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Forum Name: Gastroenterology Topics

Question: Problems with swallowing- "forgetting" how to swal


 tannilisa - Sat Nov 13, 2004 10:38 pm

Hi, I've been having some swallowing problems on and off for the past year or so, sometimes when I eat, the food goes to the back of my throat, but I "forget" how to swallow, it's really scary because the food is there but nothing happens :? I went for a barium test and it came back normal, nothing gets stuck in my esophaugus or anything, it's more of a brain signal thing where my throat can't swallow. What causes something like this to happen? should I bring it to the attention of my doctor again? I have other very strange symptoms too that have cropped up along with this.

Thanks! :)
 Dr. Russell M - Sat Nov 20, 2004 11:06 pm

User avatar Hi!

What is your doctor's opinion as to what is going on with you?

bill
 tannilisa - Sat Nov 20, 2004 11:51 pm

Well, I just recently went back to my doctor, she ran some bloodwork and I'm due back in two weeks and we'll go from there, I've been extremly exhausted and am experiencing weakness too :?
 DaveT - Sun Nov 21, 2004 12:59 am

Trouble swallowing, along with fatigue and weakness could be a sign of MS. along with about a million other things. You should ask to have an MRI done.
 Dr. Russell M - Sun Nov 21, 2004 6:25 pm

User avatar Hi!

I would leave it to your doctor to determine the cause of your problems. Swallowing difficulty can happen in a totally helpless bed-ridden patient with multiple sclerosis [MS], and MRI is not the first test to be performed in MS. MRI is usually used to locate the lesion, once the spinal fluid is examined and diagnosed as MS.

bill
 DaveT - Sun Nov 21, 2004 7:40 pm

Bill,

I speak with many people who have MS, and an MRI was always done first for them. In fact, a spinal tap is not always helpful and many neurologists don't beleive they help in making a diagnosis. An MRI is always the best way to find out if you have MS.
 nikkin - Sun Nov 21, 2004 8:38 pm

I might have something similar, I have never in my life been able to swallow something. I don't know if its a phobia that i have that Im scared to swallow or what, I just can't do it!
 Dr. Russell M - Mon Nov 22, 2004 1:26 am

User avatar Hi!

I agree MRI is a good tool for the diagnosis of MS, but again, it is used only to document a second lesion. A spinal tap is something far less expensive than MRI, and not altogether useless.

The diagnostic criteria for MS as in (Harrison's) medical textbook is as follows:


1. Examination must reveal objective abnormalities of the CNS.

2. Involvement must reflect predominantly disease of white matter long tracts, usually including (a) pyramidal pathways, (b) cerebellar pathways, (c) medial longitudinal fasciculus, (d) optic nerve, and (e) posterior columns.

3. Examination or history must implicate involvement of two or more areas of the CNS.

a. MRI may be used to document a second lesion when only one site of abnormality has been demonstrable on examination. A confirmatory MRI must have either four lesions involving the white matter or three lesions if one is periventricular in location. Acceptable lesions must be >3 mm in diameter. For patients older than 50 years, two of the following criteria must also be met: (a) lesion size >5 mm, (b) lesions adjacent to the bodies of the lateral ventricles, and (c) lesion(s) present in the posterior fossa.

b. Evoked response testing may be used to document a second lesion not evident on clinical examination.


4. The clinical pattern must consist of (a) two or more separate episodes of worsening involving different sites of the CNS, each lasting at least 24 h and occurring at least 1 month apart, or (b) gradual or stepwise progression over at least 6 months if accompanied by increased IgG synthesis or two or more oligoclonal bands. MRI may be used to document dissemination in time if a new T2 lesion or a Gd-enhancing lesion is seen 3 or more months after a clinically isolated syndrome.

