Tips for Making Life Easier with Parkinson’s Disease
MANAGING MEALTIME MADNESS
by Shelley Peterman Schwarz
The kitchen is often the busiest room in the house. It becomes a hotbed of activity when you’re preparing and eating meals. This article will help you plan, make, and serve meals so you can streamline the process and make tasks easier.
Begin by building more time into your schedule to prepare and eat meals. Make the kitchen or dining room a calm, low-stress environment by playing soft, relaxing music while you cook and eat.
Do as much planning and preparation as possible while seated at the kitchen table or at a stool pulled up to a countertop. If your energy or medication’s effectiveness waxes and wanes, prepare meals when your energy level is high, and reheat it and serve after you’ve had a chance to rest. When eating, sit close to the table and place all food and utensils within easy reach.
Meal Planning and Preparation
Choose a grocery store that will not defeat you before you begin. When deciding on a store, take into account not only prices and location but also layout and facilities, including restrooms. Is the store accessible? Are the doors easy to manage? Are the floors clear of debris and obstacles?
Ask if your neighborhood grocery store has a home delivery service if getting out to shop for groceries is a problem. Some stores will charge a flat fee, while others will require a minimum order. Delivery areas vary and so does how far in advance you must call to place your order. Large chain stores or warehouse-type grocery stores rarely deliver but they often have the names and phone numbers of delivery services that do. Or order your groceries from an online service (see the Resources section at the end of this chapter).
If you don’t want to walk unassisted through a slippery parking lot, some grocery stores will send a bagger or stock person to help you get from your car to the store door and back again. Other stores may allow you to pull up to the front door and have an employee park your car. These services are available to regular customers who have made arrangements in advance. Another option is to park next to the area where shopping carts are kept outside. Pushing a shopping cart can improve your stability when walking through the parking lot and store.
Ask the bagger to not fill your bags too full. Spread out the items into more, but lighterweight, bags. Ask that all frozen or perishable foods be put into one bag. Then when you arrive home you only need to empty one bag immediately, and the others can wait.
To make grocery shopping faster and more efficient, create a diagram of the store and list the food categories for each aisle. Then make a master list on your computer of items you buy. Before you go to the store, print out a list and circle each item you need. This method is especially helpful if you send a friend to do your grocery shopping — then there is no question about what brand and what size of a particular item you want.
Use a wagon (like a Radio Flyer™) or a wheeled wire cart to move groceries from the car to the house.
Encourage the person with PD to be involved in activities like sorting things — putting away groceries, setting the table and putting away clean silverware and dishes. If items are not put in the proper spot, quietly move them to where they belong.
To open a jar if your hands are weak, improve your grip by putting on a rubber glove, by winding a thick rubber band twice around the lid, or by using a 5” x 5”, thin, waffle-grid rubber sheet, available where kitchen gadgets are sold. These rubberized sheets make untwisting caps and lids easier. Other jar openers (that attach to the underside of a cabinet) are also available.
Use a rocker knife instead of a traditional straight knife. You can get a seesaw motion going with the rocker knife and use less energy than required with a straight knife.
Keep an extra pair of pliers in the kitchen. Use them to peel away the plastic seal from a jar of peanut butter, to pull the tab on a container of cream cheese, and to grab the sealer strip from a can of frozen orange juice or a gallon of milk.
Purchase jelly in plastic squeeze bottles so spreading it on sandwiches is easier.
If you have tremors, prepare finger foods that don’t require use of a knife and fork. Purchase cheese cubes, precut chicken strips, and cocktail-sized hot dogs just to name a few. In the produce section of the grocery store, you’ll find cut up fruits and vegetables. While they sometimes cost more than the uncut variety, the time and energy you save can be worth every penny.
