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

[Rachelle.Simpson at SESIAHS.HEALTH.NSW.GOV.AU (Rachelle Simpson)]

Thank you so much for your response Diane - I learnt so much from that!
Pardon my ignorance, but can I ask which professional conducts the
manometry testing, and the pH balance test/probe? Is that a
gastro-enterologist, a therapist working with this physician, or someone
else? Based on their findings, what type of things can they usually
advise in their management? (eg: modification to diet, medications,
swallowing strategies, etc)

Have a great day, and good luck James!
Rachelle

-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com] On Behalf Of
dgrabo at nycap.rr.com
Sent: Thursday, 12 July 2007 20:41
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
> 
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