Swallowing problems

[gallahadesquire]

My apologies if I didn't read the thread close enough, but make sure SOMEONE is paying attention to all the data. In the Olden days, it would have been your internest / primary care. Given my disillusionment with "Primary Care", find a doc you trust and let them coordinate things (I'd go ENT then GI, but that would be me). Unless you have enough medical knowledge.

[Guest]

I'll agree with the chorus that you should get medical information from health professionals, not the internet. As a general principal, cancer rarely presents with pain, unless the cancer has spread to an advanced stage. I racked my brains, and can't think of any cancer in which the cancer itself causes pain. Even when cancers come up in areas with tons of pain fibers, like the anus, cancers usually cause numbness rather than pain. I have seen many men come in with testicles the size of grapefruit before they came in because it wasn't hurting. When cancer causes pain, it's usually either because it's spread to bones and is chewing up the bone (or the bone breaks), or because the cancer has popped clear through the organ (i.e. a stomach cancer goes all the way through the stomach and the acid spills all over the place). Maybe your health plan has an Advice Nurse RN you can call? Your primary care provider would be even better...

Edited June 24, 2015 by Guest

[Rudynate]

I'll agree with the chorus that you should get medical information from health professionals, not the internet. As a general principal, cancer rarely presents with pain, unless the cancer has spread to an advanced stage. I racked my brains, and can't think of any cancer in which the cancer itself causes pain. Even when cancers come up in areas with tons of pain fibers, like the anus, cancers usually cause numbness rather than pain. I have seen many men come in with testicles the size of grapefruit before they came in because it wasn't hurting. When cancer causes pain, it's usually either because it's spread to bones and is chewing up the bone (or the bone breaks), or because the cancer has popped clear through the organ (i.e. a stomach cancer goes all the way through the stomach and the acid spills all over the place). Maybe your health plan has an Advice Nurse RN you can call? Your primary care provider would be even better...

 

 

All the advice nurse ever does is tell you to come in.

[+ FreshFluff]

Unicorn, your advice was very helpful, but I've made an appointment to see a doctor. Also, thank you for racking your brain to help me out on this!

Regardless I made an appointment with a gastroenterologist whom I'll be seeing soon..

 

My apologies if I didn't read the thread close enough, but make sure SOMEONE is paying attention to all the data. In the Olden days, it would have been your internest / primary care. Given my disillusionment with "Primary Care", find a doc you trust and let them coordinate things (I'd go ENT then GI, but that would be me). Unless you have enough medical knowledge.

 

Unfortunately, my primary care doctor is in my home state. . I was able to get a good GI doc's name name before I could find a good ENT, so I went with the former. I'll probably data-dump him with everything I can think of.

Edited June 24, 2015 by FreshFluff

[+ FreshFluff]

As promised, here is my not very dramatic update: The doctor asked some excellent questions, used the tongue depressor, and then told me he had never heard of anything like what I described. I have to give him credit though: He said it didn't sound like muscle tension due to stress either. He referred me to an ENT who can do a more appropriate test, which will probably be that barium swallow thing.

 

While I'm glad it's nothing serious so far, waiting in doctors' offices is going to get old fast.

 

All the advice nurse ever does is tell you to come in.

 

The health plan nurses? I though their main purpose was to keep people from coming in with colds and other complaints that don't require a doctor.

Edited June 24, 2015 by FreshFluff

[Guest]

As promised, here is my not very dramatic update: The doctor asked some excellent questions, used the tongue depressor, and then told me he had never heard of anything like what I described. I have to give him credit though: He said it didn't sound like muscle tension due to stress either. He referred me to an ENT who can do a more appropriate test, which will probably be that barium swallow thing.

 

While I'm glad it's nothing serious so far, waiting in doctors' offices is going to get old fast.

 

The health plan nurses? I though their main purpose was to keep people from coming in with colds and other complaints that don't require a doctor.

 

I would agree that an Advice RN's main job should be to keep people from coming in when they don't need to. If all they did was tell people to come in, it would seem to be a complete waste of money--an expense with no benefit. RN's usually command six figure incomes. Hopefully, the "more appropriate test" which the ENT will do is laryngoscopy, not a barium swallow. A barium swallow is helpful to either detect a mass lesion, which would be expected if the symptom was that of food getting stuck, or, even more importantly, to evaluate people with disordered swallowing who are at risk for aspirating into the lungs. The latter would be suspected if someone keeps choking when they swallow, or gets pneumonia, or has another condition which put the patient at risk for aspiration (neurological diseases, muscular diseases, altered mental status). The symptom of pain suggests inflammation, not a disorder of swallowing itself (dysphagia is trouble getting food or liquids down; odynophagia is pain with swallowing). A barium swallow cannot identify any reason for inflammation (unless there is an inflamed mass lesion, but in that case there will be a swallowing problem (dysphagia) in addition to pain). Although pretty safe (as long as the barium isn't aspirated--which can be a problem when you're doing a test to see if a patient is at risk for aspiration), the radiation dose isn't exactly negligible, although far less than for most CT scans (but about 30 X that of a chest X-ray and 100 X dental bite-wings). It probably increases your risk of getting cancer at some point by about 1 in 7500. All a barium swallow might find in your case would be incidental findings: that is, findings which have nothing to do with your symptoms. Hiatal hernias are often found, and they are irrelevant and certainly not the cause of the symptoms you describe. It could also show reflux, but that wouldn't explain your symptoms either.

