Archive | 5:26 PM

Which of the 3 Dysphagia Studies Should I Do?

15 Nov

Italian-cheese & bacon frittata:

This one would be easy to cook, since I’ve made it before and have the entire recipe with amounts in my own cookbook.  Also it keeps sort of well overnight so I could cook it ahead of time.  I would have to spend some time on the case history though.  Also, it’s not all that pretty to look at, not very ethnic, not healthy or nutritious, not hypoallergenic, and not entirely creative.  So I would be unlikely to win any of the categories.

Case study-

A 65 year old from Montana, that prefers Traditional American foods reminiscent of Denny’s.  She is used to eating large breakfasts such as bacon, eggs, toast, and hash browns as well as steak, pork chops, and green beans.

She had ________ which gave her ___________.  Now she needs to be on a _________ diet.

rationale-

The meal incorporates a lot of her breakfast favorites.

recipe-

pg 25 in MY cookbook:

Ingredients-

southwestern egg substitute

crumbled bacon

bacon grease

American cheese

Procedure-

Grease a muffin tin (only fill each half full of mixture–will rise) with butter/margarine (to add calories).  Use Southwest liquid eggs and substitute bacon grease for bacon (about 1 George Foreman catcher-full, or grease from 8 pieces).  Use 1 C whipping cream instead of milk to get the right calories and consistency.  +/- small sprinkle of cheese after baking.

nutritional content

Layered fajitas:

I think this one has potential.  Though it is probably the most difficult out of the three choices, since I have neither planned it, made it, or written about a case study using it.  So LOTS of work and practice would be involved.  BUT–it would be creative and visually appealing and one of the few main dishes offered.   Plus, when I made one of the components, it was super-tasty and even (picky-britches) Cool really liked it.

case study-

_______ is a 80 year old, cognitively aware, man with ALS.  Due to __________, there is risk of aspiration, and he needs to be on a puree/pudding-consistency diet.  He is having trouble getting enough calorie intake to realize an appropriate body mass index, and still likes very flavorful foods of all types.  He misses eating at bar and grill-type restaurants most.

rationale-

I put all ingredients in a food processor to make them pudding-consistency.  The peppers are flavorful, as well as nutritious due to high vitamin content.  Adding a lot of calories, by putting in cream cheese, whipping, cream, and butter liberally.

recipe-

1 pkg cream cheese

3 Tbsp Worcestershire sauce

green peppers

water to blend

nutritional content

Congee(Chinese chicken and rice porridge):

I have good rationale and the case history is one of the provided ones.  That’s good and bad, since the work is done, but I won’t get extra points or win for writing the best case study.  Though, Mindy provided me a complete recipe with amounts so all I would have to do is execute it.  But I’m not certain if it would meet the dysphagia guidelines or if I could cook it ahead of time.  As for the voting–it IS ethnic, since Mindy’s Asian parents make it, it could be creative if I do novel add-ins.  But it wouldn’t be all that pretty.  Maybe on the healthy, non-allergenic, or nutritious categories. . .

case study-

#5–Cantonese

The patient (Mr. Y) is a native of China whose first language is Cantonese. He and his wife came to the US in 1982. He is now 58 years old and lives in the Asian section of Chicago and speaks little English. He is the owner of an Asian food company. He entered the acute care hospital with symptoms of a brainstem stroke. He has mild dysarthria and severe dysphagia. As in many cultures, mealtime is a time of togetherness and socialization, and this was no different for Mr. Y and his family. His children come for dinner at least twice a week, and he and his wife are upset about his inability to eat the way he used to. Hi swallow study revealed a severe delay in triggering the pharyngeal swallow, followed by a severely weakened pharyngeal swallow with reduced laryngeal elevation. After a lot of therapy, it was found that his swallow improved with sour liquids and a variety of postural changes and exercises that targeted a better pharyngeal swallow. Mr. Y was then advised to begin drinking and eating liquids, thick liquids, purees, and mechanical soft foods.

