Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

November 2015 Independent Eating and Drinking Newsletter

	November Topics: Veterans and ALS Lemonade Can Help with Drinking and Swallowing
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 Veterans and ALS

This month we celebrated Veterans Day. A time when we remember veterans who have served the United States in both war and peace time ever since the end of World War I. On the eleventh hour, of the eleventh day, of the eleventh month of 1918, a temporary cease fire took place between Germany and the Allied countries that were fighting “the war to end all wars”, or World War I. The official end of the war came when the Treaty of Versailles was signed on June 28, 1919; however, the cease fire was celebrated as the end of the war. President Wilson declared November 11 as a commemoration of the end of the Great War and a time to recognize the heroism of the soldiers who fought and died in the war. November 11 has been expanded to honor all veterans over the years since 1918.

Unfortunately, not only do our veterans serve our country placing them at risk, they face another risk later in their lives that is just as deadly as war can be: Amyotrophic Lateral Sclerosis (ALS). Studies have shown that veterans have a far greater risk of developing ALS than their non-military counterparts, regardless of the branch of the military in which they served, or whether they served during war time or peace time. The cause is as yet unknown, but veterans as a whole are twice as likely to develop ALS as those who have never served in the military.

Several studies have confirmed that the incidence of ALS is higher in veterans than any other group. Because of this finding the Department of Veterans Affairs (VA) in 2008 implemented a regulation establishing that ALS is service connected. The regulation recognizes that if ALS occurs in a veteran, the veteran and their family should receive benefits for a service connected illness and disability. In 2011, the VA amended the regulation to stipulate that any veteran diagnosed as having ALS will immediately receive a 100% disability rating.

The VA has established a national registry of cases of ALS in military veterans. Additionally, in 2008, Congress established the National ALS Registry at the Centers for Disease and Prevention (CDC). The registry provides data to researchers about the occurrence of ALS.

Veterans who are diagnosed with ALS can receive treatment from many of the VA Hospitals throughout the US. Several of these hospitals have ALS clinics that provide multi-disciplinary services to veterans with ALS. Additional information about ALS and the services that are available can be found through the ALS Associations website. Their website is an excellent source of information and provides resource information including clinics, chapters and support groups under the “Find Local Services” tab on their home page.

In many instances eating and drinking can become difficult for people with ALS. In the Mealtime Partners April 2014 Newsletter, an article was published discussing some of the issues related to eating and drinking that may occur.

Briefly, when self-feeding and drinking are no longer possible, the individual has two choices: to be fed by a caregiver, or to use assistive technology to continue to eat independently. Equipment like the Mealtime Partner Dining System can be very helpful over an extended time. It is advisable to acquire the equipment as soon as it is identified that hand function will decline. If the equipment is available early in the disease progression, the user has the opportunity to become familiar with it before it is essential; and, the equipment can also be used on days when the person is excessively tired, or for eating food that is difficult to pick up and eat with a hand-held utensil, like soup or pudding. Because the equipment can be configured in a wide range of modes, it can be adjusted to accommodate the changing needs of the user. It can be set to operate more slowly. It can use two adaptive switches for control, and then, when needed, be changed to work with a single switch, or fully automatically, with no switches. Additionally, the Mealtime Partner is able to serve a wide range of food textures varying from normal food that is simply cut into bite sized pieces to minced and pureed food. (Click here to read the entire Newsletter article.)

Regardless of the difficulties that are experienced because of ALS, good hydration and nutrition are essential to maintain the best quality of life possible.

 

Shop Early for Holiday Presents!
A hands-free drinking system can enable someone to drink independently throughout the day and is a gift that they will appreciate all year. Mealtime Partners, Inc. has several different types of hands-free drinking systems to choose from: the Hydration Backpack with Tube Positioning; the Front Mounted Drinking System; and the Drink Aide. They can all be easily attached to a wheelchair and can be positioned to meet the individual user’s need.
Hydration Backpack with Drink Tube Positioning	The Drink Aide
The Front Mounted Drinking System
Those who are at risk of choking should consider drinking from a Provale Cup: it provides a sip of thin liquid every time it is tipped up to take a drink. It prevents the user from receiving a large "gulp" of liquid. And, for those who are required to drink thickened liquids, the Thickened Liquid Cup is an excellent choice. This cup can serve varying thicknesses of liquids and can control the volume of liquid that is served by an adjustable drinking spout that can serve a small stream of liquid or just a trickle.
The Provale Cup	Thickened Liquids Cup
To view all of the Mealtime Partners drinking products, click here. For additional guidance about how to select the appropriate drinking system for your specific needs, click here.

 

Lemonade Can Help with Drinking and Swallowing

Everyone is familiar with a version of the phrase: “When life gives you lemons make lemonade”. The phrase was first written by Elbert Hubbard in a 1915 obituary he composed for actor Marshall P. Wilder. The phrase became common place when Dale Carnegie used it in one of his books; however, eight years before Carnegie used the phrase in his book, a poem called The Optimist appeared in a 1940 edition of The Rotarian that used the sentiments of the phrase.

