Geriatric Medicine/Feeding tube

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Question
I know this might not be your expertise but I literally couldn't find anyone on the site that handle surgery in general, gastric stuff in specific, or a category somewhere between. My mother is 65 or so and had a stroke 6 years ago and has been at home mostly since then. She has speak aphasia and lack of most control  on right side. She was on  a feed tube after brain surgery where she had her stroke but we managed to get her eating solid foods again. Yesterday she seemed to have trouble taking her pills and any food and the night before she couldn't seem to swallow her pills at all without me practically forcing them down her throat. Yesterday she spent all day in hospital and will spend another night here taking I assume all meds through IV or shot.. I guess today she passed a barium swallow test and had a decent breakfast with mostly solid foods but still seems to hold stuff in her mouth. How permanent are feeding tubes usually? Compared to breathing  tubes should one be able to work their way back off of feeding tubes without much trouble ones a swallowing issue is resolved? I'm worried we're not out of the woods yet.

Answer
Hi James,

First I'd like to apologize for the delay in response time. Generally, I am able to respond within 24 hours. However, today I received an email from AllExperts stating that I had not responded to your question yet. The reason is that they did not notify me via my personal email as they normally do.

I am sorry to hear of your mother's repeated issues with eating after suffering from a stroke. If she passed a swallow test, generally this is followed by a few sessions with a speech and language therapist (SLT).  If this has not been done, I would suggest that she have an evaluation by a SLT. They would work with her to determine what thickness and what types of foods and liquids are easiest for her to swallow, and more importantly, the safest to prevent aspiration into her lungs.  

A feeding tube can be placed temporarily or permanently. Sometimes, as with my dad, a person can have a feeding tube placed to ensure nutrition is provided on days that he or she either does not feel like eating or is having difficulty eating. It is used as a backup or safety measure to ensure that the individual will receive adequate nutrition. It will also prevent future hospitalizations for this reason. Hospitalizations play havoc with the memory and general feelings of safety and well-being in our senior population.

It is important to remember that receiving nutrition is what is most important, not necessarily the manner in which it is provided. If your mom wants to continue eating foods orally and it has been determined that she can do so safely, remember to use small portions and in the consistency which she can chew and swallow best. This may be a soft diet or a mechanical diet. Only a SLT and a dietitian can determine which will be safest for your mom. Some individuals just have a tube feeding running at night when they are sleeping and that way they can eat what they want during the day. However, because of the added assurance of the night time feeding, no one will be pressuring them and there will be less angst about how much is eaten during the day.

There are many reasons why a person doesn't eat. Sometimes it's because they are not hungry. Sometimes it's because they are depressed. And sometimes, it's because the brain which has been affected by the stroke no longer remembers to eat.

I hope that this information is helpful. Again, I am sorry for the delay.

Best of luck to you and your mom!

Gayle

Geriatric Medicine

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Gayle Gwozdz

Expertise

My name is Gayle and I am an adult nurse practitioner (APRN)whose practice has focused on geriatrics in long term care facilities, evaluating and prescribing medications for medical and psychiatric conditions. I presently perform geriatric home assessments and physical exams in patients' homes. I can answer questions related to assisting adult children in keeping their parents at home, advising when a specialist should be consulted, advising if medications may be causing certain new problems that have arisen. Having cared for my dad with Alzheimer's for 14 years I am quite knowledgeable about what is normal and abnormal when it comes to this disease. I can help direct individuals to resources and support services that they may be unaware of. Lastly, I can make recommendations that can be brought back to the patient's doctor if he/she is willing to consider alternatives to the current treatment plan regarding a particular issue or medical problem.

Experience

I am an adult nurse practitioner with nearly 5 years experience in primary care, focusing on geriatric clients. I cared for my parents in the final 15 years of their lives interacting with healthcare providers, home nursing agencies, state agencies, Medicare and Medicaid representatives, palliative care and home hospice agencies. Prior to becoming an APRN I worked as an emergency dept. nurse for 15 years and 12 years for a large health insurance company providing medical reviews for underwriting, educating underwriters on medical conditions, utilization review and case management, requesting exceptions from medical directors to allow patients to receive medications or treatments not normally covered under their insurance plan, and I assisted in the area of reviewing complex medical claims for payment.

Organizations
CT APRN American Association of Nurse Practitioners (AANP) Sigma Theta Tau International (SITT) AARP

Publications
"Walk A Corridor in My Shoes" published in November, 2004, Nursing Spectrum.

Education/Credentials
Associate Degree in Nursing from Greater Harford Community College BSN from CCSU MSN in Nursing Management from the University of Hartford MBA from Rensselaer Polytechnic Institute MSN with Adult APRN from Quinnipiac University Graduate Certificate in Geriatric Care Management from the University of Florida Reiki Master Legal Nurse Consultant

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