Laryngoscopy is about as low-risk as procedures get. If it's negative and your symptoms are gone, I would drop it. If you get pain when swallowing again, someone needs to look into your esophagus and get biopsies (looking for reflux esophagitis, eosinophilic esophagitis, yeast, or whatever). A barium swallow can only add needless data, not help with your diagnosis.

[Rudynate]

I got pill esophagitis once from taking a pill with a small sip of water and then going straight to bed. I woke up a couple hours later with the worst sore throat in memory. I had a lot of difficulty swallowing food for three or four days after.

[+ Gar1eth]

I got pill esophagitis once from taking a pill with a small sip of water and then going straight to bed. I woke up a couple hours later with the worst sore throat in memory. I had a lot of difficulty swallowing food for three or four days after.

 

Alway swallow with a full glass of water and for some pills you need to stay upright for a period of time.

 

Gman

[Guest]

Always swallow with a full glass of water and for some pills you need to stay upright for a period of time.

 

Gman

The classical example are the bisphosphonates used to treat osteoporosis. These should be prescribed with ample warnings to swallow with a big glass of water, and then not to lie down until after you've had breakfast. Some antibiotics can cause an irritative esophagitis, too. Rare with most other medications.

[+ Gar1eth]

Alway swallow with a full glass of water and for some pills you need to stay upright for a period of time.

 

Gman

 

The classical example are the bisphosphonates used to treat osteoporosis. These should be prescribed with ample warnings to swallow with a big glass of water, and then not to lie down until after you've had breakfast. Some antibiotics can cause an irritative esophagitis, too. Rare with most other medications.

 

I think I remember feeling some pharyngeal soreness after swallowing a horse-pill-sized fluoroquinolone. And of course DOUBLE-Strength Bactrim ain't a Tic-Tac by any means.

 

Gman

[Rudynate]

The classical example are the bisphosphonates used to treat osteoporosis. These should be prescribed with ample warnings to swallow with a big glass of water, and then not to lie down until after you've had breakfast. Some antibiotics can cause an irritative esophagitis, too. Rare with most other medications.

 

 

Pradaxa is big offender.

[+ FreshFluff]

Thanks again, everyone, for the help. I finally made it to the ENT, who did the necessary exam and found nothing. He said the issue is mysterious, but came up with a possible cause. He ordered an MRI, which I can do if the issue continues. I'll probably let this go for now..

Edited July 23, 2015 by FreshFluff

[+ Gar1eth]

Thanks again, everyone, for the help. I finally made it to the ENT, who did the necessary exam and found nothing. He said the issue is mysterious, but came up with a possible cause. He ordered an MRI, which I can do if the issue continues. (He initially wanted a CT scan but I prefer to minimize exposure to radiation when possible.) I'll probably do it in when I have more time.

 

I'm glad everything so far is negative.

 

Gman

[Rudynate]

Fluff, there are so many factors that can be involved. The fact that it occurred right after a dental procedure could have triggered something and there might be a cause and effect relationship. You are right on target by having both the doctor and your dentist evaluate the situation. There could possibly be some sort of refered pain of a dental nature that might be contributing to the situation. However, there are also many other scenarios in addition to esophageal cancer that could be causing the issue. The Internet is a great tool, but at times it's possible to be overly informed.

 

I have always said that many patients are seemingly so well informed that they are actually uninformed in the sense that they don't have a proper grasp or understanding of the issues at hand.

 

Many of us have been in your shoes so we can relate to your concerns. Let the professionals diagnose and in the meantime take a deep breath, relax, and think positively. Easier said than done, but do try.

 

 

People tend not to appreciate the difference between information and knowledge. Highly-informed lay people think they "know." But they don't. They just have a lot of information floating around in their heads. Professionals, with their years of training and experience, "know."

[thickornotatall]

People tend not to appreciate the difference between information and knowledge. Highly-informed lay people think they "know." But they don't. They just have a lot of information floating around in their heads. Professionals, with their years of training and experience, "know."

Who knew?

[edjames]

Pain or trouble swallowing can be a symptom of a thyroid problem. It can indicate nodules on the thyroid which may interfere with swallowing.

An endocrinologist can help diagnose and a sonogram of the thyroid may be a followup.

Nodules can be benign or cancerous. Most can be removed quickly with an out patient procedure.

[+ FreshFluff]

People tend not to appreciate the difference between information and knowledge. Highly-informed lay people think they "know." But they don't. They just have a lot of information floating around in their heads. Professionals, with their years of training and experience, "know."

 

I definitely didn't know. But In this case, the pros didn't know either. The GI doc ran labs that showed severe ID anemia, but no one could explain the swallowing issue. I noticed that it resolved a couple of weeks after I started taking iron. It turns out that dysphagia (and carious variants) occasionally presents with ID anemia.

[+ Gar1eth]

I definitely didn't know. But In this case, the pros didn't know either. The GI doc ran labs that showed severe ID anemia, but no one could explain the swallowing issue. I noticed that it resolved a couple of weeks after I started taking iron. It turns out that dysphagia (and carious variants) occasionally presents with ID anemia.

 

What exactly do you mean by 'ID Anemia,'@FreshFluff? Google didn't have that abbreviation listed.

 

Gman

[+ FreshFluff]

What exactly do you mean by 'ID Anemia,'@FreshFluff? Google didn't have that abbreviation listed.

 

Gman

 

Iron deficiency anemia. There’s a rare syndrome called Plummer-Vinson that’s associated with it. Formally diagnosing would have required an endoscopy.

Edited December 28, 2019 by FreshFluff