Day 4...

Breakfast:
Readybrek and Nutella,

I had the same as yesterday for my breakfast, as it is fast to make, tastes good and keeps me full until lunch.


Lunch:
Left over Leek and Potato soup with Cheese

                                 

Again, when reheating this, it was necessary to add some milk and stir regularly.  I seasoned it with salt and pepper, and added some very finely grated cheese (which melted into the soup in the microwave).

*NOTE: it is ok to add cheese, but it must be melted and mixed in so grate it finely and stir.



Dinner:  
Vegetable Lasagne   (thick pureed consistency)

Pureed consistency lasagne

Regular consistency lasagne

We had a dinner party this evening and needed  to make both pureed and regular consistency meals. We therefore chose vegetable lasagne, as we could use the same ingredients for both, and then puree ours before putting it in the oven.  We did this whilst cooking the regular lasagne, as the pureed one needs half the amount of time in the oven.
This tasted really good and was full of flavour! We layered the pureed ingredients like you would for a normal lasagne which made it more interesting to eat.
We used blended pasta for the layers, but although we had seen examples of it done online, we really struggled to puree the pasta to a smooth consistency. It took a very long time, and needed mixing with alot of milk and butter, and even then, was still lumpy (which isn't appropriate for a puree diet). Polenta would be a better alternative, and is what we wanted to use, but it wasn't available in our local supermarket.


I really enjoyed eating as a group, as I have found that I've been eating on my own alot this week (as I would normally cook with my housemate), and when you are eating with other people, you tend to take less notice of the food.
It was good to know that it is possible to cater for a modified diet along side a regular one, without too much hassle.

Day 3...

Half way through our 5 days on a modified diet.

Breakfast:
Readybrek with Nutella.

As I said yesterday, I really enjoy having readybrek for breakfast, it is hot and it fills me up. I mixed it with nutella (chocolate and hazelnut spread) today, after a recommendation from a friend, and loved it! But then again, that isnt a surprise, as I am a self professed chocaholic. For some people this may be too sweet.

Lunch:
Butternut Squash Soup

This was lovely, as it is something that I often eat for lunch during autumn/winter. I actually bought this soup in a carton from my local super market, to save time during my busy lecture schedule. This might be a good way to take lunch with you to work, as many offices have a microwave you can use.

The main thing to note if you're going to do this, is that you must either buy smooth soup, or blend it until it is smooth. You must also be aware of the consistency, and add commercial thickener or cornflour where necessary (as I had to).

*NOTE: soup must be at least as thick as the fluids you have been recommended to drink

Dinner:
Vegetable Tikka Curry & Rice   (thick puree consistency)

This was a very satisfying meal. Because the curry had such a strong flavour, I took much less notice of the consistency.   Make sure not to add too much water when you're making the curry, so that it doesn't become too thin when you blend it (otherwise it will be necessary to add thickener or cornflour)  I used a curry paste instead of a jar of sauce.
The rice blended easily with a splash of milk but was very hot so be careful not to burn yourself
I served the curry on top of the rice so that i could eat them mixed (as the rice was quite bland).
I would also recommend serving with a table spoon of smooth mango chutney (you could blend some or buy the squirty tube).

*NOTE:  Using a garnish to improve presentation is fine. But do NOT eat it!


Desert/Snack: 
Banana, Chocolate and Peanut butter Chill

I blended two and a half  semi-frozen, sliced bananas with 3 desert spoons of peanut butter and 50g of dark chocolate. I added a small amount of thickener (but this might not be necessary) and placed it in the fridge to chill for a few hours,

This is a high protein snack that contains one portion of your daily fruit and veg.  It is also really tasty.

Some facts and figures about Dysphagia....

Dysphagia (the medical term for difficulties swallowing), affects a wide range of people, approximately:

• 90% of people with motor neurone disease (MND)
• 68% of people with dementia 
• 50% of people with head and neck cancer
• 40% of stroke survivors  (but this is as high as 78% initially)
• 30% of people with Multiple Sclerosis (MS) 

It is also possible to have dysphagia short term, caused by an infection (e.g. a UTI) or by the side effects of some drugs.

[figures taken from Health Care Services]

Dysphagia can be caused by difficulties at any of the 4 stages of a normal swallow, which are:

1. Oral Preparatory stage

2. Oral stage

3. Pharyngeal stage

4. Oesophageal stage

On average you swallow 580 times a day in order to eat, drink and manage saliva, and each swallow involves 25 different muscles, and 5 nerves. 

