Discussions By Condition: I cannot get a diagnosis.

Swallowing difficulties

Posted In: I cannot get a diagnosis. 6 Replies
  • Posted By: Anonymous
  • August 17, 2009
  • 02:35 PM

I'll try to keep this short... Female, 46. Six years ago, while drinking, a bit of coffee got stuck in my throat (not up nor down), after some days/weeks of some trouble making things go down my throat. Since then I haven't been able to swallow (specially solid food) normally, which means that right after waking up and while still sleepy I eat anything - after that I stop having the ability of controlling that part of the movement that sends food from mouth to throat. Usually the difficulties peak around the middle of the day and at evening they get a bit better. I'm able to swallow solids that can be turned into liquids in one's mouth (like crunchy cookies), if I concentrate myself real hard and swallow with a lot of water. These are the good times because twice a year I have what I now call a crisis, that may last some months: during the whole day (mid-morning to mid-evening) I can't even swallow saliva which gets to be a foam (not foamy - real foam...) and the only way of getting some of the saliva downwards is to sort of making the opposite movement (as if in spitting it out). To make matters worse, when I manage to get some food or liquid through I get a massive reaction of salivating... and not being able to swallow it.

When all this started I spent some year or two cheking all doctors and medical specialities I could think of (yes, psychiatrists too...). Brain MRI OK, blood tests OK, laringoscopy OK (no endoscopy because there was some agreement to the fact that it couldn't be achalasia and I was simply too weak to endure such a thing - besides I was unable to initiate the movements to "swallow" the tube). Nobody got any diagnosis - mainly this "OK, nothing's wrong with you, bye now" kind of answer.

Well, I'm in the midddle of a crisis right now, as you can guess, and quite desperate, as I usually get. Besides it seems to me that after every crisis symptoms worsen a little bit and now liquids are starting to "go the wrong way" quite often. A strange fact: crisis stop immediately if I get a cold or flu (which generally is the sickest I get).

Although I work really long hours and I am a bit stressed out most of the time, I don't see any connections with stress or anxiety (beginning and end of crisis, nor interruption or amelioration of symptoms during the period that a shrink decided I was nuts and drugged me with everything he could think of). And it definitely isn't an eating disorder!

By now I'm quite used to hunger pangs and to the fact that my life quality has been severely downgraded. What is sending me in a downward spiral is the fact that my work means I have to talk all day (I'm a psychologist) which is impossible if saliva isn't swallowed, and most of my day is spent on the (illusion?) of impending suffocation.

Longer than I intended - sorry.
Any ideas, anybody? Anyone ever heard anything that ressembles this? I appreciate you taking the time!

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6 Replies:

