Swallowing and Nutrition Considerations

What problems are associated with appetite & nutrition in MS?

Appetite decline: Appetite decline is a common symptom in people with advanced MS and can lead to depleted protein stores that impact skin health and overall wellbeing.

Poor fluid intake: Water is a major component of blood and dehydration reduces the body’s blood volume. This reduces oxygen and nutrient delivery to the skin. Baseline fluid requirements for an adult are a minimum of 1.5 litres per day. With swallowing problems, and sometimes concerns about incontinence, many people with MS do not take adequate fluids.

Swallowing problems: Coughing after drinking liquids, or choking while eating certain foods, particularly those with crumbly textures, are signs of swallowing difficulties, or dysphagia.

When this kind of coughing or choking occurs, the food or liquids are inhaled into the trachea (windpipe) instead of going down the oesophagus (gullet) and into the stomach. Once in the lungs, the inhaled food or liquids can cause pneumonia or abscesses.
 

How can nutritional & swallowing problems be evaluated?

Swallowing problems are initially diagnosed by a careful history and neurologic examination of the tongue and swallowing muscles. A special imaging procedure called a modified barium swallow (videofluoroscopy) is used to evaluate a person’s ability to chew and swallow solids and liquids.

In this test, the person drinks a small quantity of barium, which makes the structures of the mouth, throat, and oesophagus visible on x-ray. The movement of these structures is recorded on videotape by a videofluoroscope as the person eats or drinks foods of varying consistencies—thin liquid, thick liquid, and solid. The precise location and manner of a swallowing defect can then be identified, and treatment prescribed. It is important to remember that the testing might not replicate your experience at home.

Swallowing, like many other MS symptoms, can change from day to day and hour to hour. Therefore, the timing of the test, whether it is in the morning or afternoon for example, could make a difference in the results. A speech & language therapist is the professional who diagnoses and treats swallowing difficulties.

Many people who have difficulty swallowing also have speech disorders. Speech & language therapist also evaluate, diagnose, and treat these problems.

You can self refer to your local speech  and language therapist or GP, Public Health Nurse or your local MS Regional Office can make a referral on your behalf.

• Speech and Language

  

  The Irish Assocaition for Speech and Language Therapists