The swallowing process actually starts before the food or drink enters your mouth, because the sight and smell of food helps to trigger saliva, which aids the oral stage of the swallow, and ends with food and fluids arriving in the stomach.  
If dysphagia is not managed correctly, it can lead to choking, aspiration, pneumonia, malnutrition, dehydration and possibly even death. 

Video and general tips....

I have uploaded a video onto youtube of how to make a thick consistency leek and potato soup.  You can find it here....
https://www.youtube.com/watch?v=rbzsJowqMwM&feature=youtu.be

If you have any comments or questions don't hesitate to comment either here on my blog or on the video, and I will do my best to answer.


Main findings and tips from my week so far:

• Between cooking your food, and having prepared each ingredient, it is likely to have lost alot of temperature.  I would therefore recommend that you either keep the plate in the (switched off but warm) oven, or microwave the food for 2-3 minutes before eating it.  
• Although some of the food might not look particularly appetizing,  it can still taste great.
• Stronger tasting food seems to be better, as food tends to lose some taste as it is blended.  
• Adding cheese improves fast and texture (especially good if you're on a fortified diet.)
• Both sweet and normal potatoes blend well and taste great.  They also pipe easily so can be made to look good 
•   Fruity or chocolatey drinks are the best when thickened. 
• Definitely allow more time for the preparating and serving of food and drink.   These meals have taken me double the normal amount of time to make.

Day 2...

So day 2 of our modified diet is nearly over.

What have I drunk today? 
I've tried a number of different thickened drinks today.
I found that summer fruits squash was the most hydrating, and the best for drinking throughout the day, as it thickens easily and tastes good.
I also tried thickened water, which tasted very starchy and therefore I wouldn't recommend it.
I enjoyed a chocolate milkshake (made with nesquick powder and milk) thickened to stage 2/custard consistency. This drink actually suited being thickened, and I would really recommend it.
I also had a mocha (half coffee, half hot chocolate)  from the drinks machine at uni, half way through my morning lectures.  This was also well suited to being thick but is not a sweet as hot chocolate, which is nice for during the day.  However, I used a different thickener to what I'm used to, and made the mistake of putting it in after the liquid which meant there were lumps at the bottom of my drink.... So, my advice for today would be READ THE INSTRUCTIONS, as every thickener is different!  


Breakfast:
Instant oat cereal (readybrek) and honey

I often have porridge for breakfast so found that this was a comforting meal, because it was very similar to what I am used to.  I found that it really filled me up and was very satisfying. It doesn't take long to make (2minutes) but does require a microwave.

Lunch:
We decided to try a FORK MASHABLE lunch today rather than puree, as we wanted to see how easy it would be to go out and eat on a modified diet, and to demonstrate what this kind of meal might should look like.  So, in our lunch break, we took a trip to a local jacket potato shop.

I had a jacket potato with cheese, tuna and beans.  It was easy to mash with a fork, (although you must remember to remove the skin) and very tasty.



Dinner:
Smoked cod, potato and carrots  to a pureed consistency.

The fish was very difficult to blend, and although I added milk and butter (as recommended on recipe websites for puree meals)  I didn't manage to get it to a smooth consistency.  Although I am usually a great lover of fish, it was not something I enjoyed in a puree form.
I boiled the potatoes until they were soft, and then added butter and a small amount of milk to blend. This made them lovely and creamy.



Snacks:
Chocolate angel delight

I am a complete chocaholic and couldn't possibly have gone a week without any, so I got my chocolate fix today from an angel delight, which is also high in calcium as it is made with milk. Just be sure to allow it to set in the fridge before eating it. Or to add thickener if you wish to eat it sooner.

Day 1....

Today is day 1 of our 5 days on a modified diet, typical of one recommended to a person with dysphagia.  So here is how it went...


Breakfast:
Plain yoghurt, layered with a homemade berry coulis and sweetened with honey.

 This was a simple breakfast which was very enjoyable.  The coulis was made by blending a variety of red berries, which I would then recommend passing through a sieve to remove the seeds. It is more practical to make a whole pot of coulis that you can just use throughout the week, as this will save time.



Lunch:  
Homemade leek and potato soup.

