Hull and East Riding Speech and Language Therapy

Louise M: Yesterday, I had a Level 5 Minced and Moist diet, meaning all of my food required minimal chewing and the pieces had to be 4mm in size. I spent a lot of time thinking of ways to adapt food I already have. My breakfast didn't change much, I had my normal yoghurt and I didn't add as much milk as normal to my Weetabix, to ensure the milk was completely soaked up by the Weetabix. I normally have a sandwich, crisps and an apple for my lunch so this was definitely a no-no. I had had chilli the day before so thought this would be nice with the inside of a jacket potato. I cooked the jacket potato the previous night, however, it just wasn't soft enough so I couldn't eat that. I also had to pick all the onions, tomatoes, kidney beans and peppers out of the chilli as these weren't small enough. I also had a muffin that I mixed with yoghurt and this was a lot nicer than I thought it would be. It didn't look appetising but the taste didn't change at a...

Sarah: level 4 thick purée So for my evening meal, I made a spag bol. My hubby’s looked yummy and following advice about pureeing pasta becoming sticky I added a cheese sauce to the pasta before blending, however the starchyness of the pasta made this very sticky and I didn’t blend it for long enough to achieve a fully smooth consistency - mainly because of the noise of the blender and for fear of waking my children!!! I was really craving some garlic bread to go with it, and although it didn’t taste too bad - the creamy ness made me reluctant to finish a full portion and the taste was lacking - likely as lack of chewing required meaning taste not developed. Overall things I’ve found out are: blending needs to be carried out for a LONG time. Limited snacks available. Difficulty with savoury foods for snacks. Lots of prep required and I can imagine wearing blenders out regularly. Taste perception changed also due to textures. I really think if I was on this long term I might cons...

Puree Nightmare - Louise S Being a big foodie, I found it incredibly difficult to stick to a puree diet for the full day. I found the choice of food very limiting and requiring a lot of thought and preparation to stick to this. It seems that you can't just have a little snack without a lot of thought.  For breakfast, I only had a smoothie as I had a bit of a panic about what I could actually eat. The variety of choices only occurred to me on my way to work, so feel I missed out of a lot of calories first thing. If I had been better prepared I would have definitely blended porridge or had yogurt or something more filling. By the time I got to work I was starving!  I went to Asda to pick up a snack in the morning because I was feeling tired and needed a little pick me up. It was when I went into the shop I hadn't appreciated the lack of information on packaging for people on a puree diet. My usual go to would usually be a packet of crisps or chocolate but obvious...

Jo (dietitian): Overall it was really insightful to gain a small piece of experience of how it would be for our patients. The main thing that struck me was how organised you would need to be to plan, and prepare the food. It required a high level of skill to gain the correct consistency and required lots of equipment!! It was also extremely time consuming.   I really missed having different textures to my diet not being able to bite or chew all day was strange. My interest in food was significantly reduced today compared to usual. Having to constantly think if food was the correct consistency would become very over whelming.   I found the limiting in choice very challenging . Whilst cooking my evening meal not being able to taste it whilst cooking was really hard, likewise not being able to “nibble” i.e. grated cheese when cooking lasagne was quite miserable. Losing the ability to have a random ad hoc snack was very hard. I realised about half an hour after I had done ...

Linda: I was assigned Level 5 minced and moist diet for the day. I felt I got off lightly compared to some of my colleagues who were following pureed and liquidised diets! Level 5 minced and moist is a diet I haven’t seen many patients on before so it was all quite new to me. It was interesting to note biting is not required and only minimal chewing is required on this food texture level.   I started off the day with a similar breakfast to normal, porridge. I ensured it was of a smooth consistency and stewed some pears to add to it. I used full cream milk and single cream to add more calories, it tasted lovely and creamy but I missed a spoonful of peanut butter on the top as I would typically have.  For individuals who have dysphagia optimising nutrition by having nutrient dense meals and following food fortification principles is important in preventing malnutrition.   For lunch I had some leftovers from my dinner the night before. This was a beef rendang curry...

Harry: I was given the level 3 liquidised diet, and created a level 4 dessert for the competition. I found sticking to the level 3 diet very challenging. I struggled to keep a normal nutritional profile of a meal while keeping to the correct consistency, I tended to produce too much volume which was unrealistic to consume. I made a peanut butter milkshake for breakfast, however I found by adding oats and bananas I made the consistency too thick and had to start again. I also struggled to get used to the consistency when using the Nutilis clear thickener, I found it to alter the taste of the meal significantly. Overall I spent a lot time, energy, and thought into creating interesting meals, however the outcome was minimal in terms of taste and overall satisfaction.    I found making a level 4 pureed dessert a lot easier than the level 3 consistency. I chose a to make a chocolate mousse dessert which was a simple recipe and I didn't have to add any Nutilis clear thickener. I...

