[Dysphagia] 29 Year Old Male/Sudden Onset Dysphagia/Still Ongoing/Anything else it could be?

[EDolinger at Christianacare.org (Dolinger, Eric)]

I agree with manometry.
Also sometimes barium swallow studies are done with marshmallows...may
be of some value

Eric Dolinger, MA CCC-SLP
Senior Speech Pathologist
Christiana Care Health System 
Phone 302-733-1015
Fax 302-733-1061
edolinger at christianacare.org

Main office 302-733-1010


-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com] On Behalf Of
dgrabo at nycap.rr.com
Sent: Thursday, July 12, 2007 6:41 AM
To: James Wright
Cc: dysphagia at dysphagia.com
Subject: Re: [Dysphagia] 29 Year Old Male/Sudden Onset Dysphagia/Still
Ongoing/Anything else it could be?


Dear Jim,  
   Sorry for your frustrations.  Sounds like difficulty with the
movement or motility of the solid 
foods through 
the esophagus.  To test muscle functioning in the esophagus would
require yet another test 
called manometry.  
It would probably be best to couple this with a pH balance test/probe
since you do have 
signs of reflux as well.  
If food is retained in the esophagus you can feel tension in the throat
area (globus sensation) 
even though the 
food may have passed through the upper throat just fine.  A repeat
esophagram (barium 
swallow) using barium 
pills might highlight the problem - or not - many times this test is
"negative" but the person 
still has the 
symptoms.  

   Retry chewing solid food - but before you go to swallow, spit out the
food.  I know this 
sounds gross but you 
need to determine if the food really has been chewed so thoroughly as to
look just like 
pureed or soft foods 
(you said you had no problem with applesauce, soft cookies, etc.).  If
the solid food is much 
lumpier, then the 
obvious thing is to make sure you do chew it to a state of pureed.  If
you are chewing 
effectively, try following 
each bite with a few sips of water.  Some people find following solid
food with jello helps to 
flush the food 
through the esophagus as well.  

    If that doesn't work, stick with foods that you know you can get
down (make sure what 
you're eating is 
nutritionally sound) but slowly re-introduce one solid food per meal
starting with snack 
foods.  Fritos, potato 
chips usually mash right down to a mush and can then be swallowed.
Gradually build up to 
meats and breads.  
  
   If you're taking any other medications besides Prilosec you need to
check if the 
medications have any bearing 
on your problem, especially if the medications result in dryness.  In
any event, try increasing 
your water intake.  

    Hopefully some of these suggestions will be helpful.  Diane

----- Original Message -----
From: James Wright <jamesrwright at windstream.net>
Date: Wednesday, July 11, 2007 9:18 pm
Subject: [Dysphagia] 29 Year Old Male/Sudden Onset Dysphagia/Still
Ongoing/Anything else 
it could be?
To: dysphagia at dysphagia.com

> I am not sure what to do or where to turn. 
> 
> 
> 
> Here is my situation. Sorry if ramble. I am a 29 year old male that 
> had a
> sudden onset of dysphagia at the end of April. Stuff suddenly felt 
> as if it
> was not going down smoothly. I have been to a variety of doctors, and
> basically they are telling me it is in my head. I do have anxiety 
> now about
> eating, but only because I feel like stuff is not going down right. 
> I am
> desperate to get better since I am scheduled to go back for my MBA 
> thisfall. I had no surgeries or trauma to my throat.  The foods 
> that are giving
> me problems are "harder" solids such as rice, crackers ,even harder
> vegetables i.e. bits of carrot inside of a wrap. Softer items are 
> no problem
> for me.  Sometimes I feel as if I have to cough..I don't cough 
> anything up,
> but I have that urge. I have never had a choking episode per se, at 
> leastnone recent. (choked on a chicken bone when I was 5)I am now 
> paranoid to eat
> foods such as  chicken or hot dogs in solid form but only because I 
> havebeen having issues with them. I never had any fear of choking 
> before. I used
> to drive down the road with a 12 inch hoagie at 50 miles an hour 
> and eat
> with no problem. I know dangerous and messy, but I am using it to 
> illustratemy point that there was no long standing fear..Here are 
> the tests I have had
> so far. 
> 
> 
> 
> 1.       ENT did a Flexible Endoscopy back at beginning of May. I 
> had normal
> closure of my airway when swallowing, but I did not swallow 
> anything I would
> be having trouble with i.e. solids. The test was performed with
> pudding/applesauce with food coloring. He thought maybe it was 
> caused by
> reflux despite my lack of symptoms so I have been on Prilosec twice 
> a day
> since beginning of May. 
> 
> 2.       I had a CT scan. Nothing showed up other than mild sinus 
> disease;nothing that could account for my dysphagia. 
> 
> 3.       I had two barium swallows, regular and modified. I am not 
> sure why
> the doctor did the regular once since I never had trouble with 
> liquids. The
> modified one was down with a soft cookie; once again, I don't have 
> troublewith mushy carbs such as cookies, and Nutri-grain bars, just 
> hard stuff. I
> told the doctors that, but they did not include such a bolus in my 
> swallowtests.  
> 
> 4.       The upper GI endoscopy revealed mild felinization of my 
> esophagus.They did a biopsy. They did fine some eosinphils in my 
> esophagus, but fewer
> than 5 per high powered field. There were no visible lesions or 
> webs or
> anything like that in my esophagus. The number of cells was 
> consistent with
> reflux, but visibly I had no damage per se.  The doctor put me on a 
> Floventswallow just in case it may have been due to allergy. 
> 
> 
> 
> I am at my wit's end as to what is going on. I am going to a respected
> medical center, UPMC in Pittsburgh.  I swear I am not 
> crazy..really..I am
> not. I tried to talk myself out of there being a physical cause, 
> but I keep
> on having feelings in my throat when I am eating that alarm me. 
> Anyone have
> any idea as to what this could be? Possibly a different angle on 
> this? Any
> assistance would be appreciated. I need to get better ASAP. 
> 
> 
> 
> Thanks!
> 
> 
> 
> Jim
> 
> _______________________________________________
> Dysphagia mail list: Normal and disordered swallowing information
> Dysphagia at dysphagia.com
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
> 
_______________________________________________
Dysphagia mail list: Normal and disordered swallowing information
Dysphagia at dysphagia.com
Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
Visit the new Dysphagia Web Forum: http://dysphagia.com/forum