Dysphagia and MS

By: Elna Botes van Schalkwyk

Dysphagia and MS
This problem can really turn an enjoyable meal or evening into a painful situation. Though it does not always lead to choking, it can take an object several hours to pass through the esophagus. Even the swallowing of pills can be very problematic. Between 30 and 40 percent of people with MS experience swallowing problems at some time. However, for many people with MS-related dysphagia, these changes are so subtle that they may not be aware of them, besides experiencing the occasional coughing fit after something “goes down the wrong way”. Just like other MS symptoms, dysphagia can come on during a relapse and disappear completely or greatly improve.

Natural treatment for dysphagia:

The first remedy is one that Rocky Balboa might enjoy, and that is swallowing an uncooked egg yolk and white. The texture of the egg binds to the problematic food or pill and removes the obstruction. A lump of boiled rice can help if something like a fish bone is trapped in the esophagus. It can add more weight to the bone and push it downwards. Swallowing bread can accomplish the same thing. Gargling vinegar is a good solution when the obstruction is a large item. It can even help to soften hard bone and make it easier to swallow. Try starting with the vinegar method and then following it up with the rice or egg.

Several herbs have been known to help the throat during episodes with dysphagia. Licorice can reduce swelling and spasms and relieve pain in the gastrointestinal tract. The typical dose is 380 mg per day. Slippery elm is a demulcent, which means that it promotes the healing of and protects irritated tissues. The dose is 60 mg per day. Marshmallow is also a demulcent and an emollient (a soothing substance) and can be made in a tea with 2 to 5 g of dried leaf or root in 1 cup of boiling water. Other herbs that may be helpful are valerian, wild yam , St. John's wort, skullcap and linden flowers (Tilia).

The Heimlich Maneuver: Everyone in your household, including yourself, should learn the Heimlich Maneuver. The Heimlich Maneuver is a preventive emergency measure to use to dislodge food when someone is choking. You can perform this on yourself. Learn the Heimlich Maneuver at www.heimlichinstitute.org. You’ll be glad you did.

Here’s a couple of very helpful “common sense tips” (as she’s calling it) from Dr. Julie Stachowiak:
  • Sit Up Straight: It is important to sit up ramrod-straight, not only while eating, but also for at least 30 minutes following a meal. This applies to all situations, not just mealtimes – this means no lounging on the floor while shoving in nachos during the Superbowl and no slumping down in your chair shoving popcorn in at the movie theater.
  • Mindful Eating Challenge: We could probably all slow down when we eat. Try this technique: Place food on your fork and put it in your mouth. Put your fork down. Chew your food very thoroughly, then swallow. Do not pick up your fork again until your mouth is empty. This will allow you to work through each swallow before starting to negotiate the next bite.

    Sounds easy? Ha! Try it during your next meal. I challenge you to put a five-dollar bill next to your plate. If you can get through the entire meal using this technique, it is yours to spend on a little treat. If not, into the “piggy bank” it goes. Keep doing this at each meal. By the time you can successfully make it through a meal using this technique with no slips, I will wager that you will be able to afford a pretty nice present for yourself. You will have also developed a habit that will really benefit you in the future.
  • Don’t Talk With Food in Your Mouth: Again, how many times did you hear this while you were growing up? If only we had all listened, there wouldn’t be so many bad habits to work on breaking.
  • Thicken Your Liquids: For some people, thin liquids tend to go down the “wrong way,” causing sputtering and coughing. There are specific thickeners that can be added to liquids to help them go down more smoothly. These are usually corn starch-based.
  • Eat the Right Kinds of Foods: Hard, crumbly, dry and crunchy foods may create particles that aggravate your dysphagia. Adding gravy or avoiding these kinds of foods altogether may really help you. You may need to eat very soft or pureed foods.
  • Eat Smaller Meals: Just like with any other sustained activity, we can get “swallowing fatigue,” where our muscles get tired and our attention starts wandering towards the end of a big meal. Instead of just trying to “get done” by shoveling food in faster and taking bigger bites, try breaking meals into smaller portions. It will be easier to eat slowly and concentrate on each bite.
  • Take a Symptom Inventory: Think about how you feel before sitting down to eat. If your other symptoms seem worse at a particular time of day or under certain circumstances, there is a good chance that your dysphagia will be acting up, too. Remember, fatigue will contribute to swallowing problems. Also, it probably isn’t a good idea to eat outside in hot weather, as heat intolerance can aggravate all MS symptoms. If you happen to be at a picnic in the summer, skip the fried chicken in favor of some ice cream.
  • Alternate Liquids and Solids: For some people, swallowing difficulties show up as problems getting the food to go all the way down the esophagus. It may be helpful to take a small sip or two of a liquid between bites. This will keep the food moist and moving. End your meal with some liquid, as well.
  • Perfect Your Technique: Try tucking your chin in toward your chest slightly while swallowing. Moving your chin in one-half inch closes off the airways, preventing food and liquid from going into your respiratory passages.