehead, on a hot sunny day, was as cold as ice and very clammy. She still had the rattly chest and had problems coughing anything out. I asked if she could have what they call 'homely remedies', i.e things that do not need prescription, which they keep a small stock of. I was thinking of a cough linctus or expectorant. Just something to loosen the phlegm and make it easier to spit out.

    They didn't have any available but checked my mum's T, P and BP and said they were normal, surprisingly. They wanted to consult a doctor and said they would call one on Monday , but on Tuesday they told me that the doctor had declined to visit and simply advised sitting my mum up more. On Tuesday her forehead was perfectly normal-feeling, not that horrible clamminess, but she still can't seem to shift the phlegm. Once again all my mum's 'vital signs' were normal.

    In the evening a carer came in and started fixing a notice to the wall of my mum's bedroom. I asked what he was doing. " Oh" he replied " It's a note for the other carers to remember to add Maxijul to your mum's food and drink" . I had never heard of Maxijul and although I am happy that someone has taken note of my mum's dietary needs, I couldn't think who that would have been, out of the blue.

    Apparently a dietician came to visit my mum on Tuesday, without anyone letting me know. (I wouldn't have stopped her, of course, but I did think that it would have been useful to have been contacted first. I originally instigated a visit by a dietician following on from my mum's transfer to this home, and she was , I thought, very on the ball and made some good suggestions. Then the contact petered out, and it seems she, or another colleague from that team does continue to visit but without contacting the family).

    Maxijul is a sort of powdery/granular type additive a bit like sherbet powder or fine sugar and it tasted a bit sweet.

    Anyway, a locum doctor was called out on Tuesday night but declined to prescribe anything. I am not hammering on the door for antibiotics. I think they can be quite 'depleting' in their own way, but I can't see why they can't prescribe or permit a simple cough linctus.

    Yesterday the home rang me to say that another doctor was visiting someone else in the home and would see my mother too. She was at lunch at the time when he came and when asked by the doctor how she was, she said " I'm absolutely fine". Do you have any problems with your chest? " None at all" she said very indignantly.:) He declined to prescribe anything. The manager said my mother made her look like a fool and she had to tell the doctor to disregard my mother's own verdict.:D

    Then she said she had referred my mother to a speech and language therapist. What for? I asked, somewhat incredulous. Do they have anything to do with chest problems? I didn't think so. They are going to get the speech and language therapist to come and visit my mother at lunchtime to see how she eats her food. Is she aspirating food, which might be causing the phlegminess/chestiness? Apparently the speech and language therapist may be able to detect this. Anyone know if it is normal to involve speech and language therapists for this purpose? Seems a bit odd to me.:confused:
     
  2. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,438
    Yes. I don't know why, but speech and language therapists are the people they call about swallowing dificulties. It has always seemed odd to me but it is SOP.

    Jennifer
     
  3. Gromit

    Gromit Registered User

    Apr 3, 2006
    187
    Edinburgh
    Found this on the web re speech and language therapists.

    Hi - I found this on the web - hope its useful....

    "SLTs have clinical expertise in the areas of communication
    disorder and dysphagia (eating, drinking and swallowing
    disorder) and are therefore essential in the care and
    management of this population by the contribution of
    specialist knowledge and skills within the specialist mental
    health team.
    All people with dementia should have access to these
    specialist services.
    • SLTs aim to maximise functional gain from residual skills
    based on specialist assessment.
    • SLTs have specific skills in analysing, diagnosing and
    managing communication disorder and dysphagia and
    are trained to use a variety of techniques to do this.
    • The role of the SLT encompasses working with clients,
    their carers and the multidisciplinary team from the
    early to late stages of the disease providing services that
    aim to enable people to retain a sense of
    independence/self worth and remain at home for as
    long as possible.
    • The SLT aims to reduce the impact of the
    communication disorder and/or dysphagia on the
    person and their carers by providing advice, training
    and support to them and the multidisciplinary team, for
    example to enable people to participate in decision
    making."
    The last bit certainly indicates that you should be kept up to date so that you can take part in the "decision making" - make sure they do.