"Life handed him a lemon,
As Life sometimes will do.
His friends looked on in pity,
Assuming he was through.
They came upon him later,
Reclining in the shade
In calm contentment, drinking
A glass of lemonade." ⁽¹⁾

Lemonade has benefits other than just a pleasurable drink. This article will discuss how lemonade can help with drinking and swallowing for individuals who have eating and swallowing difficulties.

If a plain lemon is tasted, it is very sour. This impacts how our mouth reacts to the taste. The mouth tends to pucker up, we frown and the corners of our mouths turn downward. It should be noted that all of the muscle contractions caused by tasting something sour are spontaneous. We scrunch up our face without thinking about it or consciously activating any muscles. For some people, the sourness is too harsh a flavor and not pleasing to the palette. Or if the taste is pleasing, the pleasure only lasts for one or two tastes and then it becomes overwhelming for the palette. After that the sourness might appear to be bitter. As a whole, children seem to like sour flavors more than adults do. Because the taste of lemon elicits such a dramatic reaction from our mouths, the flavor can be helpful when someone experiences eating and swallowing difficulties. However, the sourness is often unappealing. To utilize the value of this flavor while avoiding any negative reactions, using lemonade, rather than pure lemon juice, is helpful.

Lemonade is a mixture of lemon juice, sugar and water. Sugar is dissolved in water and the sugar solution is added to lemon juice. The drink provides a pleasant tartness with each sip without causing the mouth to pucker to the extreme that lemon juice causes. The strength and sweetness of the lemonade can be adjusted according to the preference of the consumer. Lemonade is common in most cultures, and some people make it using honey instead of sugar. (Lemonade made with honey should never be given to infants younger than a year old because honey can have spores of a bacterium called Clostridium botulinum, which can germinate in a baby's immature digestive system and cause infant botulism that can potentially be fatal. The spores are normally harmless to adults and children over a year old, because the microorganisms normally found in the intestine keep the bacteria from growing.)

Lemonade is a useful drink as the flavor allows those consuming it to be aware of where the liquid is in their mouth and thus allow them better control over the movement of the liquid in their mouth, in preparation for swallowing. To understand how this feels, take a sip of water, hold it in your mouth for about 10 seconds, and then swallow it. While it was in your mouth were you fully aware of where the liquid was in your mouth for the whole time? Now repeat the exercise with lemonade. Were you more or less aware of where the lemonade was in your mouth than the water? Most people’s taste buds are more aware of the lemonade than water and thus the taste buds alert the brain as to where the liquid is in the mouth. This makes controlling the movement of the liquid in the mouth easier because the flavor helps our awareness of its location in the mouth. For those who have a reduced level of sensitivity in the mouth, this can be very helpful.

Lemonade has another value for people who are at risk of aspiration and are required to consume thickened liquids. Many people who drink thickened liquids complain about the flavor that the thickening agent imparts to the liquid. Manufacturers of products that thicken liquids claim that the thickening agents do not have a flavor; however, most consumers disagree with this claim and find the taste of the thickening agent unpleasant. When lemonade is thickened, the flavor is strong enough to mask the flavor of the thickener. Thus, people are willing to drink enough fluids to maintain a good level of hydration when they drink thickened lemonade.

One caution that should be observed relating to lemonade is that if someone frequently experiences acid reflux, lemonade made from real lemons should be avoided. Lemonade mixes do not have the level of acidity that is found in real lemonade. Nevertheless, lemonade mixes provide a strong enough flavor to alert the taste buds and also to mask the flavor of thickening agents.

References: 1. Flynn, Clarence Edwin (November 1940) The Rotarian, 57 (5), p62.

Did You Know? Did you know that getting medicine to the brain is a very difficult challenge? To protect the central nerves system from pathogens, the body has established a barrier that separates the brain and blood vessels serving the brain. The barrier is so good at protecting the brain from assault from external materials, that it prohibits medicine from accessing the brain. This is a major problem when the brain has cancer. Drugs to treat the cancer cannot be delivered into the brain. The barrier stops them from penetrating into the brain and the cancer cannot receive the chemo therapy necessary to treat it. Research is being conducted at several different centers throughout the world to overcome this barrier. The first human trial has been conducted using a method of delivering drugs through the blood brain barrier using micro-bubbles and ultrasound. Chemotherapy drugs are intravenously administered to the patient, followed by a small amount of micro-bubbles. When the bubbles reached the barrier they were hit with an ultrasound beam. When hit with ultrasound, the bubbles break a small pathway through the barrier and allow medicine to infiltrate the brain. Even though this research is in its very early stages, it holds promise as a way of delivering desperately needed medicine to its target in the brain.