Lack of Appetite and Spits out the food

[OldestDaughter]

Just wondering if anyone has encountered a stroke patient that refuses to eat and spits out the food when he is pushed to eat?
Patient is 81 and will drink a Boost (nutritional supplement drink) in the mornings.

[RA1]

I have the same problem with my mom who is 79 year old. My caregiver force her to eat and mom spits out. When I tell her not to give her much. Caregiver says she has to eat though. Caregiver acts like a doctor like she knows everything. Although the caregiver worked at a nursing home about 12 years.

[EvasMums]

I wish to extend my thanks as well. I just found this page and have read with great interest. I was especially intrigued to read about the nutritional suggestions for stroke patients who have also encountered aspiration pneumonia. I have worked diligently on a project for nearly the past three years, but in a different capacity -- my pup (now adult!) has had similar difficulties. I smiled as I read about feeding very ripe bananas, for example. Just one of the many things that got us through the most difficult times.

Thank you for providing this information! My research continues so should anyone think that they may have helpful suggestions or learn of furth research that is *current*, please think of me (and many thanks in advance!) Some of my efforts are portrayed at a website if you wish to visit. The home address is: http://www.caninemegaesophagus.org/ . You may be interested especially in the clinical conditions page (there are 40 disorder/diseases that can be closely associated with megaesophagus in canines, ten which are the most common on average, and it is aspiration pneumonia that takes most of our dogs).

Thanks once again!

Best regards,

Peg McIntyre
Houston Texas

[OldestDaughter]

Thanks so much for all of the information

[caregiver222]

This business of "force feeding" is (unfortunately) taught to many health care aides and nurses, who are proud of the methods they have of "force feeding". Never ever feed a stroke patient who "spits out food". Ever. If you wait a while they will take a sip of nutrient, or a half teaspoon of food.

[caregiver222]

Feeding should be tried at different times of the day and the time logged. Sometimes a stroke patient will spit out food at 6 P.M. and be able to swallow at 11:30 P.M. The daily life rhythyms are often very disrupted. This is a phenomenal problem in nursing homes, who have strict feeding schedules. Try yogurt and jello. Then add thickener to the yogurt. Try cottage cheese with apple sauce.

[caregiver222]

Sorry for the duplicate messages, but the computer screen stated "unable to process post because of HTML links". There were no HTML links, but I tried again.

[caregiver222]