  • Okay, if you don't mind I'd like to know more about the initial symptoms which led to the coffee incident. Please tell me how the earliest symptom presented itself and whether or not you have any other symptoms or circumstances that seem odd, regardless of whether you consider them related. Dysphagia can result from a number of underlying causes, so I want to be certain that we have a clear picture of how the problem manifested. It's also important to realize that stress and anxiety can indeed produce a form of dysphagia that is non-organic in origin and results from vigilence to directing influence over a function that is largely autonomic. In other words, trying to force yourself to swallow can actually become quite difficult because the coordination of the musclulature responsible is affected. As you well know, the gag reflex is one of the most difficult to extinguish and in light of precipitating factors that could have produced an aversion, it would be difficult to overcome the resistance to swallowing that might reproduce the event related to the coffee. Furthermore, psychotropic or anxiolytic therapy would have little or no effect upon extinguishing the reflex and subsequently, no change in your aversion. Changes to the dysarthria in the presence of a cold or flu would also argue against an underlying organic pathogen which is undetered by the presence of such illness. I mention these aspects collectively because you stated that the symptoms tend to be worse during the day and that they subside slightly in the evening. Although not universally true, variation in intensity would tend to argue against an underlying pathology capable of producing dysphagia. Again, however, a more clear picture of your symptomatology would be helpful in ascertaining differential considerations. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • August 18, 2009
    • 00:00 AM
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  • My brother has something similiar and it is called Oesophagial Reflux. It is where the oesophagus doesn't work correctly and swallowing can be difficult. It doesn't always happen but it is a bit painful when it occurs and makes eating a slow process. I think he may have some medication to take that helps it a bit.
    netparsley 7 Replies
    • August 18, 2009
    • 03:39 AM
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  • Okay, if you don't mind I'd like to know more about the initial symptoms which led to the coffee incident. Please tell me how the earliest symptom presented itself and whether or not you have any other symptoms or circumstances that seem odd, regardless of whether you consider them related. Dysphagia can result from a number of underlying causes, so I want to be certain that we have a clear picture of how the problem manifested. It's also important to realize that stress and anxiety can indeed produce a form of dysphagia that is non-organic in origin and results from vigilence to directing influence over a function that is largely autonomic. In other words, trying to force yourself to swallow can actually become quite difficult because the coordination of the musclulature responsible is affected. As you well know, the gag reflex is one of the most difficult to extinguish and in light of precipitating factors that could have produced an aversion, it would be difficult to overcome the resistance to swallowing that might reproduce the event related to the coffee. Furthermore, psychotropic or anxiolytic therapy would have little or no effect upon extinguishing the reflex and subsequently, no change in your aversion. Changes to the dysarthria in the presence of a cold or flu would also argue against an underlying organic pathogen which is undetered by the presence of such illness. I mention these aspects collectively because you stated that the symptoms tend to be worse during the day and that they subside slightly in the evening. Although not universally true, variation in intensity would tend to argue against an underlying pathology capable of producing dysphagia. Again, however, a more clear picture of your symptomatology would be helpful in ascertaining differential considerations. Best regards, J Cottle, MD Thank you for your kind interest. I was always quite sensitive to swallowing - always chewing things carefully and many years before I stopped being able to swallow pills. Also noticed in the couple of years before the coffee incident that it was hard for me to eat in tense social events (like professional ones where I had to really pay attention and was under scrutiny). About 2 or 3 months before the coffe incident I had gone to a throat doctor to assess what seemed to me like sometimes having a certain difficulty in "blank swallowing") and he said I had a bit of rinite. I didn't pay much attention to any of this, nor did I get worried in any way. The coffe incident was just after a lunch with some co-workers I was very relaxed with, although in the midst of a very challenging working time, just before long due holidays - I remember being very tired and generally tense.Right after the coffee incident I stopped being able to feed myself, but again I tried not to think or worry about it too much for a few days (my husband only knew something was wrong about 3 or 4 days after that, when I really started to freak out because even liquids were becoming hard for me). After that it was ***l for several months, maybe a year - not knowing what was wrong, losing 20% of weight very quickly (and I'm already thin), feeling desperately hungry all the time and not knowing how to get food into my stomach, and watching my life going hopelessly down the drain. Slowly I got to this understanding that, as long as I'm really sleepy, I can eat normally, so sometimes I even get up in the middle of the night to have a proper meal, besides a good breakfast - and then up to 12 or 16 hours of fastening. I have always had a very good health (cluster headaches in the last 4 years, and bouts of migraines ever since, but very controlled in the last 15 years), sleep very well, have a normal appetite and nothing whatsoever that looks odd. I'm psychologically very resilient, good humoured (always laughing) and not at all prone to worries about health. The only different thing is in these last few years I've started to have a general sense of fear that I link to the fact that most of the time I'm fighting this feeling of impending suffocation.Naturally, sweet, salty, hot or bitter flavours are easier to start the swallowing process, and in the rare occasions