It’s not uncommon in ALS for something to unexpectedly and abruptly aggravate your
airway and throw you into a choking fit. I know from personal experience that these choking,
gagging, gasping spells are physically exhausting, frustrating and extremely unnerving for both
the choker and the caregiver. The actions to take for choking depend on the type of choking
spell you’re having. For example:
The Heimlich Choke
A large piece of food completely blocks the airway. You can’t speak or cough. This is an
emergency! It requires the Heimlich maneuver, either by a caregiver or self-administered, to
force the blockage up and out. If not successful in two tries, call 911 and continue trying the
Heimlich while waiting for help.
The Damn-Near Heimlich Choke
A pill or bit of food sticks in your throat. After a moment you can breathe but with a scary
“heeee” sound. Just as you start getting a little air in, you start coughing and/or
gagging again. Over and over. You can feel the darn thing stuck in your throat teetering
between sliding up and making you gag and sliding down and making you cough. This is scary,
exhausting, but you can get a breath in between coughing spells. The Heimlich or assisted cough
technique may help. Focus on getting the obstruction up and out, not down the throat, because
of the danger that it will lodge more firmly or go into the lungs. Therefore, avoid back
whacking!
The Foodless Sneaky Choke
You’re just sitting there minding your own business or even snoozing when suddenly
you’re coughing and choking. A simple swallow of saliva goes awry or a dry throat or
nothing at all can set them off send your larynx
(vocal cords) into a spasm that closes off your airway. This is called a laryngospasm and
isn’t uncommon in ALS. You fight to inhale but nothing happens. You can’t take a
breath, can’t call for help, and panic crashes over you. After an eternity, you finally
suck in a thin, wheezing, tiny “eeee” breath. Slowly the spasm eases.
The only thing I’ve found that helps me through these is the hard-learned lesson that
they’re intense but short-lived. You’re not really choking, you can get some air,
and the spasm will ease in just a moment or two.
Caregivers can help by giving calm reassurance, gentle back rubbing (not whacking) and other
support in riding out the spasm.
The Phlegm From Hell Choke
You try to clear your throat. Hrrrmph. Hrrrrrrrrmph. No good. Over and over you try to break up
and cough out the thick clog in the back of your throat until you’re worn out and
gasping. My treatment is to take a dose of papaya juice or expectorant (guaifenesin, available
over the counter) to thin the secretions. Then I lie down (BiPAP on) and have my caregiver do
an assisted cough or use a cough assist machine. By lying down, I don’t have to fight
gravity to bring the mucus up. Staying well hydrated can help keep secretions thinner.
The Non-Choke Sticker
A pill or bit of tortilla chip sticks on the way down and sits there feeling like a thorn in
your throat. This little sucker can hurt for a day or more. After taking a small sip to make
sure I can still swallow, I try taking the longest drink I can. Sometimes this repeated
swallowing does the trick. Another way to dislodge it is to try different positions. Lean or be pushed side to side and foreward and back fairly quickly several times. Have someone lift you to stand if you can. If you can swallow but can't dislodge that sticker I have found that
a few bites of plain bread slathered in butter will grease it up so it can be swallowed the rest of the way.
Advice to Caregivers: In any choking situation, fake being calm and quickly go through a
list of possible actions. Ask, “Do you need a Heimlich? Assisted cough? A drink? Cough
medicine? Suction?”
Besides the physical and emotional stress of a choking attack, the real danger of
suffocation and the loss of calories due to fear of eating, choking can lead to aspiration, in
which food or pills go into the lungs and cause life-threatening pneumonia.