I made this yesterday afternoon and put it in the fridge to reheat as my lunch. I thickened the soup to a puree consistency using cornflour, and blended it until it was completely smooth.
NOTE:*Soup must always be at least the thickness of the fluids you have been recommended*
NOTE: *When reheating the soup, check the consistency. You may have to add milk (or cream if on fortified diet) as it can get even thicker when left overnight in the fridge*



Dinner:
Cheesy quorn fillets, sweet potato and pees.  To a thick puree consistency.

I roasted the quorn fillets for 15 minutes before blending with a small amount of milk and cheese (this could be fortified by adding cream instead of milk).  I roasted the sweet potato until very soft, then peeled the skin off, and mashed the flesh with a fork until smooth.  I boiled the peas and blended them.

I found that the quorn lost its temperature very quickly whilst I was preparing the other food, so I put it in the microwave to make sure it was hot before eating it.





What did I find most challenging?
First thing this morning, I woke up with a very dry mouth and really wanted a glass of pure, un-thickened water. However, I obviously couldn't have that, and plain water isn't very pleasant thickened, as it tastes starchy. So instead I had a glass of half water, half mango juice, which I thickened to stage two, or 'custard' consistency.  Although this didn't quench my thirst in the same way that water would, it was a satisfying drink, which tasted good and which was palatable at a thick consistency.

Where can you watch the videos and read more about our modified diet experience?

Tomorrow we begin our five days on a modified diet.  I will be uploading links to any videos on here, and talking about my experiences... so stay tuned. 

 My coursemates will also be doing the same on their blogs, so here are the links: 

http://ohallamdysphagiaawareness.wordpress.com/

http://dysphagiaawarenessrholden.wordpress.com/

If you want to donate... here is the link to our donations page.

https://www.justgiving.com/j-white1/

Our Dysphagia Awareness Campaign

Dysphagia is the medical term for difficulties with swallowing and usually results from a neural or physical impairment of the swallowing mechanisms (the mouth or throat). Dysphagia affects a range of people, including those with dementia, learning disabilities, brain injury, people with cancer of the mouth and throat and people who have had a stroke.


The incidence of patients with initial dysphagia following an acute stroke are between 40% and 78% (Martino 2005 as cited by the RCSLT 2009) and 68% of those with dementia in homes for the aged have dysphagia (Steele 1997 as cited by the RCSLT 2009). 
However, there is a major lack of awareness about and understanding of dysphagia. 

This is something I am keen to change.  Therefore, along side two of my peers (Rosa Holden and Olivia Hallam) I am running a campaign to help raise awareness...

During week commencing 26th of October, the three of us will be embarking upon a 5 day modified diet where we will be eating only soft food of different consistencies (focusing on purée), and drinking only thickened fluids. This is because a modified diet is one of the strategies that as future SLTs we might recommend to certain clients, as a method of managing their swallowing difficulties. We hope that by putting ourselves in the shoes of our clients (even for this short period of time) we will become more empathetic clinicians with a better understanding of the life altering changes we are asking people to make.
We are being sponsored to do this, and in compliance with the "Giving Voice to people with Dementia Campaign", all of the money we raise will be going to DementiaUK.  Here is the link if you feel you would like to donate https://www.justgiving.com/j-white1/

As part of the campaign, we will be uploading videos and blogs of our experiences; these will include us preparing and talking about meals of different consistencies.  It is our hope that clients and carers will be able to use these videos for instruction on how to make the food and drink and be able to learn some tips on making the food more palatable.

We will also be running a workshop as part of a conference within the university for other healthcare students, during which we will explain the basics of swallowing, and what can go wrong. They will have the chance to prepare and try some thickened drinks, and there will be opportunities to experiment with some of the different postural compensations for swallowing.


For more information about DementiaUK (Registered Charity no: 1039404)  please visit: http://www.dementiauk.org/

Introductions....

I am a Speech and Language Therapy student in my 3rd year of study at De Montfort University.   I am very passionate about my chosen profession, and am keen to raise awareness about our role, and the people we support. 
I believe that if society as a whole is more aware of communication and swallowing disorders, the difficulties that our clients can face on a daily basis would be greatly reduced, and there is likely to be better support available.

What is speech and language therapy (SLT)?
Speech and language therapists are allied health professionals who work with both children and adults to diagnose and manage disorders of speech, language, communication and swallowing.
Please visit the Royal College of Speech and Language Therapy, for more information:
  http://www.rcslt.org/speech_and_language_therapy/what_is_an_slt