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    Frequent Hospitalisations due to Aspiration Pneumonia/Parkinson's
    An_256989 posted:
    Hi, my father who is 89 and has Parkinsons and also COPD has been in and out of the hospital 6 times since September 2013 right up until now, April 2014, all due to aspiration pneumonias which have been increasing in severity, though antibiotics seem to now only be given to him the first or 2nd day when he is hospitalised. He currently takes generic apo-levocarb 25/100 mg half a tablet, plus whole tablet generic levocarb cr 50/200 mg at roughly 9-10 am, and then 9 hours later, gets another generic levocarb cr 50/200 mg in the evening.
    He has been seen by 4 speech patholigists over the past year, been advised to take minced/pureed food, honey thickened liquid with food, and now, nectar thick liquid between meals which has been strictly followed for a year, as advised. He has had 2 fluoroscopies, all showing trace amounts getting by the epiglottis (which does not close quickly enough) with all ingestions of the above mentioned intakes.
    My father is currently in the hospital again, being treated for a very severe case of aspiration pneumonia and the night before he was brought in from home, he talked incessantly in his bed from 9 pm to 9 am. I understand this to be an infectious type delirium, and indeed, his breathing was severely compromised for the first 2 days he was in the ER.
    Five days later, he still coughs when eating in the hospital on the assigned diet, though not terribly, but the congestion keeps going down in to his lower lung and he is unable to bring much up through coughing. Ironically, he is quite good with his walker when it comes to walking in the hospital halls (he has no balance, though, so needs to be followed) and his breathing improves upon walking, but this also leads doctors to prematurely discharge him from the hospital. Obviously, walking in itself is not enough to keep someone alive.
    We are now at the point of looking at a peg tube, and we will also try a hospital bed at home to keep his head and chest in a somewhat elevated position to help with the chest congestion. He is also on Advair, Ventonlin, Atrovent, and Spiriva, all within only the past year. Previous to this he had not needed any such medications. My main questions are: is there anything else we can do to prevent the recurrent aspiration pneumonia before we go for the peg tube? My father has lost a lot of weight in the past year (around 30-40 pounds), being normally a good 170-180. If we allow him to eat sparingly several meals throughout the day, would this prevent the aspiration (but otoh, also make him loose too much weight?), or perhaps the timing of his Parkinson's pills might make a difference in his swallowing, or improved sleep, or is it too late for all this sort of thing? My father sleeps a fair bit off and on during the day (in a chair) and recently, not too well at night in bed because of Parkinson's and the mainly chest congestion.
    He does take 1 Citalopram 20 mg in the morning with his Parkinson's medication, and I think this helps a bit. He is quite lucid during the day, espc. when he is not in the grip of yet another chest infection, and he is able to feed himself at the kitchen table, though he is a bit sloppy due also to cataracts and Parkinson's related vision problems.
    Any advice or help would be greatly appreciated, especially since my father's neurologist only writes prescriptions and is swamped by other patients such that it is very difficult to get in to see him more than once or twice a year.

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