This is very common. Never ever force feed a stroke patient, especially one that spits out food. Many aides seem to delight in "making sure the patient gets the food". The problem is that the food goes down the trachea, into the lung, and pneumonia develops. This is called "aspiration pneumonia" and a common cause of admissions to the hospital from nursing homes caring for stroke patients. My little 102 year old goes through periods when she spits out food, and she is never fed anything but liquids during this time. These periods of spitting out food have gradually diminished from a daily thing to perhaps once a month. Feeding should always be in a chair, never in bed, and this includes liquid food supplements. Go through some of my previous posts. Initially I served a variety of spicy pureed foods in tiny quantitites. Buttered mashed potatoes are a good start with garlic. I mash and mince the garlic and cook it for a minute with extra virgin olive oil before adding it to ther mashes potatoes. Pureed organic split pea soup with hot sauce and ham. All served on a small silver spoon. Initially, regaining the swallow reflex can mean two hour feeding sessions, with up to ten to fifteen minutes between spoonfuls. There is a problem in swallowing, and a problem in the peristaltic movement of the food down through the esophageous into the stomach. All strokes are different, but I would be optimistic about regaining the ability to swallow, providing the stroke is stabilized. Also never feed when the patient is sleepy. This is another invitation to aspiration pneumonia. I always provide my sweet pie with four different flavors of drink, in tiny quantities in two-ounce plastic cups. She holds the cups on her own and can tip them now to get the last bit of fluid out. She likes to take a single sip of a different flavor out of each cup. Try yogurt, instead of the "nutritional drink".  Very fluffy perfectly prepared pieces of pancake slathered in butter and maple syrup in the spoon are something else to try. The pancakes cannot be "hard".  There is often a great delay in stroke patients understanding what is expected of them. Be directly in front of them and take a spoonful of whatever you are having yourself. Yopu will find that difficulty in swallowing is often circadian related. That is to say, it is not always consistent throughout the day.  Initially, for example, I found out my sweety pie could swallow more easily late at night about 11 P.M. I cannot acount for this. Now, she swallows rather normally at reasonable hours. But the answer is to sieze the moment. A common think for aides to do is to have a "feeding session" and the entire quantity of nutritional drink is provided at that time.. This causes fatigue of the muscles involved in swallowing. When I started out to regain the swallow ability with thickened liquids I provided no more than a teaspoon of the liquid every ten minutes. Think of when you used to do push-ups. Do too many and you lose the ability to do any at all. The muscles involved in swallowing atrophy. And they tire easily.  There are also many different kinds of strokes. Remember when the doctor asks you to "stick your tongue out". One of the thinks he (should be) looking for is deflection of the tongue to one side. This indicates a clot or obstruction blocking the 12th cranial nerve. These type of strokes cause problems with the tongue, which of course doesn't help the feeding situation very much. The human brain is very resilient, and if is often possible for another part of the brain to rewire itself to take over functions that have been lost due to an infarct (death of tissue) in another part of the brain. You need to maintain proper hydration and a hydration log is necessary. Bananas are also helpful in regaining the swallow ability. But they have to be perfectly ripe. A big part of my daily priority is to insure that every day my sweety-pie has a perfectly ripened banana. I cut them into pieces about an inch long, and split the skin, to assist her in peeling them. For a year she was unable to peel the banana. She is very proud of her accomplishment. You have to insure that you and the aides know how to clear an airway. The CPR courses cover this. I have not found a single aide that knew how to do this, although all had alleged "CPR" training. Think soft and spicy or highly flavored foods to stimulate the swallow reflex. My little sweety pie likes canned mashed Mackeral with olive oil and mustard. Canadian Turbo Filit is inexpensive and properly prepared is very soft, "melts in the mouth" and is very stroke friendly. I prepare mine by soaking it overnight (or for a few hours) in lemon and I crush (very thoroughly) four or five garlic cloves, mix them with extra virgin olive oil, put in the microwave for a minute and then rub it on both sides of the turbo filet. I dip the filet in egg and then press it into flavored Italian bread crumbs. Heat an iron frying pan and about forty seconds on each side will do the trick. Then you have a choice of thinks to slather on. Sometimes I use mayo. Other times mustard. Sometimes salad dressing. Put mon a glass plate, add a teaspoon of water and drizzle with extra virgin olive oil. Cook for three minutes if you are going to out it in the fridge for re-heating. Otherwise four seems to be fine. During the last minute put strips of butter on top. The result is a protein rich food that melts on the tongue. You will have to experiment a bit. The biggest problem is leaving it in the iron frying pan too long which will produce a hardened crust. Log the foods and tastes that make your loved one happy. Just have patience and don't give up hope. In most cases the refusal to eat solid food is not psychological. The patient is trying to avoid asphyxiation. Very riped avocado with lemon is soft, tasty and another stroke-friendly favorite. But it has to be very ripe and very soft.

[caregiver222]

