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Nov 24, 2006
Learn about ALS
Newport News
about swallowing


HI all,

I'm a newbie and not diagnosed, but do work with neurological disorders and swallowing. In answer to you question Liz about swallowing:

Depending on what muscles are being affected will determine what foods you're having difficulty with during intake. Are the solids hard to chew, get stuck in your throat or further down? Does following it with liquids usually help?

You may find that moister foods slide down more easily once muscles start to weaken and you may need to finely chop some items. Sticky foods, will tend to do just that, stick, if your pharyngeal (the muscles in your throat) and esophageal muscles are losing strength and not pushing things down as well (the peristaltic waves to push foods down may be weakening).

Liquids will become a problem with time as will's the nature of the beast of ALS, in which all the muscles beccome weaker and you don't have the airway protection, thus you aspirate (any liquids, solids or foreign material going into the airway). Sometimes the innervation is lost for the proctection of cough as well, therefore a person can silently aspirate and liquids can go into the lungs w/o any symtpoms until one gets an aspiration pneumonia. Also, with the weakening of the respiratory muscles, it makes it more difficulty to clear out the aspirate.

Reflux can occur as the lower and upper esophageal sphincters of the esophagus loosen and weaken. Reflux though can occur in many people, it just may happen earlier with ALS or other neurological disorders.

If you continue to have swallowing problems, you need to ask the doctor for a videofluoroscopics swallowing examination done by a speech pathologist, so they can tell what is causing your swallowing problem and advise you on the safest way to eat as well as what textures/consistencies. S/He may also want you to have an esophagram which looks at the esophageal phase of the swallow. Manometry can also be perfomed if they think you have weakness in the peristalsis to measure the strength of your muscles.

The video swallow (VFSS also called a modified barium swallow or MBS) is painless and non-invasive. You will be given various foods and liquids mixed with barium so that it shows on xray, and it's real time and videotaped so we can see everything that happens. An esophagram or barium swallow is the same, only they look at the actual esophagus (tube to the stomach) and give you much more barium. This will give them an idea if you are refluxing and what else may be going on in your esophagus.

For now, if you are having reflux, here are things you can do:

Try to eat smaller meals frequently throughout the six smaller intstead of the usual 3 meals we're taught.

Don't bend over at the waist for an hour after meals.

Don't eat for 2-3 hours before going to bed.

Don't lie down for at least an hour after eating. Sleep with a foam wedge on your bed to keep you elevated. Extra pillows don't help as they bend you at the wrong place and can cause more reflux. You can also elevate the bed at an angle by using blocks to place the head of the bed portion of the bed up about six inches.

Don't wear tight or restrictive clothing around your waist.

Dietary changes:

Try to limit or avoid spicy foods, acidic foods like citrus and vinegars and tomato sauces, fatty foods.

Avoid carbonated beverages, caffienated beverages, chocolate and peppermint, and alcohol.

Avoid smoking.

If you chew gum, that's always good to do after meals or if you feel like you're having long as it's not peppermint! It causes you to swallow more and produce more saliva, both of which will cause more movement in your esophagus and also the saliva can help to neutralize the stomach acid and the enzyme pepcin from your stomach.

In short, a quick lesson on dsyphagia (swallowing disorders).

I hope this helps. Please ask for a swallowing evaluation!

God Bless,

Thank you so much for this infomation. May husband has had alot of difficulty in the last 3 months on swallowing. He has to drink something with every bite and he has to sleep elevated.
Linda, what great information. Thank you for posting that.

I have a question: When I take spoonfuls of yogurt to swallow pills, the yogurt seems to keep sliding back into my mouth. It will take maybe half a dozen hard swallows to get it to stay down. Is this reflux?

Also with tube feedings: these too seem not to want to stay in my stomach. Can there be reflux with the tube also? I had a few teaspoons of yogurt the other morning for my pills, then tried to take an Ensure by tube. When I uncorked the end of the tube, the yogurt came spewing out. Often the tube feedings back up rather forcefully and pop the syringe out of the tube. (By often, I mean once or twice a day.) Because I feed by gravity (not strong enough for the plunger), I do the tube lying down.

So now I wait a long time between eating by mouth with eating by tube. I also started adding a little Coke at the beginning, middle and end of the tube feedings to dissolve any clogs.

Any insight is very much appreciated.
My Husband was diagnosd with ALS in December and I am having a hard time with the pregesion of this diease. Please share your thoughts!
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