when I manage to eat something it has to be "pushed" with lots of liquids. Having my head even slightly bent backwards makes it harder. Movement as in a car can be really difficult (to swallow saliva, of course; anything else would be an impossible task). In these last 2 or 3 years I've been feeling completely drained - I really have to focus on getting through just the next minute without collapsing, but I go on with my life as if everything were OK (if swallowing doesn't depend on will power, at least having a normal life does). And it really puzzles (and scares) me this foam bouts and the uncontrollable salivation right after eating even a bite or drinking anything. I hope this is useful information; if there is anything you need to make something out of this, please just ask, as I'm at a loss trying to figure it out and getting to any relevant piece of information that might help understanding and maybe point me in the right direction to overcoming this thing.I'm deeply grateful for your taking the time to look into this!
    Anonymous 42789 Replies
    • August 18, 2009
    • 09:16 AM
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  • Okay, based upon your follow-up comments, I don't believe we're dealing with any type of organic pathology known to produce dysphagia and it appears far more likely to be psychosomatic in nature. The act of swallowing is a very orchestrated event, but nevertheless innate. In other words, the voluntary aspects of masticating food into a bolus ceases at the point where the more autonomic reflex of swallowing commences. In fact, the presence of a bolus of food, or liquid, represents the antecedent so to speak that results in a coordinated swallow response. What I believe to be occurring here is a habitual voluntary interference with the fluid autonomic process that produces a swallow response. It's also critical to realize that the only aspect of the process which is learned is that which occurs just prior to swallowing. In other words, humans learn by trial and error very young in life about how much and what kind of food and beverage products can be comfortably swallowed. It's the outcome which produces alteration in how food and beverages are consumed. I think in this instance that some predisposition is evident by your past history that has resulted in such a dramatic course at present. What you seem to interpret as hypersialosis, or extreme salivation, is actually a natural physiological response being exacerbated by the dysphagia. Food products that represent starches are actually exposed to predigestion in the mouth as a result of contact with saliva, which breaks down the starch components. It is the combination of this digestive process, together with mastication, that results in the appropriate creation of a bolus that is suitable for swallowing. What has occurred here is the purposeful interference with a natural process as a consequence of a negative outcome, ie choking on the coffee. You are unable to relinquish voluntary control, which has caused the swallow response to become dysphagic, or even arrested in some instances. It is interesting to note that you experience less resistance when sleepy or tired, which actually makes sense. Realize that voluntary control over autonomic responses becomes extinguished to a large extent as vigilence is lessened and its influence capitated. The same sort of diffculty is encountered by some patients who become vigilent to blinking or breathing, potentially complaining that something is wrong with their eyes or in the case of respiration, can't get enough air. In other words, there is a natural cadence and rhythm associated with most autonomic processes and it is awareness to, and interference with, this cadence that causes dysfunction in some instances. I trust that as a psychologist of one specialty or another, you do realize that I'm suggesting this to be a learned response and nothing to do with organic disease or physical abnormality associated with the dysphagia. I will also suggest here that a phobic manifestation has resulted with regard to fear of suffocation or choking to death. It is likely that when examined on a step-wise basis, you are unable to physically induce a swallow response and only at the far outset of being able to do so, does the natural process of salivation become dramatic due to constant welling of the saliva while repeatedly attempting to cause a swallow response to commence. It makes sense that the saliva is being partially regurgitated due to the dysphagic activity. It's critical to realize that strict voluntary control over an autonomic response causes it to lose the characteristics which make it perform in a natural context. In other words, you are incapable of invoking voluntary control over each muscle group in precise coordination that makes it possible to perform a swallow response in the same manner as it would occur under pure autonomic influence. The consequence is dysfunction. I believe that some work needs to be done in separating you from the notion that you're in imminent danger of choking and that you must extinguish your vigilence toward trying to control the swallow response and let it return to pure autonomic regulation. A barium swallow study will help identify the more technical nature of the dysphagia and I would recommend that you seek a referral for such a study to commence. I would also suggest that you seek counsel with a professional colleague who can help you determine whether and to what extent you have developed a learned response that must be extinguished in order to regain your sense of normlacy. I'm not so certain that pharmacotherapy would be of much value in this instance and for that reason, would suggest that it remain a last resort in lieu of more suitable options. You'll be fine. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • August 19, 2009
    • 00:49 AM
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  • In addition to that, you can try tapping: www.emofree.com
    Monsterlove 2921 Replies
    • August 19, 2009
    • 09:10 AM
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  • Same problem.I've lost 100 pounds due to this.Everything is exactly the same escpecially the foam in the mouth and the excess saliva.I am currently seeing a chiropractor which did help for a while but now it seems to be going the opposite way again.Both my mom and dad suffer from TMJ and believe it's related
    Anonymous 42789 Replies
    • August 29, 2009
    • 05:08 AM
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