5. The patient's neurologic condition could not better be attributed to another disease.
****
No single clinical sign or test is diagnostic of MS
****
There is no definitive diagnostic test for MS. Diagnostic criteria for clinically definite MS require documentation of two or more episodes of symptoms and two or more signs that reflect pathology in anatomically noncontiguous white matter tracts of the CNS (Table 359-2). Symptoms must last for >24 h and occur as distinct episodes that are separated by a month or more. At least one of the two required signs must be present on neurologic examination. The second may be documented by certain abnormal paraclinical tests such as MRI or evoked potentials (EPs). In patients who experience gradual progression of disability for 6 months without superimposed relapses, documentation of intrathecal IgG and visual EP testing may be used to support the diagnosis.




Note how the criteria says MRI 'may be used.' If MRI was the best way to find out if one had MS, then the criteria would have demanded MRI as essential. As such, tannilisa does not qualify to be clinically considered for diagnosing MS. Besides, two or more separate episodes involving two different sites of CNS (Central Nervous System) is not described by tannilisa here. If at all her difficulty swallowing could be fit into a clinical scenario for MS, assuming it to be progressing, a spinal tap would be useful to document oligoclonal bands, as per the criteria. A spinal tap, although not as helpful as MRI, does help in MS diagnosis, and is not as costly. Spinal tap can help point out that the patient may not have MS, and it helps exclude other diseases as well. Hence, a spinal tap can always be done first as a pointer, before opting for more expensive investigations.

bill
 Kirsty_Oz - Mon Nov 22, 2004 2:35 am

as bill has meantioned it can be many things... suggesting it is one thing or another based on a one sided view is unfair and could be disturbing to tannilisa


all the best with your results tannilisa and i hope you condition is resolved in a timely fashion.
 CED - Tue Nov 23, 2004 8:45 am

These symptoms are similiar to MS but the swallowing and fatigue/muscular weakness steer me more towards the possibility of Myasthenia Gravis(MG) with the ruling out of other causes via the MRI and blood tests...

Some of the classical signs of MG are the fatigue/weakening of "involuntary muscles" that we use constantly and 'unconsciously' everyday like swallowing... Another would be the neck muscles that keep your head erect... As I remember, MG occurs about 3 times more often in females than men... This can be a slow and progressive disease so symptoms may vary...

A list of your symptoms would help, most especially in a general order of their occurances..

Some help about your life style may have some significance... Do you exercise regularly?? Do you hike or camp?? Are you generally a good eater in terms healthy foods, etc.... Also any related family history is always helpful...

Have you had any rashes, even if intermitant...

I agree with Bill that allot of others things need to be ruled out before we venture towards MS or even MG...

Please let us know of your results and discussion with your Physician.... Thank you...
 Dr. Russell M - Tue Nov 23, 2004 11:40 pm

User avatar Hi!

I agree with CED that Myasthenia could also present with difficulty swallowing. Although, the eye muscles are usually affected first. Swallowing difficulty can also be caused by other diseases like motor neuron disease, Guillain Barre syndrome, syringobulbia, polio, diphtheria, and neurosyphilis.

I feel that if tannilisa had her workup done to the extent of a Barium swallow for her problems, her doctor in Massachussets, who had examined her, would have run through the possibilities of MG and MS in their minds (I hope). I also hope she gets over her problems soon. Difficulty swallowing can happen as complication of her thyroidectomy, if the recurrent laryngeal nerve got cut accidentally.

bill
 adriana - Sun Sep 25, 2005 7:09 pm

I had a very similar problem recently, where all of a sudden every time I ate I had a lot of difficulty swallowing and kept choking on my food. My glands would get swollen and it was awful. I started not being able to eat at all. The doctors offered no help and told me that everything appeared fine when I had tests done. I began eating very little, and kept note of times when the swallowing was worse than others.
It has turned out that my swallowing difficulties only arised when I was eating food which contained gluten eg, wheat, pasta, bread etc..BE careful, wheat is in ALOT of foods you wouldnt expect.. like soya sauce, candy etc..

Since i came up with this discovery I have been living gluten free and I've never felt better. I don't know if you've ever considered this, but if you havent, you should really try and cut all gluten/wheat containing products from your diet. Things like Rice and corn are alright, and ther's lots of alternatives and good food to eat for people with this problem. Apparently this is a allergy that you can develop any time in your life. Please let me know what you think about this idea, and if it works for you at all.

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