Saturday, April 1, 2017
barium swallow and modified upper GI
Some of you may remember last August when I was eating and then suddenly could not breathe (again) and Marc had to jump up and give me the heimlich and my granddaughter was sitting there witness to the whole pissy mess, if not you can read about it here, and I promised everyone I would go to the doctor about it. Well, I had my annual last week and I mentioned to my primary care doc in an oh-by-the-way manner about the freaky spasms and the choking thing and before I was finished talking she was writing down orders for a barium swallow test, a modified upper GI test, a chest x-ray, and a referral to an ENT. So there was plenty of fun to be had in my immediate future.
I got the x-ray right away and they scheduled the other two tests for last Monday and they had to be on an empty stomach, so nothing to eat or drink past midnight. First I talked with a speech therapist trying to tease out exactly what happens and when and how often and for how long, if there is any unifying element. There’s two issues here, one the whole spasm thing where when I swallow, the food scrapes or scratches (or something but it's always a sensation so I know what's coming even if I'm powerless to stop it) the inside of my throat and I start coughing and then sneezing forcefully and more coughing and eyes tearing and my vocal cords freeze up and I can’t talk but I can breathe fine throughout the whole event. And then there are the three times when I couldn't breathe and I think I’m choking and Marc does the heimlich on me which opens my airway barely but enough air to work through it myself, inhaling with that horrible sound and exhaling as hard as I can until I can gradually breathe completely again. And then there's the times when I aspirate tiny amounts of liquid, a few drops getting past before the glottis or larynx closes off the airway. Or when food starts to fall into my esophagus before I'm ready to swallow. Eating, it's all fun and games kids.
The speech therapist isn't convinced I'm choking in the literal sense, in that she doesn't think I've aspirated liquid or food since there is no food being expelled when Marc heimlichs me and also because if I was choking in the literal sense, once the obstruction was expelled then the airway is immediately cleared and that's not what happens with me. It's more like I'm suffocating because my airway has been closed off. She says it's a possibility that my vocal cords (larynx) are responding to some sort of stimuli which causes them to flatten out and obstruct my airway. Turns out two things happen when you swallow...the glottis closes and the larynx flattens out, both of which act to protect the airway.
So the first test was to swallow this thin barium liquid while she and the radiologist watched and conferred on the x-ray. I was turned to the screen so I could watch too. The first thing I did when they turned the screen on and I could see my skull and jaw and teeth was laugh. I mean we all know there's a skeleton inside us but to see it in real time and watch myself swallow was weird. The point of this test was to see if whatever it is that happens that causes either the spasm or suffocation happens while they can watch but of course, it never does. There were four thicknesses of this stuff but she passed over the middle two and went straight to the thick 'pudding' of barium, then with a bit of graham cracker mixed in but still no cigar.
Then they had me drink a bit of fizzy stuff to get air in my stomach and then this other medium thickness barium stuff a few swallows at a time while they watched further down the esophagus and from different positions. I couldn’t see that part. Then I had to drink a whole cup of the thick barium which was about the consistency of a milk shake but it didn’t taste nearly as bad as I had feared and they took x-rays every 30 minutes or so until it reached where the upper and lower intestines came together. They said everything looked good and I could go. They’ll send the test results to both my doctor and the ENT I went to see the following Thursday. The speech therapist also gave me a lot of printed info on swallowing disorders and strategies for coping with it. I went home and finally got to eat around 3 PM.
TMI? Not yet.
It would have been nice had they given me a little warning about what to expect when it all came out the other end. Seriously ooky.