Care Recipient Health

My dad has Alzheimer's and I've recently noticed he has trouble swallowing when he eats. Is this common?

Dysphagia—the umbrella name for swallowing disorders—occurs in later-stage Alzheimer's when "the deterioration of tongue, throat, and voice-box muscles and sensation interferes with swallowing coordination," says Robert W. Bastian, MD, founder of the Bastian Voice Institute for Voice, Swallowing, and Airway Disorders in Chicago.

There are, according to Dr. Bastian, noticeable warning signs: "Frequent coughing during and after drinking or eating, or a ‘gargly' voice" are chief among them.

Dr. Bastian does offer some remedies. "Be sure he eats with attention and vigor. Also, choose food carefully. In many cases, thin liquids [should be] avoided; thicker liquids flow through the throat more slowly and give more time to respond and re-swallow. And," he adds, "consider patient positioning; many swallow better with their chin tucked down toward the chest, as though gazing at one's belt buckle." Also, coaching can help. Dr. Bastian suggests you encourage your dad to "optimize the eating experience: ‘Swallow again, Dad. Let's sip a little juice next.'" The right kind of attention is a potent ally.

My father is in a rehab facility where he gets daily physical therapy but still appears weak. How can I tell if he's making real progress?

"While you need to have some trust in your father's healthcare team," says Evan T. Cohen, PT, MA, NCS, assistant professor of physical therapy at Rutgers University, "the team may fail to clearly explain expectations in understandable terms." The best fix, Cohen suggests, is to "find common language" and establish short-term goals.

"Identify what the therapist thinks is progress and, objectively, what you think is progress," Cohen says. "You might say you don't see progress and think, Why is Dad not walking yet? But the therapist's scale may be very small. Together, identify specific goals and the time frame for those goals. Mini-goals are critical. If an understandable benchmark is established, it's easier to see if it's achieved."

Meet with therapy coordinators to judge your father's progress. As for how often, Cohen says it depends on how frequently the team meets. Either try to meet with the team or get a report after each meeting.

My mom, who's prone to colds and flu, is on several different prescriptions. How can I tell if an OTC cold/flu medicine will adversely interact with her prescriptions?

"When choosing an OTC medication, it is important to discuss your prescription medications with your pharmacist so he or she can check for potential interactions," says Karen A. DiStefano, RPh, a member of the Rhode Island Board of Pharmacy. "Filling all of your prescriptions at the same pharmacy will make it easy for your pharmacist to check if there are any medications to be avoided.

"Patients with high blood pressure, for instance, should avoid cold and flu products that contain the nasal decongestants pseudoephedrine or phenylephrine," warns DiStefano, who is also a CVS pharmacist, since both of these active ingredients can increase blood pressure. For those with high blood pressure, other treatment options are available, such as those marked HBP or BP, which use chlorpheniramine maleate as their active antihistamine ingredient. Such medications could, however, affect "other conditions that may need to be considered when choosing an OTC product," she says, including "thyroid disorders, asthma and diabetes."

My father has an incontinence problem, and as a result I have a problem getting odors out of his clothing and linen when I launder them. Is there a way to get such odors out of materials?

The good news: "Any detergent, when used in accordance with the directions for heavy soils, will eliminate these odors," says Russ Maziarka, Product Manager for Ecolab, Inc., a leading provider of cleaning, food safety and health-protection products, in St. Paul, MN. Doing so will require a few extra procedures.

"The first step would be to maintain a clean environment," Maziarka advises. "If the clothes are held in a hamper for an extended period of time prior to washing, the hamper must be cleaned with soap, hot water and a disinfectant each time the clothes are washed. To insure that you eliminate even the highest level of odors, you may want to rinse or pre-soak the clothes in hot water prior to putting them into the washing machine. When washing the clothes, follow the detergent use instructions for heavy soils, and wash the clothes in a normal manner."

Maziarka adds that too many items in the washer prevents a good rinse. Also, other solutions or wash formulas may be used, but in this case, he says, "No special chemical is needed."

Over the winter, Mom had a small melanoma removed. What can I do to keep her protected but still have her get time in the fresh air?

The recommended course of action is not so much avoidance as protection, according to Jim Baral, MD, associate clinical professor of dermatology, Mount Sinai School of Medicine in New York. "Your mother should lead a perfectly normal life, like anyone else, and I recommend not becoming a recluse and not walking with an umbrella.

"But she should take precautions," he adds. "Winter or summer, your mom should apply a high-reading sunscreen, at least 45 SPF, every two hours when out. And remember, she has to apply it to her ears, lips, and hands—any exposed part of her body. I stress this: Every two hours; that's the latest teaching. Also, I recommend she wear a wide-brim hat. And if you go to the beach, which you absolutely can, apply every two hours and sit in the shade. This applies to everybody. The time, if possible, to avoid being out is between 10 a.m. and 4 p.m."

Going further, Dr. Baral suggests your mother have follow-up dermatology exams "on a regular basis, every six months at least. And all her blood relatives should be examined once a year."