    Hope it goes well.

    Kindest regards

    Alison
     
  4. DeborahBlythe

    DeborahBlythe Registered User

    Dec 1, 2006
    9,222
    Brilliant. Jennifer and Alison, thanks so much for your kind and prompt replies. I'll keep you posted.
     
  5. Sandy

    Sandy Registered User

    Mar 23, 2005
    6,847
  6. DeborahBlythe

    DeborahBlythe Registered User

    Dec 1, 2006
    9,222
    Sandy, thank you. That is all really helpful and kind of you to bring it to my attention.
    I went in at lunchtime today, knowing that the GP at least would be visiting and who knows, maybe one of those rare birds: a speech and language therapist. ( I'd have been surprised as they are much in demand, but surprising things do sometimes happen) My mother was sitting up looking alert and keen to eat. They brought a chicken dish in a slightly spicy sauce, with rice. The chicken was far too dry and needed cutting into minuscule pieces so I asked for the soft option which turned out to be pureed beef and mash. My mother wouldn't touch it so I persevered with the chicken and we made considerable progress. I don't know what would have happened if I hadn't been there. My mother could not have cut the food up herself.

    In the middle of all this the lovely GP turned up and was steered in my direction. I just wanted to ask what the objection to linctus was and he said that it doesn't do any good, even the ones calling themselves expectorants. The only ingredient that calms or soothes is the syrup or sugar. He wouldn't accept that there was any beneficial ingredient in expectorants, which is, to my mind, odd as I have been prescribed them for myself in the past. My mother shot him one of her film star smiles, which always makes me laugh and he said that 'they all have a bit of chestiness here. It's what happens in nursing homes. We'll see what the dietician has to say' (I think he meant S and LT, not dietician.)

    My mum ate a dish of yogurt and then wanted to 'go and have some tea'. I took her out into the garden for the third time this year and we sat under a chestnut tree and surveyed the surroundings..

    Last time we'd gone out, a few days ago, she claimed to have been able to hear the birdsong, which I rather doubted as she is very hard of hearing in one ear and deaf in the other. This time,as I wheeled her along, she commented on the birdsong herself and started whistling back responses to the birds! I couldn't believe it! When did I last hear her whistle? Must have been ten years ago!

    It was quite an idyllic afternoon. Warm, but not too warm, still but the air full of bird ditties and chattering. She usually can't wait to go up to bed after her lunch but this time she wanted to stay outside and drink tea, then would drowse a little, then awake and watch a squirrel cavorting or the gardener on his knees over by the greenhouse, or the staff scampering behind a fence to sit out with their (belated) lunches.. I don't suppose we held any scintillating conversation but what we said was enough. Better than enough, all things considered. I adjust the chair to make it recline or move the footplate to change the angle of her legs. I took her to see the roses again and this time she was wide-eyed at their colour and beauty.

    No I don't think we settled any international conflicts. But there was definitely a sense of peace at least in the small circle we inhabited this golden May afternoon.
     
  7. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    My mum was visited by a SALT several weeks ago when she wasn't eating much at all. I was also surprised as I hadn't heard of SALTs being used in this regard. I wasn't asked if I wanted to be there but I suppose if I had wanted to be I could have. I was told later that the SALT had said that my mum did still have a swallow reflex but that it was slow. When I went to the home on Wednesday there was a sealed letter there which was addressed to 'the carers of A--- C----', so I of course opened it. It contained a quite detailed report of the findings and recommendations of the SALT which I still haven't had a chance to read properly. It was also obviously intended for the PAID carers of my mum, but the home obviously hadn't realised that either! I am going to photocopy it and give it back to them to go on her file and hopefully be acted on. One of the recommendations for meals was blended salad! :eek:
     
  8. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Deborah, what an idyllic afternoon with your mum, and so poetically described. Definitely one for the memory book. I hope the SALT manages to solve your mum's problems.

