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My mother-in-law (MIL) had a series of strokes that ended up putting her in the hospital with a UTI that had turned into sepsis. That was 5yrs ago. It all rendered her unable to walk, and she has limited ability to talk. She can sit in a wheelchair for about an hour or so before needing to lay down in bed. She is unable to use her right arm. She has limited use of her left arm. There has been no change in her condition in the last 5yrs.



However within the last couple of weeks, I've noticed that when she's eating, she bites her tongue and/or her bottom lip at least one or more times per meal. She also seems to be mildly choking on her food more often, like every other meal versus rarely. I'm concerned that she's deteriorating in some capacity.



I should also add that she had a very mild case of COVID back in June. It was only a mild cough, and they only tested her for it because the woman in the room next door to her got very sick. The cough went away after a week or two. She did yawn a lot for about a month after the cough went away. This was the first time she had gotten COVID.



She just had a check up with her doctor a month ago, and her stats were the same except that she was a little anemic.



I've read that trouble eating has to do with pons function, and can be affected in stroke victims, but I've only found references to that as something that happens at the time of the stroke, and not something that develops later on it's own without a catalyst. Could her mild case of COVID have been the catalyst? Could this be related to different cause (her mother has dementia)? Wondering if anyone else has experience with this happening to their loved ones?

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It sounds like your MIL needs a swallow study (done by a speech/language pathologist) and a general examination of how she is eating.

Ask her doctor to order one and then find out if the facility have any suggestions.

If not, I believe ASHA maintains a directory.

https://find.asha.org/pro/#sort=relevancy&f:@provider=[Speech-Language%20Pathologist]
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Contact her doctor to get a speech evaluation like yesterday. Choking on food leads to aspiration pneumona. Perhaps she needs to be changed to pureed diet.
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Would it be possible to locate a Speech Therapist to visit your MIL?
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AnnReid Sep 2023
A speech therapist with expertise in eating and swallowing dysfunction in geriatric clients might be able to be very helpful, and yes, “mild” COVID could cause cognitive changes in vulnerable clients as part of its aftermath.
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My late husband who had a massive stroke(at the age of 48)affecting his right side and speech, later(late 60's)developed vascular dementia and started choking on his food which caused aspiration pneumonia and almost killed him. Most people don't survive that.
I would definitely have her doctor order a swallowing test for her, but in the meantime I would only give her pureed foods(pretty much whatever she eats now can be pureed)and thicken ALL of her drinks with the product Thick-It. That will help her food and drinks go into her stomach and not her lungs.

And I'm sure her neurologist already told her/you that people that have had a stroke are much more likely to later develop dementia, and as in my husbands case it's usually vascular which is the most aggressive.
I wish you both well.
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I know people who developed cognitive decline after a “mild” case of Covid. In one case, he only had a cough and slight fever, though his wife had a more severe case of it and died of Covid 23 hours after she started coughing. The man’s brain fog never lifted. He was active and high functioning before Covid but went to assisted living a year ago and continues to decline mentally. He will go into memory care there when the time comes. In another case, a person healthy before getting Covid lost smell and taste, which never recovered. This person doesn’t enjoy eating now. So yes, there are many ways of not recovering from Covid. I have observed other examples also.
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Thank you all for your responses. We are in touch with her doctor, but sometimes waiting for an appointment and clinical diagnosis can be nerve-wracking in a situation that already feels like a constant game of whack-a-mole when it comes to managing elder care. Having some ideas of what it might be can help alleviate my anxiety while the doctors figure it out. We are very cognizant of the dangers of pneumonia induced by food particles getting into the lungs of stroke victims, so that's high up there on my list of concerns about the biting and choking.
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