Swallowing is a function that happens so automatically that we never give it much thought until something goes wrong. Most of us have experienced the occasional coughing and sputtering that comes with “swallowing down the Sunday throat.” However, when you have MS, those episodes can become more frequent and bothersome, to the point that they affect safety of oral intake. Swallowing problems, also known as “dysphagia,” can vary in MS from occasional episodes of something “going down the wrong throat” to more serious symptoms of unintended weight loss or repeated cases of pneumonia due to aspiration. Dysphagia can also have a negative impact on quality of life.
Fortunately, much can be done to address dysphagia. A speech/language pathologist (SLP) can assess the swallow during an office evaluation or a radiology test called a modified barium swallow, which is a moving x-ray of swallow function. Based upon this assessment, the SLP may recommend direct swallowing therapy, compensatory strategies, and in conjunction with the dietitian, diet texture modifications to improve the safety and efficiency of the swallow.
Safe swallow strategies may include slowing the pace of eating to accommodate a delayed swallow “trigger,” or tucking the chin to the chest while swallowing to help protect the airway. While strategies recommended will vary according to the specific problem, a couple universal suggestions may help you swallow more safely. Be more mindful while eating; reduce distractions and refrain from conversation until swallowing is complete. Be aware that fatigue can also impede swallowing; take rest breaks during long meals or eat shorter, more frequent meals. Most importantly, maintain good oral hygiene and visit the dentist regularly. Controlling oral bacteria reduces the risk of development of pneumonia if aspiration does occur.
A registered dietitian can assess nutritional status and provide information on a suitable nutritious diet which will prevent aspiration and help make eating a pleasurable experience. Nutrition concerns include under nutrition, dehydration, altered tastes, and aspiration. Poor nutritional status is associated with health risks as impaired wound healing, higher risk of infections and possibly impaired mental and physical function. Depending on the SLP’s advice, a modification of food textures may be advised. Food with mixed textures and irregular lumps are the least safe. A RD can advise in ways to increase the calorie and protein content of meals and beverages and provide practical tips for the consistency of foods. Most important is maximizing nutrition in appetizing, good tasting meals.