    Brenda, blended salad sounds disgusting!:eek:
     
  9. DeborahBlythe

    DeborahBlythe Registered User

    Dec 1, 2006
    9,222
    Thank you Hazel. It was so nice to be outside the confines of the home which are noisy after mealtimes with residents calling for attention and kitchen staff thrashing around trying to get all the clearing and washing up done. It was also cooler outside. Once my mother was back in her room she was soon feeling too warm even with a big circular fan blowing. She didn't want to do anything but sleep and certainly didn't want any supper. I don't think this was 'giving up on life' or anything drastic or sinister. Just too darn hot.

    Brenda, that's really interesting about your mum's S&LT. Let's hope the other recommendations are better than the one about blended salad:D Still, I suppose you could call it consomme or Vichysoisse or something, and it would have all those useful vitamins and folic acid intact etc. Pretty sure my mum wouldn't be fooled though.:) It's probably already on the menu at Heston Blumenthal's restaurant.
    :D
     
  10. Nell

    Nell Registered User

    Aug 9, 2005
    1,170
    Australia
    Dear Deborah,
    Nothing to do with your post, but . . .!!
    Are you a writer by profession? Your posts (and poems!) are so beautifully worded,, I feel sure you must be a famous author in disguise?!!
    (Sorry to be nosy!!)
     
  11. Taffy

    Taffy Registered User

    Apr 15, 2007
    1,314
    Hi Debroah
    My mum was referred to a speech therapist because of a persistent cough and occasional swallowing problems, like yourself I didn't see much sense in it, but when the therapist started her testing which involved mum actually swallowing all different consistency of foods and fluids she could tell that the problem was caused by the dementia, a thickener was ordered for mum's fluids and solid food had to be cut up fine and covered in a gravy or sauce. The therapist said, the fluids going into her lungs was the greatest concern, but when the dementia nurse came to visit she said to stop the thickener as it wasn't that palatable and as mum enjoyed her cuppa let her have it and let nature take its cause mums GP agreed.Mum enjoys her cuppa again still coughs but what was the point of the therapist in the first place when they don't want to follow her recommendations.:confused:
     
  12. DeborahBlythe

    DeborahBlythe Registered User

    Dec 1, 2006
    9,222
    #12 DeborahBlythe, May 28, 2007
    Last edited: May 28, 2007
    Taffy, I'm glad your mum is still enjoying her cuppa. I think that there is a secxret ingredient in tea which seems to soothe a lot of my mum's worries. I hope it isn't thet ea that is making her cough. She will hardly ever refuse a cup and has the most entertaining set of faces which she pulls if it isn't 'quite right'. Thanks for posting here. I am clearly way behind in my understanding of S and LT practice, but not any more, thanks to the briliiant TPers here.
    Nell, shhh, don't mention my fame, I couldn't cope with the paparrazzi. It's hard to describe exactly WHAT I am at the moment. I'm in limbo. You'll find more accomplished writers than me in the Poems section: Karen for one. But everyone has it in them, I think, to write movingly. Many TP contributors bring very heartfelt emotion to their postings, expressed with simplicity and honesty, Hazel and Sylvia in particular. Jude writes extremely well, and so do you Nell and Brenda and Cate. Connie's postings are full of love, Brucie's full of wisdom. Grommit and Margarita both have a beautiful gift for humour. Jennifer is breathtakingly thorough and well informed. There are many stars in the TP firmament!:)
     
  13. DeborahBlythe

    DeborahBlythe Registered User

    Dec 1, 2006
    9,222
    #13 DeborahBlythe, Jun 12, 2007
    Last edited: Jun 12, 2007
    Update; the value of thickeners?

