I hate when my food “goes down the wrong way”!

If a Smurf chokes, what colour does it turn?

Esophagus Woes

By K. Strachan

The first time I experienced the terribly confusing, intensely uncomfortable torrent of cramping pain rippling across my chest, down my left arm, over my left shoulder and into my back, was on the way home from an unexpectedly graphic and violent action flick.

It was after midnight as I left Polo Park’s Theatre complex, on a cold January night. It was snowing… a lot; large puffy flakes were swirling every which-way making successful navigation of the roadway a major challenge, even within the city.

I was troubled, and not just by the weather or driving conditions. I was beginning to think that the intense pressure in my chest, the increasingly painful waves crashing up and down my left side, the sweat literally spurting from every pore, and my rising nausea was signally that I was in the throes of a significant heart incident.

Polo Park’s theatre complex was a full 15 km from my home and just slightly further to the nearest hospital. And it was a hospital that I was now aiming for.

Truth be told, I shouldn’t have driven myself to the Emergency Room. I should’ve summoned an ambulance at the theatre. I was simply attempting to expedite my trip. Stupid choice? Perhaps, but after what seemed like forever, I arrived at the Victoria Hospital and presented myself to the triage staff.

I must’ve looked terribly compromised as I stumbled, dripping sweat and clutching my chest, into and then through the outer doors of the Vic’s emergency entrance. The triage nurse on duty flew from behind the her station, grabbing a wheelchair and a colleague as she sprinted towards me. In a blink, I was rapidly positioned in the chair and whisked into the back for treatment of some kind. By this point, my heart was pounding right out of my chest and I was most definitely panicky…

…More than a full day later I was released – returning to my regular scheduled life. Side note: Isn’t this just like Parkinson’s Disease – a life punctuated by medical visits, calm periods followed by unexpected turmoil!

Over my stay, I had been prodigiously poked and prodded, having copious bloodwork done. Additionally, I had been scanned repeatedly – EKGs, x-rays, an esophageal manometry and an MRI. I had been seen by the emergency docs and eventually by two specialists.

To my surprise the Cardiologist spent very little time talking to me. Why? Turns out I hadn’t been experiencing the trauma of a major heart incident/attack. Relief on that front. The Gastroenterologist (a doctor specializing in the digestion system) however, did.

What I had been experiencing were violent esophageal spasms! What? I’d never heard of them. But here’s the skinny on what seems to be an ongoing issue for me.

Mayo Clinic Explains Esophageal Spasms

Esophageal spasms are extremely painful contractions within the esophagus, a tube that runs from the mouth to the stomach. They often present as sudden, severe chest pain that lasts from a few minutes to many hours and are sometimes mistaken for a heart attack/incident.

What exactly causes esophageal spasms is currently a mystery. However, they appear to be related to atypical functioning of nerves that control the muscles one uses to swallow.

It can be a challenge to recognizing these spasms for what they are, or rather, for what they are not! Here’s why:

Symptoms of Esophageal Spasms

• A feeling of heartburn or a painful squeezing type of chest pain
• Intense chest pain that may spread to the neck, arm or back
• Trying to swallow food or liquid during a spasm, may cause a person to bring it back up within seconds

Sounds like a heart attack? Feels like a heart attack? Therefore, must be a heart attack? Not necessarily so, it turned out! I was relieved that in my situation I had decided to get my collection of symptoms checked by competent medical practitioners at a reputable hospital ER.

Mitigating the Problem – Part 2

To understand better how my story fits with Parkinson’s Disease, we have to skip forward a couple of decades to my Parkinson’s Disease Diagnosis Date (PDDD). Most of the individuals I know impacted by this neurodegenerative disorder, vividly recall the chest-seizing, mind-numbing moment when it was decided by well trained Neurologists and/or Movement Specialists (also neurologists) that they had Parkinson’s disease. My PDDD was November 25, 2000 at 11:30 AM! Based on multiple, extensive diagnostic sessions, during which my history of ongoing issues with my digestive system, overly stiff musculature, chronic pain and speech issues to name a few of the key symptoms I had experienced historically, indicated an earlier onset of the disease. The consensus was that I’ve likely had Parkinson’s disease since my mid-30s! Crikey!!!! This did explain a lot about my medical history though, despite the incredible shock it caused.