This is very common. Never ever force feed a stroke patient, especially one that spits out food. Many aides seem to delight in "making sure the patient gets the food". The problem is that the food goes down the trachea, into the lung, and pneumonia develops. This is called "aspiration pneumonia" and a common cause of admissions to the hospital from nursing homes caring for stroke patients. My little 102 year old goes through periods when she spits out food, and she is never fed anything but liquids during this time. These periods of spitting out food have gradually diminished from a daily thing to perhaps once a month. Feeding should always be in a chair, never in bed, and this includes liquid food supplements. Go through some of my previous posts. Initially I served a variety of spicy pureed foods in tiny quantitites. Buttered mashed potatoes are a good start with garlic. I mash and mince the garlic and cook it for a minute with extra virgin olive oil before adding it to ther mashes potatoes. Pureed organic split pea soup with hot sauce and ham. All served on a small silver spoon. Initially, regaining the swallow reflex can mean two hour feeding sessions, with up to ten to fifteen minutes between spoonfuls. There is a problem in swallowing, and a problem in the peristaltic movement of the food down through the esophageous into the stomach. All strokes are different, but I would be optimistic about regaining the ability to swallow, providing the stroke is stabilized. Also never feed when the patient is sleepy. This is another invitation to aspiration pneumonia. I always provide my sweet pie with four different flavors of drink, in tiny quantities in two-ounce plastic cups. She holds the cups on her own and can tip them now to get the last bit of fluid out. She likes to take a single sip of a different flavor out of each cup. Try yogurt, instead of the nutritional drink.  Very fluffy perfectly prepared pieces of pancake slathered in butter and maple syrup in the spoon are something else to try. The pancakes cannot be "hard".  There is often a great delay in stroke patients understanding what is expected of them. Be directly in front of them and take a spoonful of whatever you are having yourself. Yopu will find that difficulty in swallowing is often circadian related. That is to say, it is not always consistent throughout the day.  Initially, for example, I found out my sweety pie could swallow more easily late at night about 11 P.M. I cannot acount for this. Now, she swallows rather normally at reasonable hours. But the answer is to sieze the moment. A common think for aides to do is to have a "feeding session" and the entire quantity of nutritional drink is provided at that time.. This causes fatigue of the muscles involved in swallowing. When I started out to regain the swallow ability with thickened liquids I provided no more than a teaspoon of the liquid every ten minutes. Think of when you used to do push-ups. Do too many and you lose the ability to do any at all. The muscles involved in swallowing atrophy. And they tire easily.  There are also many different kinds of strokes. Remember when the doctor asks you to "stick your tongue out". One of the thinks he (should be) looking for is deflection of the tongue to one side. This indicates a clot or obstruction blocking the 12th cranial nerve. These type of strokes cause problems with the tongue, which of course doesn't help the feeding situation very much. The human brain is very resilient, and if is often possible for another part of the brain to rewire itself to take over functions that have been lost due to an infarct  in another part of the brain. You need to maintain proper hydration and a hydration log is necessary. Bananas are also helpful in regaining the swallow ability. But they have to be perfectly ripe. A big part of my daily priority is to insure that every day my sweety-pie has a perfectly ripened banana. I cut them into pieces about an inch long, and split the skin, to assist her in peeling them. For a year she was unable to peel the banana. She is very proud of her accomplishment. You have to insure that you and the aides know how to clear an airway. The CPR courses cover this. I have not found a single aide that knew how to do this, although all had alleged CPR training. Think soft and spicy or highly flavored foods to stimulate the swallow reflex. My little sweety pie likes canned mashed Mackeral with olive oil and mustard. Canadian Turbo Filet is inexpensive and properly prepared is very soft, "melts in the mouth" and is very stroke friendly. I prepare mine by soaking it overnight  in lemon and I crush very thoroughly four or five garlic cloves, mix them with extra virgin olive oil, put in the microwave for a minute and then rub it on both sides of the turbo filet. I dip the filet in egg and then press it into flavored Italian bread crumbs. Heat an iron frying pan and about forty seconds on each side will do the trick. Then you have a choice of thinks to slather on. Sometimes I use mayo. Other times mustard. Sometimes salad dressing. Put mon a glass plate, add a teaspoon of water and drizzle with extra virgin olive oil. Cook for three minutes if you are going to out it in the fridge for re-heating. Otherwise four seems to be fine. During the last minute put strips of butter on top. The result is a protein rich food that melts on the tongue. You will have to experiment a bit. The biggest problem is leaving it in the iron frying pan too long which will produce a hardened crust. Log the foods and tastes that make your loved one happy. Just have patience and don't give up hope. In most cases the refusal to eat solid food is not psychological. The patient is trying to avoid asphyxiation. Very riped avocado with lemon is soft, tasty and another stroke-friendly favorite. But it has to be very ripe and very soft.

[caregiver222]