Making and/or Using Simple Adaptive Devices at Mealtimes
If grasping and holding onto silverware is difficult, use modeling clay to build up the handles. Or take foam tubing, which comes in a variety of thicknesses, and build up the handles on utensils. Another solution is to purchase stainless steel flatware with big bamboo or plastic handles that are easier to grip. Some specialty catalogs and medical supply stores sell inexpensive utensils specially designed for easy use. (Using weighted, built-up utensils may also help decrease tremors while eating.)
Use a glass or metal pie pan instead of a regular plate if you have trouble keeping food from sliding off the plate. Use a plate guard or a pasta bowl with high sides because it will be easier to get food onto the spoon or fork. Plate guards can be attached to plates to provide a rim on one side. Use your fork to push food against the guard, where food will fall onto the fork. Plate guards also help reduce spills.
Place Dycem™ rubber pads or Rubbermaid™ mats underneath plates, cups, and serving dishes to keep them from sliding.
Make handling a drinking glass easier if you have hand tremors or a weakened grip:
Fill glasses half-full.
Wind several thick rubber bands around the glass.
Drink from a plastic water bottle (or sports bottle) instead of a glass. The small opening at the top prevents beverages from sloshing out, and when sealed, the cap prevents spills if the bottle is accidentally bumped.
Use a flexible plastic drinking straw instead of drinking directly out of a glass. To better hold a straw in place, find a lid of a plastic container (the same diameter as your glass), punch a hole in the lid, and insert a straw into the hole. You’ll find that the straw does not slide around in the glass.
Use a child’s cup with a built-in straw for drinking. The Tommee Tippee™ cup is made of unbreakable plastic and has a spout and a see-through cover. The curved base is weighted to prevent spilling.
Drink from a cup or mug that has two handles.
Eating and Drinking Tips for People with Swallowing Difficulties
Swallowing is a very complex process, and difficulties in chewing or swallowing (dysphagia) can cause additional health problems. It is estimated that 50% of people with PD will experience dysphagia at some time during the course of their illness.
If you experience difficulty swallowing, ask your doctor for a referral to a speech/language pathologist (SLP), along with a prescription for “swallowing evaluation and therapy.” A swallowing study and a video fluoroscopic evaluation by a specially trained SLP can best diagnose exactly what part of the swallowing process is causing you problems, and recommend a treatment program for you. You and the people who help you will learn important tips that can help keep you healthy.
One important consideration affecting swallowing ease may be when you take your medication. Consult with your physician on how to time your medications to facilitate swallowing, and experiment with what works best for you.
To reduce swallowing difficulties:
Plan a regular mealtime schedule. Give yourself at least twice the time it usually takes to eat the meal. Don’t allow yourself to feel hurried, because stress can exacerbate symptoms and make swallowing even more difficult. Minimize mealtime distractions by turning off the television and radio and keeping conversation to a minimum.
If you find that you fatigue too much when eating a whole meal, plan 5 or 6 smaller meals during the day or snack throughout the day. If chewing is too difficult, but your swallowing is good, drink a food supplement such as Ensure™, Boost™, or Carnation Instant Breakfast™ to supplement your diet. Check with your doctor to make sure that the protein content of those drinks doesn’t interfere with the absorption of your medications.
Suck on a few crushed ice cubes about 20 minutes before mealtime to reduce any swelling in your throat. Or eat something very cold and sour like lemon or lime sherbet before you begin to eat. This may help to improve saliva production for people with dry mouth. It may also stimulate the muscles necessary for swallowing and reduce tongue delay. Although not proven, it may be helpful to eat spoonfuls of the cold, sour food periodically during the meal to continue improved swallowing and to help clear the mouth and throat of food particles.
Sit in an upright position with both feet on the floor, and stay upright for at least 30 minutes after a meal. Reclining or lying flat while eating can cause food to remain in the esophagus or to back up into it. If you have frequent heartburn, it is important to consult with a good gastroenterologist. Frequent bouts of heartburn can damage the esophagus. In rare cases, food can be refluxed all the way up and into the throat. The major danger when that happens is that some of the refluxed material could get into the airway and down into the lungs. When foreign material gets into the lungs, it can cause pneumonia.
