I'm sorry, Applesauce.

The other day, a friend was checking out my Facebook profile, and asked me, Nania.  Why do you have "I'm sorry, Applesauce" written under your profile picture?  Astute question.  In answering this, I have to tell you a little bit about medical Speech-Language Pathology.  Bear with me.  It's time for some learning, folks. 


In the hospital setting, Speech Pathologists spend a large portion of their time diagnosing and treating dysphagia.  Dysphagia is any type of swallowing disorder that can occur in your mouth (oral), throat (pharyngeal), or in the tube that leads to your stomach (esophageal.)  The causes for these problems are endless.  Strokes, brain tumors, progressive neurological diseases, craniofacial disorders and surgeries, old age, even certain medications can cause dysphagia, and can result in a patient's inability to eat safely.


It's actually really sad and life-alterating, because dysphagia can very commonly lead to aspiration pneumonia -- that's when your throat fails to protect your airway from food and water -- so every time you eat and drink, a little bit of food or liquid gets down into your airway... and collects in your lungs.  (You have ALL aspirated before.  Recall anytime that you weren't paying close enough attention while eating/drinking, and something went down the wrong way.... resulting in uncontrolled, tearful coughing that is oftentimes painful.)   Now imagine if that happened with every bite/sip you took.  Next thing you know, you're coughing, running a terrible fever, and you find yourself in the doctor's office feeling weak and unable to eat.  See videofluoroscopic image below.  This is a motion x-ray study that Speech Pathologists use to diagnose dysphagia.  (The arrows show aspirated material.)

(Sometimes these patients end up NPO -- which stands for Non per oral -- where they cannot be given any food, liquid or medication through their mouth -- and they have to eat through a feeding tube which can be placed through your nose if the problem is temporary... or can be surgically inserted somewhere along your digestive tract, if the problem is expected to persist.)  


Okay, enough with the science of it.  Here's the applesauce part:


In order to diagnose dysphagia, Speech Pathologists first do a bedside feeding exam, where we give the patients various consistencies of food and water to see what elicits a gagging or choking reflex.  This is a prime indicator of dysphagia.  


Since the hospital is able to modify foods based on a patient's needs -- we give these various testing consistencies to see if there is ANYTHING that doesn't seem to be going down the wrong tube.  Thin liquids, like water, are commonly aspirated (which makes sense because swallowing is all about good timing.  And if things are not timed-well, the fastest-moving consistencies are the most likely to slip into the airway.)  The solution to this problem?  Thickened liquids and pureed foods.  See below:

Yes, friends.  Imagine getting a plate of food that looks like this.  One of the saddest interactions I had to have with patients was:


Patient: "Excuse me, Nania.  What is the beige pile?"
Nania: "Um.  Let me look at the receipt that came with your tray."
P: "Ok.  It smells like fish."
N: "Yes, I agree.  But it's actually chicken."
P: "Oh."
N: "The green is broccoli."
P: "Yeah.  I can tell by the tiny flecks."
N: "Yeah.  Um.  I've heard the mashed potatoes are good."
P: "Okay.  I'll eat those."  *Patient half-heartedly smiles.*
N: "That sounds good.  Do you need anything else?" *Smile back, trying not to show pity on my face.*
P: "No.  But thank you very much. I'm good for now."  


*sigh*


Anyway.  Back to the applesauce.  Geez.  Applesauce is one of the standard testing materials to see if a patient can tolerate a pureed diet.  And unfortunately -- some people can't even eat that.  So what happens as a result?  Coughing, choking, red-blue-faced-ness... and applesauce being expectorated, oftentimes projectile-style, from both the mouth AND the nose.  I have seen it so many times, that now -- I'm sorry, Applesauce, but I can't eat you anymore.  How dearly you were once loved by me.  


I'll try to end this quasi-despressing post on a helpful note, at least.  If you know someone who needs modified food, the best resource in the biz is the "I Can't Chew" Cookbook:

It really helps make modified foods more enjoyable -- and I wish more people who needed it knew about it.  So there you go.  Spread the word.  Available at Amazon, used, for as little as 5 bucks.  


And be sure to take care of your mouths and throats people.  If I EVER EVER EVER see you smoking, I will take the back side of your t-shirt and stick it in an industrial paper shredder.  And no, I won't unplug it until you promise to stop smoking... or until the shredder consumes your whole shirt.  Now, that is one thing that will never need pureed foods to survive. 


-NL