We All Scream for Ice Cream: But does that include patients on thickened liquids?

It's 2012, my first year on the job as an SLP. I'm working in a nursing home in South Jersey, and I'm out of my mind excited because I'm helping people eat and drink the things they love. Honestly, what better job could there possibly be in the world? This is why I got into the field, and it's why I've stayed in it for the last 12 years. I'm working with my patient, Eddie, who asks me for some ice cream. "Sure!" I proudly respond. "I'd be happy to get it for you; just give me a minute." I go through the winding corridors to the kitchen, where I see our dietician. I kindly ask for some ice cream to bring back to our friend, Eddie, but I am struck with a brick wall of new knowledge I had never known before. "I'm sorry, but Ice cream melts down to a thin liquid, so we can't give it to our residents, George." Insert brain explosion emoji. 

Is it true?

First of all, that's horrible. Patients with thin liquid dysphagia have it bad enough having to slurp down warm, thick milk and spoon out their coffee for breakfast, but now they can't have their ice cream for dessert? What kind of world are we living in? 

Second of all, really? Ice cream melts down to a thin liquid? Is the body that hot and oropharyngeal transit so long that it melts before passing through the cricopharyngeal segment into the esophagus? And it's so thick to begin with... Does it really melt all the way down to a thin liquid? I've seen melted ice cream before… Heck, I've drunk melted ice cream before, and it sure doesn't feel like a thin liquid. 

Ice cream is one of the most beloved foods on earth. Yet many of us have deprived our patients with dysphagia of this pleasure because of the theory that it melts down to thin liquid. Some of us have become members of what I call the special force of the food police, known as the ice cream police. I, too, have fallen into this pattern, having shamelessly swiped ice cream away from salivating patients because, "Oh, didn't you know that ice cream is considered a thin liquid?" Yup... Awful. But is this even true? Has it even been tested? Until recently, it hasn't, but thanks to Caroline Brindo, MA/CCC-SLP, BCS-S, we may finally have some answers. 

What the ice cream police did NOT count on was Caroline Brindo coming into the picture. Caroline is a dysphagia specialist whose dad, Gregg, just so happens to be a retired ice cream specialist (yes, this is a thing, and yes, I am considering a career change as I write this). Fate would have it that this perfect team would be sent directly from the ice cream heavens to empirically determine whether ice cream actually melts down. 

What the ice cream dream team found: 

The way ice cream melts depends on several variables, such as its contents, processing methods, freezing and serving temperature, and serving method. So Caroline did an IDDSI flow test on a range of ice cream brands after a 30-second mouth hold to essentially warm the ice cream to a consistency we can expect to see as it makes its way down the hatch. The conclusion? The ice cream brands ranged from an IDSSI moderate to extremely thick after the 30-second mouth hold. Yup, it's nowhere near thin liquid viscosity. 

However, there are some caveats to these findings. Some ice cream brands melted to thin and slightly thick liquid after sitting out for 2-6 hours. The good news is this risk is typically higher when the more expensive brands of ice cream (probably not the ones your facility is purchasing). But to be safe, we may not want ice cream sitting out for hours, which isn't a bad solution for a dessert that's supposed to be served frozen. And when in doubt, IDDSI flow test the ice cream your facility carries since there are so many variables to consider.

This might be some of the best news I've received since 2012. If I had a time machine... Well, if I had a time machine, the first thing I'd do is tell my 7th-grade self that my pants were going to rip that Tuesday morning after gym class and to keep a spare pair in my locker, but the NEXT thing I'd do is give ice cream to Eddie and enjoy that wonderful smile of his. Because that's what dysphagia management is all about. Not policing. Not monitoring. Not taking something delicious away from someone who has worked his whole life to enjoy it. It's about bringing safety and joy to the people we serve. Thank you, Caroline, for making that easier. 

*New course offered for ethics credit: Let Us Eat: The ethics of swallowing in older adults at high risk