Keep your chin pointed down as you chew and swallow. In addition, gently touching or massaging the front of the throat right before or during eating may help stimulate swallowing.
Concentrate on each step of the swallowing process. Make sure you have enough saliva or moisture in your mouth to get the food into your esophagus. Do not try to eat if you are too fatigued to concentrate on chewing and swallowing.
Take bite-sized portions (about one-half spoonful) of food. Chew deliberately. Swallow each bite completely before you take another. Chew hard with the food on one side of the mouth, and then move the food to the other side and chew hard some more. Take comfortable sips of liquids to reduce the risk of aspiration. If swallowing liquids at the same time as solid foods is difficult, stick to one substance at a time before you try to swallow another.
If you have a cough that you can’t stop, try eating a spoonful of applesauce. Its cool, smooth texture can help soothe your irritated throat. Applesauce now comes in single-serving cups so you can carry one with you for instant relief. However, if your cough persists, food may have gone down into your airway. A cough is your body’s natural protective mechanism for getting rid of foreign material in the airway. The signs of silent aspiration (food particles that go into the airway, but you do not feel them) may be respiratory problems, fever, chest noises, and then pneumonia. Consult a doctor immediately if you experience any of these symptoms.
If you feel that you are choking while swallowing, close your mouth, breathe through your nose, and calm down. Taking that one breath will give you enough air to help avoid panic and will help you breathe normally. Ask family members and helpers to learn the Heimlich maneuver in case you choke while trying to swallow. A doctor or other healthcare professional can demonstrate and teach the procedure.
Tips if Drooling is a Problem
When drooling is a problem, chew gum. It helps remind you to swallow more often.
Make it a deliberate habit to try to swallow your saliva regularly to reduce its accumulation in your mouth. Close your lips firmly, move the saliva to the back of your throat, and swallow. Swallow any excess saliva before you attempt to speak.
Food consistency and texture
The texture of food becomes more important when you can taste only sweet, sour, or salt. See which textures work better for you. However, if you have trouble swallowing, be sure to have a swallowing study done, which can tell you if thickened liquids might help and how to experiment with various degrees of thickness.
Swallowing can be easier if you stick with foods of a soft, even consistency. An example would be creamy, whipped mashed potatoes (not lumpy and dry, on the one hand, and not thin and runny, on the other, but smooth and somewhat viscous like sour cream).
Avoid foods that easily pose a choking hazard:
Steak is the number one thing people choke on. Eat ground steak instead.
Dry foods that break into small pieces like seeds, nuts, or baked goods.
Foods that irritate your throat (such as vinegar) or cause you to choke (potato chips, etc.).
Stick with foods that are easy to swallow:
Baby foods and cereals. Baby foods have a smooth, easy-to-swallow consistency.
Strained, thickened soups. Puree a favorite soup in a food processor or blender to remove chunks. Then, thicken the soup with mashed potatoes (or strained, mashed peas, beans, lentils, or chickpeas), blend, and serve.
Strained, thickened fruits. Use a food processor to combine your favorite fruits with cottage cheese, cream cheese, or yogurt. Strain off excess liquid, blend until desired consistency is reached, and then serve.
Yogurt. Buy the smooth or blended variety, or puree the fruit-on-the-bottom variety in a blender until smooth.
Thick puddings.
Soft bread with crusts removed. Take your time with bread. Eat one small piece at a time. Suck on it until it is soaked in saliva, and swallow it with one big gulp.
Canned liquid diets. Some of these may be too thin, so you can thicken them with cornstarch. Also, relying solely on liquid diets can result in low blood albumin, so you might want to add dried egg white powder to the liquid if you plan to use liquid diets for an extended period.
