Breakfast: Porridge. Lunch: Leftover deconstructed cottage pie Dinner: The rest of the leftover deconstructed cottage pie (BORED) Snacks: Hummus
Breakfast: Porridge. Lunch: Pureed sandwich and supplement drink Dinner: Pureed cheesy beans (after a few pints of Guinness) Snacks: Mashed potato
So I totally failed to try anything other than porridge for breakfast for the last couple of days. It’s difficult to think of anything more adventurous when you’re pushed for time (another lesson for the difficulties of following a modified diet with life getting in the way). Saturday morning will be a better time to try. Rachel and I were on placement on Thursday so I had leftovers from the previous meals for lunch. I met up with some friends in Camberwell afterwards, and realised I didn’t have any food on me to keep me going. After a few moments of panic and not being able to think of what I could eat, I went and got some hummus from a falafel restaurant. Perhaps not allowed due to the lemon juice, but it wasn’t too acidic. There really aren’t many options of puree food available to eat on the go!
I got home quite late and ended up having the final leftovers for dinner. I found myself thinking again about the need to have a lot of different options prepared in advance to keep meals varied, as I was certainly bored of my deconstructed cottage pie.
While Rachel and I were on placement on Thursday, our colleagues talked to us about soaking solutions to make foods into a puree texture whilst still maintaining their appearance. Although we haven’t seen this recommended to our clients yet, we thought it would be good to get an idea of the range of dysphagia products available. Rachel got the ingredients for a pate sandwich and during the break in our morning lecture on Friday we followed the instructions to make a pureed sandwich.
We had to make up the thickener solution, then soak the bread in it (crusts removed), add the sandwich filling and then put the sandwiches in the fridge. Normally, the process of making a meal is pleasurable and helps create an appetite. Making our sandwiches was not an inspiring experience. The bread became sloppy and it was difficult to get the filling in. The results were also not great. Despite leaving the sandwiches soaking for about 2 hours, the bread was still quite solid, so we had to mush the sandwiches up to achieve the right texture. Maybe this process might be good for a cake or a biscuit, but I would think twice before recommending it for sandwiches.
Rachel and I both had supplement drinks to boost our calorie intake for lunch, and confronted with our “sandwiches” I was definitely glad to have something to wash them down with. I had a chocolate flavour drink, and while it was tasty, it was also quite cloying and left a sticky residue in the mouth. Not ideal, especially considering many of our clients have issues with a dry or sticky mouth as a result of saliva changes because of radiotherapy treatment.
During a study session in the afternoon, people were passing around snacks to share, including mini eggs. Smelling the chocolate and knowing I wasn’t able to eat it was pretty hard. I really love sharing food- it’s a wonderful communal experience, so not being part of the shared enjoyment of eating was difficult.
In the evening, I went to the pub with some friends, and again had the same issue of not being able to share food- this time, crisps. The pub had a few options which seemed puree-able, including an irish stew with potatoes. I thought it would be a good opportunity to see how willing staff might be to make changes for a modified texture diet. I went up to the busy bar to try my luck. The bartender pulled a face when I said I had some specific dietary requirements, but seemed glad it wasn’t to do with allergies and was very willing to check with the chef to see whether they could puree the meal for me. Unfortunately, their stick blender had broken that morning (also meaning that their soup option was unavailable).I told them about the puree diet challenge and about my work as an SLT student with head and neck cancer clients. The staff were incredibly apologetic about not being able to modify the meal, and even offered up a few suggestions of some things I could try elsewhere. It was heartening to see that they were so willing to help, but I did reflect that it might be easier to ask for modifications in some settings rather than others. It had also taken some courage to ask in the first place, which some people could find difficult.
My friend later told me that she hadn’t ordered dinner so that I wouldn’t feel bad. I thought this was a wonderful show of solidarity (thank you Jess!), and also made us both reflect on the way in which the restrictions of a modified diet can affect not only the person following the diet, but also their friends and significant others.
I got home quite late, and made myself some pureed cheesy beans. Honestly, this was the best thing I’ve had so far this week. Very comforting and filling. I felt really bad about the noise of the blender so late at night though! I’m sure that there would be a period of adjustment and then normalisation if this diet were forever, but keeping all these additional considerations in mind just to be able to have some food is really tiring.
Swallowing exercises: I managed to squeeze in some exercise practice during one of our lectures, as one of the voice exercises to release jaw tension was the same as one of our swallowing exercises. It hasn’t become any easier to fit the exercises into the day and I’ve only been completing 2/3 of the sets. Perhaps this is because I know I don’t absolutely HAVE to do them. This made me think about our clients. Often, they report that they haven’t done their exercises as they see them as being pointless, and we spend time in sessions motivating them to complete them regularly. Part of this involves explaining the rationale behind the exercises and how they relate to clients’ recovery. Without internalising this knowledge, it is understandable that some clients might feel like they don’t HAVE to do the exercises either. This reiterated to me the importance of educating our clients to keep them engaged in therapy.