Dear Mary,

My father has had several mini strokes over the last five years but still lives alone and is able to do most things for himself. I call or visit everyday and prepare frozen meals for him to put in the microwave. He also comes over for dinner every Sunday and more often when my schedule allows it. I noticed recently that he coughs while eating but at no other time. He said he gets a tickle in his throat when he eats ever since he choked on a piece of chicken a couple of weeks ago. He is reluctant to see the doctor but I am feeling uneasy about this. Is it something I should worry about?

Dear Reader,

Coughing while eating is a symptom of food and/or fluid is going down the “wrong pipe” and if left unchecked will result in choking and aspiration pneumonia – a condition caused by the food or fluid entering the lungs. Since your father has suffered strokes before it is possible that he has had another one that now has affected his ability to swallow properly. He should be examined by his physician and a swallow study done. During this test (which takes about an hour) the person drinks a barium solution while a radiologist watches moving X-ray images on a video screen looking for any swallowing defects. The safest food and fluid consistencies can be determined and, if appropriate, a speech therapist engaged to teach exercises to prevent further choking or aspiration.

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Dear Mary,

I am caring for my sister who has Multiple Sclerosis. She is getting progressively weaker and needs a lot more help. Fortunately, she has long-term care insurance and I have been able to hire the help she needs. The problem is her mood. She is so down that she does not want to get out of bed in the morning. If she could, she would stay in bed twenty-four hours a day with the shades drawn. It is an effort just to get her to talk to me. I know from reading about MS that cognitive changes can occur. Is there anything that can be done for her or is this just to be expected and accepted?

Dear Reader,

Cognitive changes are common in MS and depression is typical during the course of the disease. According to the National Multiple Sclerosis Society clinical depression is more common among MS affected persons than in the general population and treatment is strongly recommended. With the wide range of antidepressant medications available today and with good counseling there is no reason for your sister to suffer. Please contact her primary care physician and request a psychiatric consult. .

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Dear Mary,

My mother and father live in a senior apartment building. I travel quite a distance to visit them every weekend. Mom has dementia and Dad has cardiovascular disease but he is very sharp mentally. When I visit I shop and prepare frozen meals for them to eat for the week as well as clean and do the laundry. I make all their appointments and call to remind them the night before. Mom attends an adult day center three times a week, but really should go more often. When she is home, she spends her days sleeping on the sofa or wandering the building. Dad does not notice when she goes out because he is focused on his computer. Recently, management told him he had to put an alarm system on the door so he would know when she leaves. They have enough money saved to provide her with more day care and even in-home help but he will not spend it. It seems the more I do the more he depends on me even though he resents my help. He says I am trying to “control” things. The apartment complex has a geriatric social worker on staff that can get them what they need but he will have no part of it.

Mary, these trips are wearing me out both physically and emotionally. My personal life is non-existent and my husband has reached his limit with me. I have tried to talk sense into my father to spend some money on home care services but it is like talking to a brick wall. What else can I do?

You are enabling your father to be dependent on you by being the personal maid and secretary. He is competent to make decisions and no amount of urging from you will get him to spend his money. The more you push, the more tight-fisted he will be. However, your mother’s wellbeing is important, so you cannot just walk away. Enlist the help of the social worker to keep a watchful eye on the situation. If things get bad enough management will step in and force a change. Gradually scale back your visits and call your parents frequently throughout the week so they do not feel abandoned and you feel comfortable..

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