Fruit nectars. Thicker than most juices, nectars are less likely to be aspirated when swallowed. Look for apricot, pear, mango, and banana nectar in the ethnic or specialty aisle of your supermarket. Tomato juice is another thicker beverage that can be easier to swallow.
Thick spreads like hummus or cream cheese. Serve on soft, crustless bread or eat as a snack with a spoon.
Mashed avocado or banana.
Try variations on your favorite food and drinks to make them easier to swallow. For instance, if you find regular orange juice irritating to your throat, try orange juice with pulp, or the low-acidity kind.
Swallowing Pills and Vitamins
Some pills can be difficult to swallow, so ask your doctor or pharmacist if your medication will retain its potency if it is ground up and combined with food. If your doctor advises against grinding up your pills, try swallowing the pill with fruit nectar instead of water. Or swallow it along with a spoonful of applesauce or honey, or try coating the pill with a little butter or pudding.
Put the pill into your mouth, tilt your chin down, look down into the bottom of your glass of water, and swallow. Continue to look down during the entire swallowing process. Some people find that this works much better than tilting your head backwards when swallowing a pill.
RESOURCES
Online grocery stores are a convenient way to shop. You can periodically place your order over the Internet to avoid going out in inclement weather or you can schedule regular grocery delivery of your favorite foods. Unfortunately, this type of service only covers certain areas of the country. Continue to check these Web sites for changes in their delivery areas. Also, check your local grocery stores to see if they offer online grocery shopping or home delivery.
Thickeners can make liquids and prepared foods easier to swallow. Diamond Crystal brand (http://www.diamondcrystal.com) makes a product called Thicken Right® Instant Food Thickener, which can be mixed with liquids and prepared foods to thicken them to whatever consistency you desire. Order their products from any of the following distributors:
D.C. Distributors, Inc.
P.O. Box 224
Amherst, NY 14226
(800) 827-6763
(716) 825-5834
Med-Diet Laboratories
3600 Holly Ln., Ste. 80
Plymouth, MN 55447
(800) MED-DIET
(800) 633-3438
(763) 550-2022 Fax
Bruce Medical
411 Waverly Oaks Rd., Ste. 154
Waltham, MA 02452
(800) 225-8446
(781) 894-9519 Fax
“Swallowing Safely, Swallowing Nutritiously: A Manual for the Swallowing Impaired” written by Maxine Dereiko, a Registered, Licensed Dietitian and Patricia Stout MS, CCC and “Recipes for Easy Chewing and Safe Swallowing” by Dereiko and Elaine Teutsch, R.N., MS offer help to people with moderate to severe swallowing problems. $15 plus $3.50 for shipping and handling. Allow 4-6 weeks for delivery.
Dereiko-Teutsch & Associates
P.O. Box 8366
Portland, OR 97207
(503) 241-8077
(503) 241-1490 Fax
There are many adaptive devices to make meal preparation, eating, and drinking easier. Contact the following companies for a catalog:
Sammons-Preston, Inc. (Enrichments)
A Subsidiary of Bissell Health Care Corp.)
P.O. Box 5071
Bollingbrook, IL 60440
(800) 323-5547
(800) 547-4333 Fax
Easy Street
8 Spring Brook Road
Foxboro, MA 02035
(800) 959-EASY
http:www.easystreetco.com
Maxi Aids, Inc.
42 Executive Blvd.
Farmingdale, NY 11735
(800) 522-6294
(631) 752-0521
(631) 752-0738 TTY
(631) 752-0689 Fax
Smith & Nephew Inc. Rehab
P.O. Box 1005
Germantown, WI 53022-8205
(800) 558-8633
(800) 545-7758 Fax
From Parkinson’s Disease: 300 Tips for Making Life Easier by Shelley Peterman Schwarz. Copyright © 2002 by Demos Medical Publishing. Excerpted by arrangement with Demos Medical Publishing. $18.95. Available in local bookstores or call 800-532-8663 or click here.