    The S&LT cancelled the appointment last Monday but turned up yesterday. By now my mum's chest had stopped rattling,( the original worry) though she does still cough a little after drinking.
    For the last two days she has been very drowsy. I found her in the dining room asleep in her chair at lunchtime on Sunday, and had a devil of a job to interest her in food, but she did drink eagerly. Yesterday she was more awake to start with but again didn't want much food and this time wasn't interested in drink either.

    However, when the S&LT arrived and leant over her 'asleep' in her bed, and asked how she was , my mother suddenly sprang awake, beamed at her and reassured her she was fine, thank you. :)

    The S&LT gave her some fruit juice which my mother drank steadily and as she did so the S&LT watched her carefully and held a sort of stethoscope to my mother's neck. At the end, she said my mother had a slightly weakened swallowing reflex, and she has recommended the use of some thickening granules, added to all fluids. She stirred a few froma 9 gram sachet into the juice and watched my mother drink it.

    The point of the thickeners is that apparently they are supposed to make fluids easier to swallow, less likely to disappear down the wrong route ending up in the lungs. They contain no nutrients, just a form of starch. When the thickened fluid has reached the tummy, it becomes runny again, she said.

    However, consistency is important. If you add too much thickener, it makes the fluid 'slodgy'. The fluid has to be the consistency of a runny syrup and still able, of course, to pass through the spout of a beaker. She recommended that carers add only a small amount to start with, and wait 30 seconds to see what the consistency has reached. Then add more if need be.

    I have to say that alarm bells started ringing at this point because the thought of carers waiting 30 seconds for anything is a bit far-fetched in my mum's home. Their normal modus operandi is to fly in, do whatever deed needs doing, and fly out again in smart time.

    Later, after she had gone, I decided to try to make a cup of tea, (my mum's favourite drink), using the granules that remained in the sachet. The proportions mentioned on the packet say a full sachet (9 grams) to 200 mls of fluid. The nurse present thought that the usual beakers held 200 mls, but I soon doubted this. With the less-than-9-grams remaining in the sachet, the tea in the beaker was so thick you could almost have stood a spoon up in it and of course my mum wasn't having any. I took it downstairs and showed the nurse so that he could see what had happened.

    I was so concerned by the time I left that I wondered if there was any point in using the thickener at all. Worse to be offered undrinkable stodgy fluid than fluid that is its normal consistency, I suspect. At least in my mum's case.

    On Sunday my mum had moments of sunshine and humour, yesterday she sensed me dabbing with a tissue at her lips, to make them clean and out of the blue she looked fiercely at me and said " Wicked girl! " I was really startled as she has only once turned on me before. I protested that I was trying to make her fresh and she calmed down. She ate no supper . I sat trying to tempt her, cajoling, muttering, joking and finally I just talked and talked about all the things she used to cook for us as children. Casseroles, roast lamb, lemon meringue tart, rock cakes, soused herrings, liver and bacon, Bishops cake, bubble and squeak, blue lollipops. She was not responding until after a while she smiled and started to try and join in. " Blue lollipops?" she echoed my words. " Blue lollipops were on the edge". It didn't make total sense, but at least she was getting something from my burblings. I began to feel like a blue lollipop myself.
     
  14. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    69,884
    Kent
    Oh Deborah, you are trying so hard to keep your mother as comfortable as possible. I don`t envy you.

    About the Granules.

    Do they thicken up after a while, or is the consistency you have as you mix it, how it stays.

    Also, do they thicken up more in hot lquid, and could that explain why the tea was so thick.

    Sometimes it takes a while to get used to different procedures.

    Love xx
     
  15. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Hi Deborah

    Hope you manage to get the thickener sorted. I suppose it's like gelatine, you never know if it's going to work -- at least, I always have problems with it!

    I'm glad you managed to get through to your mum, talking about food. Blue lollipop? Is this a new thread for Tea Room?

    Well done, you're doing everything you can for your mum.

    Love,
     

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