Create a soft food or beverage that this client would like and would be appropriate.

rationale-

My Asian roomie, Mindy shared a traditional family recipe that she consumes when she is ill.  Her parents often made it when she was a child and she was sick with the flu or it was just a gray and rainy day and the family wanted comfort food.  Depending how much water you use, you can adjust the thickness of it.  The wonderful thing about this dish, is there are limitless modifications that can change it slightly to avoid boredom.  It can be made plain (with some salt) or with stuff in it (ground beef, shredded chicken, fish, meats, ma po tofu, etc… it can get really elaborate).

recipe-

yield: Serves 4

active time: 40 min

total time: 5 1/2 hr

Also known as jook, congee turns up in Chinese households morning, noon, and night. This thick rendition is made heartier with the addition of chicken.

Ingredients

  • 3 1/2 to 4-lb chicken, cut into serving pieces, including back and giblets (exclude liver)
  • 10 cups water
  • 3 tablespoons Chinese rice wine or medium-dry sherry
  • 3 (1/4-inch-thick) slices fresh ginger
  • 3 scallions, halved crosswise and smashed with flat side of a heavy knife
  • 1/2 teaspoon salt
  • 1 cup long-grain rice
  • Accompaniment: fine julliene of fresh ginger, thinly sliced scallions, and Asian sesame oil

Preparation

Bring chicken and water to a boil in a 5-quart heavy pot, skimming froth. Add wine, ginger, scallions, and salt and cook at a bare simmer, uncovered, 20 minutes, or until breast meat is just cooked through. Transfer 1 breast half with tongs to a bowl and continue to cook stock at a bare simmer, skimming froth as neccessary, 2 hours and 40 minutes. Meanwhile, cool chicken breast long enough to remove skin and bones, returning skin and bones to stock.

Cool breast meat completely and tear into shreds. Chill shreds, covered, and bring to room temperature before serving.

Pour stock through a large seive into a large bowl and discard solids. (you should have about 8 cups: if less, add water; if more, cook longer after adding rice.) Return stock to cleaned pot and add rice. Bring to a boil and stir. Reduce heat to low and simmer, covered until consistency of oatmeal, about 1 3/4 hours, stirring frequently during last 1/2 hour of cooking. (Congee will continue to thicken as it stands. thin with water if necessary.)

Season congee with salt. Serve topped with chicken and accompaniments.

Cooks’ note: • Stock can be made 1 day ahead. Cool. uncovered, before chilling, covered. Discard solidified fat.

nutritional content-

 

blend performance and competition

15 Nov

Often weather condition/s were [unconcop] not contractible negative optimal independent clause for coordinating conjuction be/ing outside in lycra and sequence. dependent clause = embedded sentence

Using my peripheral vision, I scanned right and left, to make sure I was lined up in perfect formation with my teammates. Despite the downward angle of my head, I could tell the lights were bright.  Staring at my own, freshly polished white leather performance shoes, I could only hear the chatter and rustling of the audience that had amassed in the large auditorium earlier in the day.  I tried to remain calm and collected, but I could hear my own tense breathing as I anticipated the first notes of “Twilight Zone,” which would cue the beginning of the dance.  Hoping the music would be loud enough, cued to the right spot, and playing at the correct speed, I worried more that the stage would be slick under my taps.  Experience and the knowledge that the sticky Pepsi they had poured over the stage was sure to do its job and provide traction helped assuage my  nerves.  At least we are not dancing outside in the middle of a gravelly street in wind and rain or blazing sunshine, like we had to do for performance routines, I told myself.  I adjusted my arm just slightly, feeling the sequence of my fuchsia and turquoise lycra costume brush my shoulder as I did.  The grinding synthesizer echoed throughout the room and without thought, I stood straight, smile pasted on my garishly made-up face, and threw my arms into a left arrow to begin the dance.

Sometimes nerves would cause team members to wander off track and you would have to steer them back in the right direction. Pretending you were having fun and there was no problem or deviation from the routine was ingrained in all of us, as we had practiced showmanship along with the steps until it was second nature.  Luckily, during this performance everyone was in their proper place and remembering their cues and steps.  We did not have to employ any flexibility or perform damage control.

As I did the buck joey I knew there were only a few steps left in the song, one more line formation, and then we would do our final toss.  Then, we would have exactly three minutes to line up on the wings of the stage for our entrance to “When Doves Cry.” This meant running off stage, hastily throwing off our pink satin shorts and peeling off our pink and turquoise leotards and slipping into our purple leotards with the sheer purple split-leg pants.  Remember the headband, I reminded myself as I  completed the last vine of the song, making sure my right toe was pointed and that I elevated my knee as high as possible on the forward crossover.