Patients with multiple sclerosis suffer from a plethora of symptoms, and with each case of the disease progressing differently, the uniqueness of each situation makes it difficult to keep track of everything that a patient needs to look out for. While the issue of mobility is perhaps the most well known and heavily treated, some other symptoms are just as serious and have dire consequences if not addressed.
One such symptom is dysphagia, or difficulty swallowing. This can be defined as trouble starting the process of swallowing or the feeling of having food stuck in the throat or chest. There are obvious dangers when this problem arises, but some aren’t so obvious. It’s important for MS patients to know everything they can about their disease, and that includes these seven facts about swallowing problems.
1. How swallowing problems occur
Multiple sclerosis is an autoimmune disease, which means the body attacks itself. In this particular disease, the immune system targets the myelin in the central nervous system (CNS). Myelin is the coating that both protects the nerves and speeds up electrical impulses and neural signals. In these attacks, the nerves are damaged, which can cause problems in several areas of the body, depending on where the legions are formed and the nerve fibers are destroyed. Often, there is damage to (or at least inflammation) around nerves that control swallowing and speech. This leads to the difficulty in swallowing.
2. When dysphagia occurs
Up to forty percent of multiple sclerosis patients suffer from dysphagia at some point during their disease. In many cases, this doesn’t become a serious problem until the disease has advanced; however, because the attacks on the nerves seem to be random, any symptom can occur at any stage. Often, those with relapsing-remitting MS experience some level of dysphagia and speech difficulty during relapses, with some remission allowing them to have normal functionality most of the time.
3. Coughing and choking hazards
When a patient with dysphagia tries to swallow, they often experience difficulty getting the food or liquid down. They:
- Cough when attempting to swallow liquids
- Choke on certain foods, especially if they are dry or crumbly in texture
- May gag on food that seems to get stuck in their throats
- Induce heartburn or similar heaviness to the chest when food seems to be stuck in the esophagus
All of these lead to further dangers.
4. Food and liquid in the lungs
Because swallowing is a problem, not all food and liquid makes it down the esophagus to the stomach and is instead inhaled into the lungs through the trachea. This induces coughing and choking, as well as feelings of irritation in the lungs that could last for days. Sometimes, a person won’t even know that they’ve inhaled a very small amount of food or water, a condition known as silent aspiration, which can also have negative effects.
In fact, these substances in the lungs could cause complications in multiple sclerosis patients such as abscesses or pneumonia. Aside from the obvious threat of these problems, any sort of infection in a patient with MS can exacerbate other symptoms and cause a relapse, and because many medications suppress the immune system, can become extremely dangerous to the patient.
5. Not enough food and water
Because food and liquid aren’t swallowed appropriately, a patient with MS has a greater risk of malnutrition and dehydration. This only becomes worse if the patient gets frustrated and refuses to eat or drink. While it’s no wonder, considering that continued effort can lead to extreme fatigue, finding ways to remedy this problem is essential to the continued health and strength of the patient.
6. Diagnosing dysphagia
Before any sort of treatment is prescribed, the condition must be diagnosed. The MS patient will swallow a small amount of barium, a substance that causes all the parts of the mouth, throat, and esophagus to “glow” on an x-ray. Then, the patient is given various consistencies of food and liquid to eat and drink, while a videofluoroscope (an x-ray video) is taken of these areas, helping to identify which types of food and drink cause problems with chewing and swallowing, as well as where in the process the trouble occurs. All of this is done by a speech-language pathologist.
7. Treating dysphagia
There is no cure for multiple sclerosis, and treatments are meant to either manage symptoms or slow the progression of the disease. In the case of dysphagia, there is nothing to be done about the nerve damage. However, speech-language pathologists, who can also help with the accompanying speech problems that typically occur with patients experiencing dysphagia, have several strategies to assist in coping with the swallowing issues.
- Exercises can assist in strengthening the weakened muscles of the throat and neck so that symptoms are minimized during a flare up.
- Stimulation of the nerves and muscles in the throat, mouth, and around the esophagus may be an option to help improve the functionality of swallowing from beginning to end.
- Strategies for safer eating habits are taught, including best body and head position to increase swallowing capabilities.
- Techniques such as double swallowing can be taught to help with efficiency and assuring nutrients reach their destination. In addition, ways to do so without exerting too much energy and causing fatigue can be discussed and learned.
- Dietary changes may be suggested to avoid some of the foods and drinks that cause the worst reactions in MS patients when swallowing.
While most symptoms can’t be remedied completely and there is no cure for multiple sclerosis, it’s important that patients diligently assess their symptoms to learn which are most detrimental and if they are getting worse. In addition, treating those symptoms with the tools available is crucial to living a full, happy life.
Even with the major symptoms, such as ambulatory problems and dysphagia, there are options and methods to improve quality of life. Taking the time to speak to a physician about possible solutions for the worst of these scenarios can truly change the course of life, if not the course of the disease.