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Hard to Swallow

By Cherie Binns
girl-865304_1920-(1).jpgFor most of us, getting a diagnosis of multiple sclerosis is “hard to swallow.” However, for some of us, one of our symptoms can be just that: hard to swallow. The technical word for this is dysphagia, which literally means difficult or painful swallowing.

My first experience with this was at a picnic for my husband’s professional association. I had just put a forkful of food in my mouth when the girl sitting next to me said something to me and I turned my head to answer her and felt the food slip, unchewed, into my windpipe. I could not breathe and I could not bring it back up. Fortunately, someone at the event noticed what was happening, did the Heimlich, and I am here to tell the story. This began to happen more and more often if there was a conversation at the dinner table that I would try to enter when I had food in my mouth. Sometimes I would wake from a sound sleep choking on my own saliva. This was very different from swallowing something and having it get stuck on the way down because it would flip into my trachea or airway rather than my esophagus which sits next to the airway taking food to the stomach. 

In the normal process of swallowing, the tongue pushes food back in the mouth causing it to fall backward into the esophagus. When this happens, a tiny but important flap of tissue called the epiglottis falls over the windpipe or trachea preventing food from entering the airway. 

In some of us with MS, the nerve impulses that help this process to naturally happen are short-circuited and the food flops back into the throat and the natural muscles of swallowing go awry allowing that food to fall into the airway before the epiglottis gets a chance to cover it. This is uncomfortable and can, in some cases, be life-threatening. So, what can we do to prevent this? It is true that we should never talk with food in our mouth as the act of talking uses some of the muscles that would normally protect our airway should food enter it unintended. Also turning your head or looking up distracts those muscles as well so face forward while chewing or swallowing. In severe cases, we might even be asked to tuck our chin prior to swallowing as that forces the epiglottis into place and it is nearly impossible in that position for any food or liquid to enter the airway. Small mouthfuls of food are also a must as the larger the amount of food being swallowed, the more potential there is for the airway to become obstructed.

In my case, my neurologist ordered a swallowing study done. This a short simple test where I was asked to drink a liquid about the consistency of a milk shake (banana flavored). That liquid shows up on fluoroscopy (a type of X-ray moving picture) and can identify whether swallowing is happening normally, or something is making it hard to swallow or interfering with the process. That was normal when I was looking straight ahead or had my chin tucked but there was not complete closure of the airway when my head was turned to the side or when I was looking up (another reason not to throw my head back when trying to swallow a pill).

You do need to see a doctor when this happens to find out if there is a reason this is happening such as a polyp (skin tab) or even cancer in the throat or esophagus. Sometimes reflux from the stomach (heartburn) can damage the tissues of the throat causing this to happen as well. These are generally quite treatable and often require no medication but simple, easy to follow exercises and changes of habit:
  1.  Take small mouthfuls of food and chew thoroughly before trying to swallow.
  2.  Do not try to speak when you have food in your mouth.
  3. Look straight ahead or even tuck your chin a bit when swallowing to make sure the epiglottis closes fully before food heads down.
  4. Learn how to do the Heimlich on yourself and be sure that those around you – especially any caregivers – know how to do it as well.

A speech therapist may be consulted in more severe cases to work with an individual who has dysphagia which is common to several neurological conditions in addition to MS: including but not limited to stroke, traumatic brain injury, Parkinson’s, Myasthenia Gravis, ALS.

If this is happening to you and you have not mentioned this to your neurologist or primary care physician, please do. It can be easily diagnosed and generally easily managed.