The Art Of The Swallow
Stanley Fierston
My MS has produced both swallowing and speaking problems, and I’m told the two are often connected. To handle them, I’ve been taught a facial exercise routine that I now do every day. As a result, my speech is no longer slurred and my swallowing difficulties, while not gone, have been reduced. I’ve also learned some tricks to ease coughing, choking, and throat irritation.
FIRST, AN EXPLANATION
Swallowing is a complicated process. There are approximately 30 muscles and 6 cranial nerves involved in every swallow. Lesions or nerve damage from MS can interfere with control or cause subtle weakness, and the result is dysphagia–the medical word for swallowing problems.
The process of swallowing begins when you put food in your mouth. Chewing reduces the food to a size and consistency that can be swallowed by grinding it up and mixing it with saliva, which also aids in digestion. Once the food is ready to swallow, it is pushed back toward your throat by your tongue, which presses up against the roof of your mouth. Next, a valve closes, keeping the food from getting into your lungs. Then the chewed food moves down through the esophagus into the stomach. Liquids travel in a similar manner, but they move more quickly. Your tongue and other muscles are required to delicately adjust the quantity of food to be swallowed. Some of these actions are under your conscious control, but others aren’t. Just the same, I took the whole process for granted, just as you did before MS.
A great many people with MS probably have some swallowing problems. These range from an occasional cough or a throat you just can’t clear to a slowing down of the whole swallowing process. The most serious problem occurs when food particles or liquids accidentally enter the lungs, which can cause a type of pneumonia.
The good news is that most swallowing problems can be managed. A speech/ language pathologist (SLP) is the specialist who can best diagnose and treat dysphagia. To evaluate your swallowing problem, you are usually asked to swallow a barium liquid while your mouth and throat are x-rayed and filmed. When the film is viewed, the barium reveals the details of your swallow so the SLP can diagnose your problem exactly.
The SLP will usually suggest some exercises to improve muscle strength or coordination. A change in the position of your head can also affect swallowing and coughing, and your SLP may teach you to move your head to one side or the other. (Try this first at home. Experiments in a restaurant can be embarrassing.) Within a month or so, I found swallowing easier.
SELF-HELP TIPS
In addition to exercises and strategies the SLP prescribes, you can do some things to help yourself. Here are some self-help tips I’ve used successfully:
* You can identify and then stop eating foods that your throat finds most irritating–vinegar, for instance–or foods that cause you to choke, such as potato chips.
* It helps to chew food thoroughly, so take your time at meals. Adjust the size of what you put in your mouth so that you swallow an amount you’ re comfortable with.
* Baby food, with its smooth texture, is a possible solution for some people. For me, pureed foods preserve familiar tastes.
* My biggest problem is coughing that I just can’t seem to stop. I’ve found that eating some applesauce helps. Its texture seems to break the constant irritation that I sometimes feel in my throat. You can buy applesauce in small, sealed, one-serving packets. I carry some in my pocket for instant relief.
* Liquids present special problems for me because the swallow has to be faster. I have great difficulty with plain water, for instance. I try to swallow too much and choke with a loud cough. The secret here is straightforward–I take small, and not too many, swallows. I’ve found that I can handle 3 swallows of water in a row, but I’ll cough after 4. I think my muscles simply get tired. This may also explain why swallowing is more difficult when fatigue washes over me.
* You can also try small variations to make your favorite things easier to swallow. For example, I’ve found regular orange juice irritating, but I cough much less if I drink orange juice with pulp.
* Your throat nerves and muscles might get confused when you try to swallow liquids along with solid food. So the trick here is don’t mix them!
* If swallowing liquids continues to be a problem, you may be advised to use a thickener that fools your throat into believing that it’s dealing with a more solid food. But, in most cases, you can continue to enjoy familiar foods as long as you practice your therapeutic exercises regularly and are willing to experiment with subtle variations that might reduce your swallowing problems. That’s been my experience.
Stanley Fierston is a retired electrical engineer He has had MS for more than 16 years.
COPYRIGHT 2000 National Multiple Sclerosis Society
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