Why I use a speech therapist to help me with swallowing problems

How I handle dysphagia, common among people with multiple sclerosis

Benjamin Hofmeister avatar

by Benjamin Hofmeister |

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I’ve been betrayed by my breakfast cereal.

Other than eating it, I’m not sure what I did to deserve this. I always liked cereal and thought we had a good relationship. The only disagreement we’ve had was when I tried mixing two high-fiber cereals. The result was a bowl of something that looked like it should’ve been raked up into neat piles in the yard. It also made me a bit too, um, regular.

That wasn’t the cereal’s fault, and I never blamed it, so I’m not sure why we’re at odds now. I’m as cordial to it as I ever was, but it keeps trying to choke me.

Come to think of it, a lot of foods and liquids have it in for me these days, but it really isn’t their fault. Even though I can do things to make the situation better (or worse), it isn’t my fault, either. As usual, the real enemy is my multiple sclerosis (MS).

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According to a recent study, nearly 50% of MS patients reported having difficulties with swallowing, a condition known as dysphagia. It’s not just annoying; dysphagia can also lead to choking or aspiration, which, in turn, can cause serious complications like pneumonia.

The remedy that has helped me greatly is seeing a speech-language pathologist, also known as a speech therapist. Before I was referred to one, I thought speech therapists just helped with pronunciation or enunciation issues. I quickly learned, though, that they’re the experts to see when you’re having problems swallowing.

I performed a swallow test, which unfortunately had me consuming a variety of substances laced with barium. Then a diagnosis was given and several therapies suggested.

The first was simple positioning. I tend to eat while I’m in my wheelchair and have a bad habit of wanting to be slightly reclined. That’s a recipe for choking, so it was recommended that I try to eat more upright.

A second recommendation had to do with the consistency of the foods I was trying to swallow at once. Having both solids and liquids in your mouth at the same time isn’t recommended. Foods that have a dual consistency of both a solid and a liquid, like cereal, for example, are especially dangerous, my therapist said. These risky foods might include soups, stews, and even juicy fruits.

Swallowing difficulties, including choking, can’t be entirely eliminated, so a large part of speech therapy is focused on strengthening the muscles associated with swallowing and coughing. For coughing, it’s important to be able to expel anything that gets aspirated into the lungs. A number of exercises can help strengthen these muscles.

If you’re in a wheelchair like me, you might want to study techniques for performing the Heimlich maneuver on a person in a wheelchair. You might also want to make sure that family members or caregivers know the maneuver as well.

I’m almost never completely alone, but I’ve had times by myself while eating when I’ve had a slight swallowing problem. I started thinking about what I could run into with my wheelchair to expel an inhaled object. Since a lot of my time has been spent eliminating objects that I might run into, this thinking can be an exercise in creativity.

I’m not quite ready to give up on cereal. I still eat it. I just make sure that I eat it in a way that eliminates the dual-consistency problem as best I can. For me, that means not having a spoonful of both cereal and milk at the same time. It’s slow and not how nature intended, but it’s another one of my MS workarounds — a technique, rather than a tool in my MS toolbox.

MS may try to choke me from time to time, but with certain precautions, I can still be a cereal killer.


Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, Bionews, and are intended to spark discussion about issues pertaining to multiple sclerosis.

Comments

Kathy Allen avatar

Kathy Allen

I also have had this difficulty. I have a dry mouth & have had choking when eating with pain below my neck. One of the recommendations was to drink something between each bite. I also found that If I have 'my pills' prior to starting to eat, thats a good start ie wet/moist mouth/throat.
I haven't had the swallowing test but this began during the pandemic but will have shortly. Related I think is that my voice is low/quiet, I am often asked to repeat myself.
Always something to learn about. Thanks, Kathy

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Yes, always something new to learn with multiple sclerosis. I sometimes want to ask it are you a magazine because there seems to be a new issue with you every month.

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Ora Kofman avatar

Ora Kofman

cereal killer - good!

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thanks I was really proud of that pun.

How do you know when a pun is mature?

When it is fully groan.

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Claire Grace avatar

Claire Grace

I would like to know what the exercises are for strengthening muscles for coughing and swallowing

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Hi Claire. The device my speech therapist recommended to me is called an EMST. https://emst150.com/product/emst150/

I haven't been the best about keeping up with my exercises, but it works great. The other recommendations from therapist are mostly Behavioral or postural. Remembering not to talk when I eat (two of my favorite activities) and keeping my chin down when I swallow or just two examples.

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Tom H avatar

Tom H

Great article, as always! I have really enjoyed your commentary since you began writing for the site. Similarly, I have progressive MS, experience several of the same issues you discuss (including the swallowing issues), and I severed in the military. I am in my early 40’s (diagnosed about 6 year ago), and use a cane/rollator. I have not yet progressed to the wheelchair.

For my swallowing issues, they performed three separate swallowing tests. The white “liquid” they make you drink was not horrible. The test with tube down the throat while you swallow was not so fun!!

I am glad you mentioned going to speech therapy helped, as I was a bit skeptical anything would help, given one of the primary causes of my swallowing issues relates to muscle atrophy. I also experience muscle spasms in my throat when I eat, which they prescribed a smooth muscle relaxer to help. I am still too early to report on any benefits of the medication.

I will have to go schedule a speech therapy appointment. Thank you for highlighting this issue. Keep up the great articles.

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thanks for reading and for the comment Tom.

No the barium swallow wasn't horrible but it won't make my top 10 list of experiences either. Really I'm grateful for the results of the swallowing study and glad to know that there are steps we can take to prevent swallowing issues.

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Leissa Schultz Kopinski avatar

Leissa Schultz Kopinski

I am 53 and have had primary progressive MS for the last 23 years. I am in wheelchair also. I was eating cereal alone in my house and I had a choking incident leading to a laryngeal spasm. This has led me to a swallow study next week. I will then be going to a speech therapist too. I love your columns. Keep up the great work and take care!

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thanks Leissa!

And hear people thought spasticity in legs or arms was bad. Those are annoying and uncomfortable but aving a muscle spasm in your throat is damn right awful.

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Lucy Pye avatar

Lucy Pye

I too have seen a speech and language therapist for my choking in the past but thought beyond it now until raised ugly head again recently - it doesn't happen often but scary when it does! I had no idea it is so common in those with MS as if we don't have enough to deal with on a daily basis.

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thanks for the comment Lucy! I feel the same way. With everything else I've got to deal with, it dismays me that eating and drinking can be problems too.

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