[Dysphagia] celiac disease

[marthac at noln.com (Martha Carbone)]

I have a 90-year-old woman with celiac disease on my caseload. I saw 
her at the bedside two days ago. She had oral stage problems (excessive 
chewing, pocketing of food after swallows). No overt s/s of aspiration 
at the bedside, but she is likely silently aspirating secondary to 
failure to thrive (extremely thin), RLL pneumonia. Because of her 
severe gluten intolerance and other allergies, it was decided she 
cannot have a VFSS. I had gathered gluten-free foods, but Varibar has 
modified corn starch, which her daughter says is not good. Also, felt 
she would not tolerate gastrograffin well.

She is currently on mechanical soft diet and thin liquids. I am 
recommending that if they want to consider the safest, easiest diet 
level, to try puree and nectar thickened liquids for her. Although corn 
is not prohibited on the info I have read for this disease, the 
daughter is adamant that mom is allergic to that and so she would not 
tolerate the usual thickeners. I am wondering if anyone has any good 
ideas on alternative thickeners to try. Per her daughter, mom can have 
tapioca flour. I thought we could experiment using that. The only other 
suggestion I had was to try blended "smoothie" type meals/drinks with 
foods she can have that would be puree-to-nectar consistency. Any other 
ideas/suggestions? Thanks for any thoughts.

Sincerely,

Martha Carbone, MS, CCC-SLP