An appointment had been arranged for Isobel to see the new Speech and Language Therapist at tea time on Thursday. I was therefore surprised to get a phone call at 1pm to say that Isobel would be seen this afternoon. A further phone call arranged a meeting at a quarter past two.

Isobel ate most of her breakfast and a pot of balanced supplement. She also ate all of her lunch and dessert. It was no surprise therefore to find she was very soundly asleep when I arrived. The new S&L therapist, Victoria from Auckland in New Zealand was already there with her supervisor. A complete second lunch had been provided! After ten minutes I gave up trying to tempt Isobel into waking and we settled for discussion. They seemed happy with my description of how Isobel eats. We seem to be in a sort of stable period again at the moment; if Isobel wakes she will eat fairly easily although she does tire after about one and a half items. Her swallowing is probably very variable. I can't detect with certainty when she swallows, but some (<10%) swallows are very clear and powerful. Isobel often takes a number of swallows to clear her mouth but will indicate that she has not done this by refusing to open her mouth. If her mouth is empty, she will usually open it in response to the stimulus of a touch on the lip from a spoon; but sometimes she will open her mouth in response to a verbal request. I said that I could no longer discern Isobel's preferences for food, she will usually eat anything if she is ready but does seem to respond to talking about what is going to be fed to her. In my opinion, she seemed keenest to eat fruit yogurt, although this is rather thin and runny and more difficult to feed to her. The therapists thought ordinary yogurt possibly too thin and potentially dangerous. They will discuss alternatives with the Centre staff. They asked if Isobel chewed the little lumps of fruit in the yogurt; I said that she usually did, but she tended to chew any food even if it did not need chewing. They were happy with Isobel's overall level of nutrition, they are aware that she often misses one meal a day (most often lunch) and often has two not three pots of balanced supplement. I commented on the difference in thickness in the different flavours, the vanilla (which smells delicious) is thin compared to the much more solid chocolate. They confirmed they were aware of this, it might be a good idea in future to stick to chocolate rather than seeking variety. I made up a beaker of drink to indicate the amount of thickening used, this was satisfactory. I mentioned the odd behavior of tea when thickened with maize starch, the supervisor said that she believed this was due to a reaction between the starch and the fat in the milk in the tea. It could be reduced by thickening the tea before milk was added, then adding milk at the last minute before it was drunk - but would still happen after some minutes. I expressed the view that this was not worth doing for Isobel, she did not seem to particularly want hot drinks and orange and blackcurrant squash were very palatable when thickened. It was agreed that no more could be done today. Victoria would come back at tea time next Tuesday in order to see Isobel eating. We all left at just before 3pm.

I went back in to see Isobel a few minutes after 5pm. Her tea was ready a couple of minutes later and she ate the first course with no problems. She ate part of the yogurt dessert, then had a rest for a few minutes before resuming and finishing it. While Isobel dozed for a few minutes I massaged and manipulated her right arm. This is now showing distinct signs of wasting compared to its swollen state a few months ago, Isobel remains of course unable to move it at all. Edmund confirmed that the swab sample taken last week showed signs of an infection and Isobel would start a course of antibiotics tomorrow morning. After a short while I woke Isobel and she drank a large (300ml not 200ml) beaker of blackcurrant squash, although she tired towards the end. Overall she has eaten and drunk well today. Isobel was able to give some yes and no responses to questions today. She indicated that she would like some of her book read to her and I read half a dozen pages before she fell very soundly asleep. I watered the plants and went home a few minutes before 8pm.