Kinza: I am on a IDDSI level 6 diet. I also made a level 4 mango and peach pudding. I found the diet to be fairly similar to what I usually have for example sweet potato, and soft foods. However, for my dessert I struggled to keep the texture and taste palatable. It required time for preparation and ensuring it was the correct consistency. I imagined myself in the position of someone with dysphagia on a level 4 diet and this made me realise the challenges involved in their everyday life and how this can affect their relationship with food. When adding the thickener 'Nutilitis' this gave an unpleasant after taste. I found this day interesting and was able to reflect on this experience for my learning as a student dietitian. I will carry this experience and understanding throughout my career as a future dietitian.

Rebecca: I was assigned level 4 for the day and I really did underestimate the amount of prep work and kitchen utensils that it would take to make everything. I made pureed blueberry and vanilla porridge, chicken avocado and potato blend and for the bake off I made lemon cheesecake with a pureed biscuit base. I wasn’t able to finish all my portions, the savoury blend was too sickly and it was quite difficult to adjust to eating a lot of extra cream and milk in the day. Despite being hungry I am really glad I have been able to experience this and the barriers that are experienced by those on a pureed diet. It’s been really good joining up with the speech and language therapists for the afternoon.

Sarah: level 4 thick purée - 7pm and I’m really hungry. Snacks are proving challenging and having watched the kids eat their tea it’s now the bedtime hour and I’m grumpy and hungry! Really looking forwards to my spag bol.

Sarah - 10am level 4 thick purée. So far it’s only early morning and I’ve already had some difficulty! Stuff takes much longer in the blender than anticipated in order to become smooth and no longer grainy! My smoothie for breakfast was probably not quite thick enough and had raspberry pips in, and I’m re-thinking lunch of a tin of soup as that will need thickening somehow. I’ve needed to wash the blender up 3 times already and the kitchen looks like a bomb site!!! Lots of forward prep needed and I’m really beginning to appreciate just how complex a recommendation of a purée diet really is. Limited options are available to buy (a wander around morrisons last night revealed a real dearth of any off the shelf food that would meet the criteria - particularly savoury). No real info or advice available on the internet either about recepies... maybe an info recipe booklet might be something we should consider developing in the department - kind of like a weeks worth of meal plan to get yo...

Enjoyed an IDDSI Level 6 'soft and bite sized' pasta salad with feta cheese for lunch today. It took longer to prepare than my usual lunch - but was worth the effort.  Next time I would definitely buy small pasta shapes which fit the criteria for this diet (bite size pieces 1.5cms for adults) rather than using my usual pasta from the cupboard. Made me think about the planning and preparation needed for patients and their carers to ensure meals comply with the guidelines. Am looking forward to hearing the results from the Great British Blend Off which took place at The Beacon this lunchtime!

Educating a Nursing Home We kicked off Swallowing Awareness week on Monday with a trip to a local Nursing Home educate staff about dysphagia and the change to IDDSI. Staff have received training through different formats around the change to IDDSI, but we took the opportunity to reinforce the importance of adhering to the recommendations.  We had around 25 staff attending over the course of the afternoon, ranging from therapy staff to chefs and carers.  The first station raised awareness around different red flags to look for when working with patients. Within the nursing home, we typically carry out bedside assessments due to ease of having the patient's in the setting and using what is available. We showed videos of videofluoroscopy assessments which peaked the interest of lots of people and gave them further inside into alternative methods of assessment to support our recommendations.  The second station gave staff the opportunity to have a go at thickening drink...

Sarah: sooo Louise and I had a great afternoon at the East Riding Community Hospital - on the ward (& we found a few nurses in the physio dept too!). We set up a dysphagia trolley and wheeled ourselves around - sharing info and answering questions with staff, patients and families. Spreading awarenss of swallowing difficulites and also providing a bit of patient specific advice to families and some informal training to new starter and agency staff. I think this was well recieved and we managed to reach a bigger audience being mobile than i have ever done so before when asking people to come to me for a drop in training session - i think we might make if a quarterly update session! Here are a few photos (i hope) of our afternoon So - on to thinking about Wednesday... I'm pretty happy with my plan for my "blend off" pudding entry, however planning the days meals (I picked out level 4 puree) has really made me question the complexities we pose our patients...

Welcome! The Hull and East Riding Community Teams consists of 14 valuable staff members all varying in competency and skill. We work closely to meet the Speech and Language Therapy needs of adults within the community. We work towards supporting people with a range of speech, language and communication problems as well as swallowing problems. Referrals for swallowing problems (known as Dysphagia) continues to increase, and this seems to be most of the work we do today. People with dysphagia often have other health conditions which affects their eating, drinking and swallowing abilities. This ranges from clients who have had a stroke, to those with degenerative conditions such as Dementia and Parkinson’s Disease. Dysphagia can have potentially life-threatening consequences. They can result in choking, pneumonia, chest infections, dehydration, malnutrition and weight loss. This can have a real impact on the clients’ quality of life as well as those around them. Giving Voice c...