Lessons learned from the dysphagia symptoms that come with my ALS

How I've adjusted my restaurant protocols and even my posture to swallow

Dagmar Munn avatar

by Dagmar Munn |

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Swallowing. It’s such a simple thing for most to do. But swallowing can also be a scary maneuver, especially when it turns into an ALS symptom called dysphagia. I began experiencing it about four years after my initial ALS diagnosis. And because that was nine years ago, I’m sharing a few tips and the lessons I’ve learned within that time.

In my column “When ALS Becomes a Hard Act to Swallow,” I describe my first days of dysphagia.  I wrote about calmly sipping coffee one morning till I suddenly felt the hot liquid traveling straight down into my lungs. Luckily, a few minutes of nasty gagging, coughing, and gasping for air saved me from having to dial up my local EMTs. A follow-up visit to my ALS clinic confirmed the diagnosis.

With my form of dysphagia, I can chew and swallow normal foods, but I have to add a powdered thickener to all my liquids.

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Too much powder

In restaurants, I used to feel embarrassed about having to drink a thickened beverage and invented various ways to blend in with other diners. One strategy was to order a cup of coffee and stir in the powder from a repurposed pill bottle that I carried in my purse. But I soon realized that the act of thickening my coffee at the table and drinking it with a straw drew way too many stares from diners.

To add to my frustration, the pill bottle once came open in my purse, coating everything inside with a yucky, sticky powder. It was obvious I needed a better way to prevent such an unfortunate incident, as well as strengthen my self-confidence.

Now, I follow the simple (and much more logical) method of bringing my premixed drink in a kid-size sports bottle with a built-in straw. The bottle is small and inconspicuous, and the restaurant staff doesn’t mind. I sit and sip with an air of confidence. Funny thing, when I looked around the room, I realized people were so self-absorbed in conversations or typing on their phones that no one was noticing me anyway.

Focus and strength

By far, one of the most important lessons I’ve learned from having dysphagia is the interconnectedness of our bodies. Let me explain.

Swallowing, for me, has become a maneuver best done with absolute focus and good posture. I’m careful to minimize distractions while eating, such as reading, watching TV, or having conversations. Conversations? Yes. I follow a personal rule of never talking while eating. Well, it’s not quite that severe; I make sure that I chew and swallow completely before answering someone’s question. It also helps that if the meal includes conversations, I take smaller bites of food or focus on the discussion entirely and take my leftovers home in a box.

Practicing good sitting posture while eating and drinking helps prevent further swallowing issues. The best way to keep myself from slumping and slouching is to strengthen my back, neck, and abdominal muscles, which validates the morning and evening exercises I do each day.

Finally, I’ve learned to adjust and adapt, and I’m always ready to move on to the next solution. Although our ALS symptoms may vary from one patient to another, we all share the same wish of finding the best way we can continue to live our lives. And I know we can learn to live well while we live with ALS.

Note: ALS 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 ALS News Today or its parent company, BioNews, and are intended to spark discussion about issues pertaining to ALS.


Lis Carr avatar

Lis Carr

I was Diagnosed last May. The worst day of my life. I started noticing last summer it was difficult to knee in my gardens and work. I had to sit with a stool with arms to help myself up. I just have it in my right foot ( which has resulted in Drop Foot) I can walk, but to very far without pain in my hip. I've tried to pray it away but it hasn't worked. My two biggest sadnesses ia leaving my beautiful Husband who is such a beautiful support to me. I wanted to grow old with him. I try to stay positive and tell myself I'll live 10 more years without more debilitating issues. I hope we can stay in touch. I live in Rochester NY Blessings Lis

shane spiegelman avatar

shane spiegelman

Love the detail and humor in your post. You are on target. It is all about adjustments.

Dagmar Munn avatar

Dagmar Munn

Thank you!

Hanna avatar


Hi, I am very inspired by all of your beneficial and unique ideas to improve the lifestyle of ALS individuals. I presently have very little problem with my swallowing, and as you purported I to place extreme focus when I’m eating. However, in my last 2 multidisciplinary visits to my neurologist the topic of a feeding tube continues to surface. They would like to place one within the next 3 months. I love eating my chicken wings and my brisket, and was wondering what are your thoughts on a feeding tube and if most ALS individuals need one.
Thank you & God Bless,

Dagmar Munn avatar

Dagmar Munn

Hello Hanna, the need for a feeding tube for an ALS patient varies widely. For example, some patients are having swallowing issues and need it asap. Others don't "need" it for swallowing, but their respiratory scores are low - - which might hinder being put under anaesthesia later on, so a feeding tube is placed early on. Neurologists and dieticians want to avoid missing this window of opportunity... so, they often bring the topic up during your visits. However, some ALS patients live many years without ever needing a feeding tube. This is a decision to be made by you and your doctor.

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