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Doctors' Answers to "Frequently Asked Questions" - Swallowing


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 10/31/1999]
Question: I have been taking Nortriptyline for about 6 months after being diagnosed via Motility Study for Esophegeal Spasma. Since I was unhappy with the side effects of Noritriptyline, my physician recently switched me to ProCardia. My normal intake of calcium is 1500 mgs via food and supplemants. Is this going to be a problem since ProCardia is a calcium blocker? Do you know of any studies of the effectiveness of ProCardia in treating patients with my condition? Thanks.

Answer: Although they are in a class of drugs called calcium channel blockers, your oral calcium intake will have no effect. The calcium channel blocking is occurring in the muscle cells and has nothing to do with intake or serum levels of calcium. Calcium channel blockers are the mainstay of treatment of recurrent esophageal spasm.

Eating Difficulties Due to Swallowing Problems [posted 11/10/98]
Question: My 84 year old mother in a nursing home, has severe Dismensia, diabetis, is non-communicative, has stopped eating and drinking due to choking. She is on an I.V. for hydration only, and the speech therapy team advises N.P.O. due to asperation fear. Has not eaten or drink for 14-16 days. Any helpful suggestions?

Answer: Did a swallowing evaluation get performed by the speech therapist? If so, you either have the choice of some type of feeding tube or taking the chance of aspiration pneumonia and the risk of infection/death that that entails. Sometimes there is a difference in solids and liquids. I'd get the details of the study.

Painful Swallowing [posted 11/10/98]
Question: I am a white male, age 48. I have recently quit smoking but prior have smoked 2/3 packs a day for 30 years. I drink approximately 12/18 12 oz. beers a week. I have had this problem for the last 10 months. I have been to 3 different doctors and 2 different hospitals and spent approximately $8,000. to find out basically nothing. The first ENT scoped my throat in her office, sent me to the hospital for a thyroid function test and a barium swallow x-ray. All test results were fine according to her and she started me on some prevacid. I went back to see her in a couple of weeks and told her the prevacid did not do anything. She said there was nothing more she could do and referred me to a gastrologist. The gastrologist performed a larnyscopy on me at outpatient and took some biopsyís of my stomach. He told me the biopsy results were fine and put me on some amitriptyline and also told me to keep taking the prevacid. The second ENT I saw did not like the idea of the gastrologist performing the larnyscopy on me, as he said this was not his field of expertise. He set up and performed another larnyscopy on me with the exact same results but for twice the money! He also told me to keep taking the prevacid and to stop smoking and that there was nothing else he could do for me either. I am in dire need of some reliable advice. All 3 of the doctors I have seen seem to be stuck on the idea that this problem that I have can be nothing other than reflux. They have all asked me about all of the symptoms of this and all 3 were told time and time again that I have none of the symptoms of reflux. In the beginning, the pain would come and go. Sometimes be gone for as much as a month at a time. Recently though, it is constant. It feels like a blockage in my throat just below where my jawbone is and most of the time it is very painful getting by this spot just swallowing naturally. When eating, it feels like food actually get stuck there, not to the point where I feel like I am going to choke but just something that does not want to go down. I also have a very foul taste in my mouth all of the time since the onset of this.

Answer: Sounds like you have a difficulty swallowing. A swallowing evaluation(usually done by a speech therapist) would be the first thing. Second, you may have a Zenker's Diverticula. This is a congenital "pouch" at about the area you are indicating. It produces foul breath and occasionally pain. A barium swallow is usually the best way to find it. Good luck.

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