This is very common. Never ever force feed a stroke patient, especially one that spits out food. Many aides seem to delight in "making sure the patient gets the food". The problem is that the food goes down the trachea, into the lung, and pneumonia develops. This is called "aspiration pneumonia" and a common cause of admissions to the hospital from nursing homes caring for stroke patients. My little 102 year old goes through periods when she spits out food, and she is never fed anything but liquids during this time. These periods of spitting out food have gradually diminished from a daily thing to perhaps once a month. Feeding should always be in a chair, never in bed, and this includes liquid food supplements. Go through some of my previous posts. Initially I served a variety of spicy pureed foods in tiny quantitites. Buttered mashed potatoes are a good start with garlic. I mash and mince the garlic and cook it for a minute with extra virgin olive oil before adding it to ther mashes potatoes. Pureed organic split pea soup with hot sauce and ham. All served on a small silver spoon. Initially, regaining the swallow reflex can mean two hour feeding sessions, with up to ten to fifteen minutes between spoonfuls. There is a problem in swallowing, and a problem in the peristaltic movement of the food down through the esophageous into the stomach. All strokes are different, but I would be optimistic about regaining the ability to swallow, providing the stroke is stabilized. Also never feed when the patient is sleepy. This is another invitation to aspiration pneumonia. I always provide my sweet pie with four different flavors of drink, in tiny quantities in two-ounce plastic cups. She holds the cups on her own and can tip them now to get the last bit of fluid out. She likes to take a single sip of a different flavor out of each cup. Try yogurt, instead of the "nutritional drink".  Very fluffy perfectly prepared pieces of pancake slathered in butter and maple syrup in the spoon are something else to try. The pancakes cannot be "hard".  There is often a great delay in stroke patients understanding what is expected of them. Be directly in front of them and take a spoonful of whatever you are having yourself. Yopu will find that difficulty in swallowing is often circadian related. That is to say, it is not always consistent throughout the day.  Initially, for example, I found out my sweety pie could swallow more easily late at night about 11 P.M. I cannot acount for this. Now, she swallows rather normally at reasonable hours. But the answer is to sieze the moment. A common think for aides to do is to have a "feeding session" and the entire quantity of nutritional drink is provided at that time.. This causes fatigue of the muscles involved in swallowing. When I started out to regain the swallow ability with thickened liquids I provided no more than a teaspoon of the liquid every ten minutes. Think of when you used to do push-ups. Do too many and you lose the ability to do any at all. The muscles involved in swallowing atrophy. And they tire easily.  There are also many different kinds of strokes. Remember when the doctor asks you to "stick your tongue out". One of the thinks he (should be) looking for is deflection of the tongue to one side. This indicates a clot or obstruction blocking the 12th cranial nerve. These type of strokes cause problems with the tongue, which of course doesn't help the feeding situation very much. The human brain is very resilient, and if is often possible for another part of the brain to rewire itself to take over functions that have been lost due to an infarct (death of tissue) in another part of the brain. You need to maintain proper hydration and a hydration log is necessary. Bananas are also helpful in regaining the swallow ability. But they have to be perfectly ripe. A big part of my daily priority is to insure that every day my sweety-pie has a perfectly ripened banana. I cut them into pieces about an inch long, and split the skin, to assist her in peeling them. For a year she was unable to peel the banana. She is very proud of her accomplishment. You have to insure that you and the aides know how to clear an airway. The CPR courses cover this. I have not found a single aide that knew how to do this, although all had alleged "CPR" training. Think soft and spicy or highly flavored foods to stimulate the swallow reflex. My little sweety pie likes canned mashed Mackeral with olive oil and mustard. Canadian Turbo Filit is inexpensive and properly prepared is very soft, "melts in the mouth" and is very stroke friendly. I prepare mine by soaking it overnight (or for a few hours) in lemon and I crush (very thoroughly) four or five garlic cloves, mix them with extra virgin olive oil, put in the microwave for a minute and then rub it on both sides of the turbo filet. I dip the filet in egg and then press it into flavored Italian bread crumbs. Heat an iron frying pan and about forty seconds on each side will do the trick. Then you have a choice of thinks to slather on. Sometimes I use mayo. Other times mustard. Sometimes salad dressing. Put mon a glass plate, add a teaspoon of water and drizzle with extra virgin olive oil. Cook for three minutes if you are going to out it in the fridge for re-heating. Otherwise four seems to be fine. During the last minute put strips of butter on top. The result is a protein rich food that melts on the tongue. You will have to experiment a bit. The biggest problem is leaving it in the iron frying pan too long which will produce a hardened crust. Log the foods and tastes that make your loved one happy. Just have patience and don't give up hope. In most cases the refusal to eat solid food is not psychological. The patient is trying to avoid asphyxiation. Very riped avocado with lemon is soft, tasty and another stroke-friendly favorite. But it has to be very ripe and very soft.