Eating can be an exhausting process for ALS patients and can cause choking.
ALS, also known as Lou Gehrig's disease, stands for amyotrophic lateral sclerosis. It is a progressive disease that affects the nerve cells in the brain and spinal cord. Motor neurons connect to the spinal cord from the brain and to the muscles throughout the body. As motor neurons die, patients lose the ability to control their body and eventually become paralyzed. When the muscles in the throat deteriorate, ALS patients begin to choke.
Causes of Choking
When ALS patients develop problems with swallowing, they often first notice that they salivate more, according to the ALS Association. The excess saliva not only making daily functioning more difficult, it can also be life-threatening because it can cause choking. This is especially of concern during mealtime, when the body increases saliva, making choking more of a hazard.
Preventing Choking
The ALS Association suggests that patients who have difficulty with swallowing make a checklist of preventative measures before they eat, to reduce the likelihood of choking. This checklist includes eating in a relaxing environment; sitting up as straight as possible with the head tilted slightly forward and the chin down to prevent food from going down the airway; not breathing until food has been completely swallowed; eating slowing and thoroughly chewing food; concentrating on swallowing and removing distractions such as radio or TV; coughing whenever necessary to prevent food from going down the airway; not eating alone and making sure someone in the room knows the Heimlich maneuver; cleaning the mouth after eating; and sitting in an upright position for at least 20 minutes after eating.
Diet Changes that Prevent Choking
As the disease progresses and swallowing becomes increasingly difficult, a change in diet may be necessary. For example, thicker liquids such as fruit nectar may be easier to swallow than thin liquids like coffee, tea, water or soda. It may become necessary to add a commercial thickening powder to liquids to make them a similar consistency as fruit nectar. Soups may need to be further broken down in a blender or thickened with mashed potatoes or baby cereal. Soft, moist food is easier for an ALS patient to chew, therefore making it easier to swallow because they are not so tired from chewing. These foods can include meatloaf, boneless fish filets, canned fruit, ripe bananas, pudding, macaroni and cheese and others.
Foods to Avoid
Certain foods are very difficult to chew and should be avoided at all times if the patient has difficulty swallowing. Such foods are raw fruits and vegetables, nuts, peanut butter, corn, crackers, bread and lettuce.
Managing Saliva
People without ALS swallow normally and without thinking about it. People with ALS have to concentrate and make a concerted effort to swallow. They can help manage their excretions by avoiding very sweet foods; remembering to swallow frequently, but slowly and carefully as it is possible to choke on saliva alone; using a suction machine to clear the mouth if necessary; using milk substitutes if milk seems to make the excretions worse; and avoiding chocolate.
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