Wednesday, January 28, 2015

Why the thickened liquid challenge is important

Empathy via participation is a technique that probably deserves wider attention in health professions education. Drs Eric Widera and Alex Smith and the team at UCSF have come up with the ingenious Thickened Liquids Challenge. Thickened liquids can be a treatment that is overly used and poorly understood for any person who has swallowing difficulties. Most clinicians will be familiar with the terms ‘nectar-thickened’ and ‘honey-thickened’ from any experience in geriatrics or neurology. So taking the popularity of the ALS Ice Bucket Challenge and mashing it up with a likely non-harmful* experiential opportunity for the clinician to “take their own medicine,” we have the Thickened Liquids Challenge. The rules are thus:

  • 12 Hour Challenge: All fluids must be thickened to “honey consistency” using a beverage thickener for a 12 hour contiguous period. Food does not have to be thickened.
  • Mini-challenge: drink an 8 ounce drink thickened to honey consistency (coffee, wine, juice, water, or any drink of your choice)
  • Videotape yourself and include an announcement that you accept the challenge
  • If you fail the challenge you must donate $20 to a geriatrics or palliative care charity of your choice (see notes below for some suggestions)
  • At the end of your challenge, nominate a minimum of three other people/teams to participate in the challenge
  • When posting the challenge online, please use the hashtag #thickenedliquidchallenge

So I was challenged last week by Eric. I took that challenge and here is my video of the 12 hour experience condensed down to 4 minutes.


As you can see I could not last that 12 hours. But it wasn't the gross factor that got to me, it was plain thirst. Thirst for cold thin runny liquids that the thickened stuff just wasn't satisfying. Actually the nectar-thickened pre-mixed apple juice was not bad at all. I just thought of it like an apple smoothie, and really didn't have any problems.

I did learn a few things along the way:
  • Your local speech therapist/speech pathologist may have some samples to share with you
  • You have to stir a lot of thickener to get to the right consistency
  • They do not sell thickener at WalMart - but it is on Amazon
  • Clean up any thickened liquid you spill. It hardened like cement on my counter tops the next morning
  • That liquid cement you just drank, well...let’s say a few days later, I had some work to do (thus the asterisk above about non-harmful)
  • Making a video about this was actually fun and allowed me to feel creative (self-care for the week - CHECK!)
  • Orange juice and BBQ do not go together well - thickened or not
  • Pre-thickened and nectar consistency were very tolerable
  • Mixing the thickener before I could drink was frustrating and made me feel more thirsty
  • Your mindset towards thickened liquids is important to tolerating them
  • Speech therapists do not universally love thickened liquids, in fact they may be concerned doctors rely too much on them. 
  • It is better to work with rather than against speech therapy 
I nominated a few people but I do encourage anyone who reads this to nominate themselves and give it a try. And then to post a video! We will happily host videos as will GeriPal if you don’t have a YouTube channel.

The posting is the important part! Participation and public sharing make this different than all of the people I told about this, who said, “Oh yeah, I did that when I was a (nurse/medical/speech) student.” Yet without sharing that experience more widely we miss out as healthcare professionals to do some education to our peers and the public. So I hope many of you will take this up and give the Thickened Liquid Challenge a try!

Christian Sinclair, MD, FAAHPM is a palliative care doctor at the University of Kansas Medical Center and editor of Pallimed. When not advocating for health care professionals to use social media you can find him playing board games.

Image Credit: "Thickened Liquid" Christian Sinclair for Pallimed, licensed via CC BY NC-SA 4.0

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