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Dear Allen, > Eating with general slowness and difficulties in chewing and swallowing has > become a major and time-consuming problem. On several occasions food bolus > has become lodged in the esophagus and required an endoscopy to remove. The eating difficulties you describe are not uncommon in people with PD. The first thing you should do is ask your physician for a referral to a speech language pathologist, who can determine the likelihood of aspiration pneumonia, choking danger, and also can teach safe swallowing techniques. > We are looking for any suggestions to avoid the step > of a feeding tube. How does that work? When do you decide it is necessary? With regard to use of a feeding tube, your physician and dietitian can determine the need for placement. A very strong consideration, in my opinion, is unplanned weight loss. Many otherwise healthy people with PD are unable to eat at a normal pace, and therefore cannot ingest enough nutrients to maintain weight and health. Use of a feeding tube means that hydration can be maintained, calories and other nutrients can be safely ingested, and -- if safe swallowing techniques are used -- the individual can still dine with family and friends, enjoying meals and eating as much as is possible. Feeding tubes can help people stay healthy, both physically and mentally, living in their own homes; whereas weight loss and malnutrition are predictors of hip fracture, dehydration, confusion, behavior changes, and many other illnesses. My very best regards, Kathrynne -- Kathrynne Holden, MS, RD Medical nutrition therapy for Parkinson's disease Author: "Eat well, stay well with Parkinson's disease" "Parkinson's disease: assessing and managing unique nutrition needs;" "Risk for malnutrition and bone fracture in Parkinson'sdisease," J Nutr Elderly. V18:3;1999. http://www.nutritionucanlivewith.com/