Monday, February 2, 2015

My 12-Hour #ThickenedLiquidChallenge (aka: My Texture Theory Tested)

by Holly Yang, MD

I was issued the Thickened Liquid Challenge by Dr. Christian Sinclair. I had resigned myself to the knowledge that I would not escape it the minute I saw it on GeriPal. I somehow had avoided the ice bucket version, so I figured it was my turn. On the upside, it gave me a chance to test a hypothesis that I've been considering for a while.

So, I have been espousing this theory that people are texture people or taste people. Some people can't eat the tops of asparagus because the texture weirds them out. Those people probably can't eat raw oysters, and definitely won't like most things I drank in the thickened liquid challenge. So, I decided to film a mini-documentary of my not-at-all-scientific test of this theory, one minute for each hour.

So, if you watched it, you were able to see the results of my experiment, and you know the final outcome. Here's a quick summary slide.

I also wanted to pass on a few things I learned along the way.

1) There are naturally thicker beverages I enjoy that I drink now. God forbid I have trouble with dysphagia in the future, I will likely stick to those things. Why not recommend some of these things to our patients?

2) Some things that I thought would be awful, were actually okay, not great, but okay. (Well, for me anyway.)

3) Some things that I thought would be okay, were really, really not.

4) Don't give your spouse the "not now" look when he tries to make filming recommendations, or he may keep his mouth shut about taking it easy with the thickener too.

5) Patience is a virtue, and may help you avoid unpleasant things. Give the thickener time or everything becomes pudding thick either in the glass or in your stomach. (See #4)

6) Thickened liquids can make you feel really full. (See #5)

7) Thickened liquids may be able to hydrate you, as perplexing as that seems while you are "drinking" them, but they make your mouth really dry. Good oral care is going to be necessary for your patients.

8) If you drink a frozen frappucino too quickly in order to keep it "honey thick" consistency, it will most definitely give you an ice-cream headache to replace your caffeine-withdrawal headache.

9) Bananas = #thickenedliquidhack

10) Carbonated beverages get crazy bubbly with thickener added. Not Mentos bubbly, but more like root beer float bubbly.

11) We should think twice before asking patients to do things we aren't willing to do ourselves. Certainly not things that we make "yuck faces" at and giggle about. Not cool, Robert Frost!

12) Add ice cubes AFTER thickener when drinking scotch.

Unanswered questions:

1) How do you brush your teeth on a thickened liquid restriction?

2) Does Fitbit have a calorie count for thickener?

3) Exactly when does a liquid become a solid?

Thanks for watching, and thanks for reading.

If you haven't been nominated for the challenge, nominate yourself, and then a few of your best friends, frienemies, or that person at work that bugs you. Or... hope and pray that no one calls you out.

Seriously though, I think we should know what we are asking our patients and families to do, put ourselves at their place at the table instead of labeling them "noncompliant," work on shared decision making with real information (see GeriPal post), and help them incorporate what ever the decision is in the tastiest way possible with our nutrition and speech and language pathology colleagues as partners (See posts here and here).


Holly Yang is a Hospice and Palliative Medicine doc practicing at Scripps Health in San Diego, with a particular love for medical education, especially the communication, international, and moving the field forward bits. She is also fascinated by the intersections of #hpm, humanities, and spirituality. Holly surfs whenever she can, and has a bit of an obsession with Kansas City barbecue.

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