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I believe it would be when you start to see a steady progressive weight loss. The person would no longer be able to maintain adequate nutrition or hydration by mouth.

Or more importantly if this person had moderate-severe dsyphagia ( swallowing problems) that resulted in episodes of choking, gagging or aspiration(food /drink getting into your lungs) this could lead to pneumonia.

Lisa - MS CCC-SLP

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Q: What stage does a peg get implanted in to a person with Pseudo bulbar palsy?
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