Since my diagnosis, I have had a swallow study done twice; both have indicated that my esophagus is compromised, neurodegeneratively. I am struggling with swallowing properly and choke while eating and drinking with some regularity. The term for this is DYSPHAGIA.

There are two types of Dysphagia:

• Oropharyngeal dysphagia occurs in the top of the throat behind the mouth. Patients with PD most commonly experience symptoms of oropharyngeal dysphagia.
• Esophageal dysphagia occurs only in the esophagus.

If dysphagia is present, the muscles in the esophagus may not contract as strongly, quickly, or in an organized way. The Mayo Clinic provides some details about what you might expect with Dysphagia!

It’s likely I am experiencing the former type of Dysphasia, as food I swallow gets stuck in my esophagus at the epiglottis – a trapdoor that flips between my lungs and digestive tract. 

Luckily, there are treatment protocols to help mitigate some of the inherent challenges with problematic swallowing and a ne’er-do-well esophagus (choking, loss of airway, aggressive infections, lung damage, etc…). For example,

• Dopamine agonists (such as ropinirole and apomorphine) – This type of medicine mimics dopamine and tricks the brain into thinking there is enough dopamine in the body, which can improve some symptoms.
• Rehabilitation – This can include swallowing behavioural therapy and speech pathology to help train the muscles and improve swallowing.

What have I done to help myself with dysphagia? Besides scheduling annual swallow study testing with my Speech-Language Pathologist to better track the degenerative progression of my Dysphasia, I participate in an hour long PD focussed choir twice weekly and through my involvement volunteering at St. Amant Centre; I read for 45 minutes weekly to my “PAL.”

U-Turn Parkinson’s offers U-Tunes which is a Music Therapist designed class that incorporates breath work, vocal warm-up, and singing/music activities to promote overall wellness. U-Tunes uses the powerful effects of music to sustain neurological processes such as coordination, movement, and rhythm. In addition, the program supports the strengthening and maintenance of the voice and swallowing ability.

I have also participated in Singing with Parkinsons , an online choir led by Paula Wolfson. There is a clear connection between singing and stronger voice and swallowing abilities.

• Group singing has been long proven to provide physical, emotional and social benefits.
• For those with Parkinson’s disease, it may increase vocal strength, breathing and swallowing control

Supporting my voice and swallowing improvement plan, my reading at St. Amant primarily provides me with regular opportunities to sustain and strengthen my voice and throat muscles.

I’ve also had recommendations from my work with a Speech and Language Pathologist at the Movement Centre in Winnipeg near Deer Lodge Hospital:

• Eat slowly
• Do not use straws
• Teaspoon size bites and sips
• Alternate food with liquid intake (food bite, swallow twice; liquid sip, swallow twice, REPEAT)
• Avoid mixed consistencies
• Add sauces or condiments to moisten food
• Avoid high risk foods choking food like hotdogs, hard candies, grapes, nuts, baby carrots and the like. Cut these items length-wise so they aren’t circular
• Pay close attention to your oral care: brush and clean after each meal.

What a list!! It’s taken me considerable effort to establish these new eating protocols. It’s a work in progress.

After all is said and done, my swallowing ability will likely degenerate further; my esophagus will continue its problematic contractions, I will continue to choke and experience esophageal spasms. It’s the nature of this disease. However, the work I do strengthening my voice, sensibly preparing and consuming food and drink decreasing food and liquid risks, paying closer attention when I am eating and minimizing distractions has helped.

I both have a stronger voice and am better able to sustain conversations for longer. I am swallowing with greater presence of mind as well which amounts to choking less. At least for the time being.

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