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Men's Health, Opinion, Women's Health

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #9: “Choking” (Food-Related)

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DYSPHAGIA covers a wide range of troubles, symptoms and diseases, as indicated from the excellent Infographic posted August 21, 2020. I have already discussed GERD, or trouble with the food coming back up after being swallowed.

This post will be on “choking”, or getting the food into the Airway instead of the Esophagus, or swallowing tube. In the future, I will develop a post in “swallowing difficulties”, or trouble getting the food to pass easily and freely down the esophagus into the stomach.

CHEWING the food properly is rare in our rushed, fast-food society, but it is very important, the first part of the digestion process. Mastication breaks the food into smaller particles that are easier to digest, and also EASIER TO SWALLOW. Saliva flows as you chew, and contains Ptyalin, an enzyme which breaks down starch into absorbable sugars.

Chewing also SLOWS down the rate of eating, improves enjoyment, and allows more time for the stomach to send Satiety signals to the brain. This leads to less overeating and weight gain. In children, chewing is said to aid in jaw development and to reduce dental crowding and need for Orthodontia.

Some people have trouble in Initiating the swallowing process. This can be caused by neurological problems like Parkinson’s Disease. It can also be Psychological, a reflection of fear of discomfort on swallowing.

I have the opposite problem, a tendency to swallow too eagerly and rapidly, causing me to choke on liquids, sometimes even on water. I went to an ENT specializing in swallowing problems. He checked the sensitivity of my throat to touch, and found it normal.

Apparently LESSENED sensitivity is the main concern, which would
lead to Aspiration of food. The only guidance he gave me was to eat and drink more slowly. I find that I am most likely to choke when I drink wine, or a tasty beverage which I tend to “slurp” so as to fan the aroma out broadly in my mouth. I am having a hard time breaking myself of that habit.

Sometimes I find that residual amounts of food builds up in the back of my throat, probably by my epiglottis. I worry about nuts especially. If I don’t drink some water to flush it away, I am likely to choke on it. I guess that is the reason people are told to offer some water to a person who is choking.

I seem to be choking more as I get older, which is reasonable. Swallowing requires an amazingly intricate coordination and motion in the throat area, especially in getting the epiglottis, the little door that closes off the windpipe, to close properly.

My other dexterities are fading, why should swallowing be an exception? Pill swallowing is getting more frequent and more problematic at the same time.

Tablets are worse than capsules, maybe because they are not as slick. There is one size in particular that tends to get stuck in the back of my throat just above the uvula. I sometimes have to cough a lot and choke the offending object back up. One more reason to constantly try to cut down the number of pills.

There is one good thing about this problem, however. I now take the pills separately with a big swallow of water, improving my Hydration.

–Dr. C.

Men's Health, Resources, Women's Health

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #1 – THE “CHRONIC COUGH”

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In my 88 years, I have had at least a dozen medical problems. Some have gone away on their own, some have been removed surgically, and a few have become CHRONIC, lasting for years, ultimately becoming a part of my life.

I have compiled a list of these and other SYMPTOMS & CONDITIONS I have seen as a physician. Over the next year, I will discuss them one by one, appending these vetted articles for further reading.

The ‘CHRONIC COUGH’ will be the first discussed.

As an Allergist, I was involved with coughing all of my adult life. If my patients did NOT have asthma, they usually coughed from mucus pouring down the back of their throat (post-nasal drip), from their allergic nasal condition (allergic rhinitis), or sometimes from the associated SINUSITIS drainage.

Asthma was a much more common cause of Chronic Cough for my Patients, sometimes theIr main problem. All asthmatic have a chronic inflammation of their breathing tubes(bronchi), and the resulting BRONCHITIS irritates the airway nerve endings, causing Cough.

Without enough narrowing of the airways to cause wheezing, this is called “cough equivalent asthma”. With the addition of airway narrowing (constriction) to the above situation, ASTHMA results.

There is added shortness of breath (dyspnea), and the cough becomes the “tight” wheezy cough of full-blown Asthma.

COPD (chronic obstructive pulmonary disease) may be a residue of long-term asthma, but commonly results from cigarette  smoking. Where loss of alveolae (air sacs) predominates, dyspnea (shortness of breath) is more common.

Where bronchial tube inflammation is more prominent, mucus and cough result. This cough is useful in clearing the mucus; a USEFUL COUGH (although my Patients did not always appreciate their friend, which could be bad enough to cause hernias or incontinence). 

Gastro-esophageal reflux is a chronic condition where stomach contents are not retained in the stomach by the G-E Sphincter ( a type of “purse-string” Gate), but spill(reflux) up, when not restrained by gravity, at NIGHT. The ACIDIC STOMACH CONTENTS burn the esophagus on the way up(heart burn), and are often aspirated into the airways during sleep, causing inflammation and COUGH.

There are many other less common CHRONIC LUNG ( pulmonary) DISEASES (conditions) such as sarcoidosis, bronchiectasis, interstitial pneumonitis, TB, and cancer, that can be diagnosed by imaging (X-Ray, etc.). Heart failure can also cause cough, as can blood pressure medication (ACE inhibitors). 

Smoking is an obvious cause; chronic smoking, chronic cough. Smokers know what is causing their cough, and usually don’t bother coming to the Doctor unless they cough up some blood, or develop one of the myriads of diseases caused by their habit.

If you have a chronic cough, check with your Primary Care Doctor, who may refer you to an Allergist or Pulmonologist. The following article will be useful to your understanding of cough, and will provide a LIST OF QUESTIONS the DOCTOR will likely ask you.

—Dr. C.

Further reading #1

Further reading #2