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Ask Dr. Gott 2/15
Swallowing problem leaves man puzzled
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    DEAR DR. GOTT: I am a 75-year-old male in reasonably good health. The reason I am writing is to relate a series of events that still puzzles me.
    About eight years ago, after taking a bite of salad at a backyard barbeque, I felt a pain. It was in the upper center area of my chest and felt as if a muscle in my esophagus had constricted and would not allow the food to continue its passage to my stomach. My breathing was not affected, but my speech was. It was hoarse, raspy and very weak. There was also some nausea while the muscle spasm continued.
    Someone told me to drink some water to "wash it down," but it only added to the discomfort. I decided not to do anything else and waited for the sensation to pass. About 10 minutes later, the symptoms slowly disappeared, and I was able to finish eating as though nothing had happened.
    Since that time, I have had six or seven more episodes, usually one a year. They all cause the same symptoms — namely, a localized feeling of pain and constriction in the central chest, speech impairment and nausea. I have found that instead of waiting for the eventual easing of symptoms, I can achieve immediate relief by leaning over a toilet and putting my finger on the back of my tongue to induce my gag reflex. I do not have to vomit, just gag, and it seems to be enough to dislodge the food and allow it to pass normally.
    One of these episodes occurred when I swallowed a single drink of water. This tells me that, at least in this case, it was not caused by a poorly chewed morsel of food.
    Because these events do not, thus far, appear to be life threatening, I am more curious about a cause than alarmed.
    DEAR READER: Your symptoms strongly suggest esophageal spasm (constriction of the swallowing muscles). To diagnose this problem, you will need to have an X-ray swallowing study. You may also benefit from a referral to a gastroenterologist. Depending on the outcome of the swallowing test, the doctor may choose to do an endoscopy (lighted fiberoptic tube with a camera). This procedure allows the doctor to see your esophagus, stomach and a portion of the small intestine. In this manner, the physician can identify any abnormalities that may be present, such as an ulcer.
    Although you are probably correct in assuming that this problem doesn't indicate something serious, I would feel more comfortable — as I am sure you would — being able to prove that. See what the gastroenterologist has to say.
    To give you related information, I am sending you a copy of my Health Report "Medical Specialists."
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