[Dysphagia] 29 Year Old Male/Sudden OnsetDysphagia/StillOngoing/Anything else it could be?

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

Just remembered the this article as well

 
Pimentel M, Bonorris GG, Chow EJ, Lin HC. 
Peppermint oil improves the manometric findings in diffuse esophageal
spasm.
J Clin Gastroenterol. 2001 Jul;33(1):27-31. 
 

Peppermint Oil Treatment
After completing the baseline recording, with the manometric
catheter remaining in place, subjects were asked to rapidly swallow
an unblinded solution of five drops of 11% peppermint oil
(Schilling, Pure Peppermint Extract; McCormick & Co., Inc, Hunt
Valley, MD, U.S.A.) in 10 mL of distilled water. Ten minutes after
drinking the peppermint oil, the esophageal manometry was repeated.
Identical manometry protocols were followed before and
after the administration of peppermint oil. The dose of peppermint
oil was selected based on clinical experience with one outpatient
with DES who found that five drops was the optimal dose to
acutely improve his symptoms. The timing of the effect of the
peppermint oil was determined by a preliminary study of two
patients with peristaltic analysis 5, 10, and 15 minutes after ingestion
of the peppermint oil, with improvement being observed after
5 minutes in both subjects.

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 Speech Julie
Sent: Saturday, July 14, 2007 2:35 PM
To: James Wright; dysphagia at dysphagia.com
Subject: Re: [Dysphagia] 29 Year Old Male/Sudden
OnsetDysphagia/StillOngoing/Anything else it could be?


Dear Jim,

Hang in there!  I don't think anyone on this list thinks its "all in
your 
head".  I agree with the manometry evaluation.  This would help identify
a 
motility problem.  Dysmotility symptoms can range from feeling as though

food gets stopped somewhere, feeling like it doesn't go through to
severe 
chest pain.  It is often intermittent, so the person doesn't know when
to 
expect it.  However, it can be very consistent as well.  The other tests
you 
have had ruled out structural abnormality, but not functional
abnormality. 
Do keep in mind that the manometric evaluation could also come back
normal 
if your problem is intermittent.

Since you have been found to have reflux, I would try to pull out all
the 
behavioral/ dietary/ positioning modifications for reflux (you can email
me 
off list if you want lots of suggestions).  Lots of dysmotilty is as a 
result of reflux and although you are on Prilosec, that only decreases
the 
acidity of what comes up, does not stop the act of the contents coming
back 
up.  You may want to try warm fluids (like warm decaf tea) with meals
which 
has been shown to aid esophageal clearance and decrease the likelihood
of 
spasm.  Cold foods and liquids can make the symptoms worse.

Good luck.  I see lots of people just like you for swallowing exams on a

weekly basis!  Keep up posted.

Sincerely, Julie
----- Original Message ----- 
From: "James Wright" <jamesrwright at windstream.net>
To: <dysphagia at dysphagia.com>
Sent: Wednesday, July 11, 2007 9:16 PM
Subject: [Dysphagia] 29 Year Old Male/Sudden Onset 
Dysphagia/StillOngoing/Anything else it could be?


>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
this
> fall. 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
least
> none 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
have
> been 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 
> illustrate
> my 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
trouble
> with 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
swallow
> tests.
>
> 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 
> Flovent
> swallow 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