I had a long chat by telephone with Victoria, the speech and language therapist this afternoon. I gave a description of Isobel's problems, the weakening of swallowing and need for multiple swallows to clear her mouth, resulting in eating being much slower than a few weeks ago. We agreed that the decline in Isobel's eating was what we expected and no input from Victoria at this stage was likely to improve matters. Victoria was of the opinion that all the strategies now being used were the best that could be found. She will check again in a couple of weeks.

I went in to see Isobel at the usual time but was held up by traffic on the A2 slip road and did not get in until almost half past five. June had already been with Isobel for over half an hour, Isobel had been asleep, but occasionally coughing. June had to leave almost at once, a couple of minutes after Isobel's tea arrived. Isobel did not have a good start to the day. She ate only a quarter of her breakfast and could not manage a pot of balanced supplement. She also could not be woken for dinner. Later in the afternoon she ate a pot of balanced supplement. She drank only moderately during the day.

I managed to get Isobel to eat all her main course and drink half a beaker of blackcurrant squash; but it was a desperate struggle. This took two hours altogether and was punctuated by dozens of coughing incidents in which no significant amounts of food were expelled but a fine spray of food and drink constantly hit me. I found out that the coughs were often occurring just after swallows, which I had not noticed before. Isobel had drunk a little of the drink while eating the main course but was incredibly slow while finishing the remainder of the half beaker after finishing eating. The yogurt dessert had been foregone, the intention being to give Isobel a pot of balanced supplement after she had taken a full beaker of drink, but she was completely exhausted and fell asleep after half a beaker. I decided to let her sleep and recover before giving her the second half beaker of squash.

While Isobel was sleeping, Dallas and Mike arrived en route from Ramsgate. We chatted for an hour while Isobel slept, they left just before half nine. As soon as they had gone I woke Isobel, with some difficulty as she was still very tired. However she drank the second half of the beaker of squash more quickly, but as soon as she finished she fell fast asleep again. I abandoned hope of giving her anything more - Edmund will try to give her a pot of balanced supplement later tonight. I went home just after a quarter to ten.