(Sorry. Couldn’t resist the title.)

Over the past year to year and a half (I’m not sure exactly when it started), I have experienced some minor trouble swallowing. I would take a sip of a beverage or a bite of something to start a meal, and I would hiccup and feel the food “stick” in my throat. I also sometimes feel like I have a swelling in my throat, and if I turn my head up and to one side–I think turning it to the right is what bothers me–for a long time, I have to “rest” my head because it feels (and this is probably totally inaccurate, but this is the impression I have) like the tendons in the left side of my neck are pressing against whatever swelling is in there and it bothers me. It’s more annoying than painful.

I do tend to get ear infections relatively often (this appears to be what may be causing some of the lymph nodes in front of my ears to remain just slightly enlarged apparently forever and ever, which also drives me nuts), so this may somehow be related to drainage or swelling from my ears. And my mother has been on synthetic thyroid hormone for as long as I can remember, so I thought perhaps that was the source of the neck swelling if it indeed exists, but whenever I’ve had my thyroid levels checked, they’ve been fine.

Anyway, I never had food actually get stuck, and usually after the first bite I was fine, so my swallowing problem wasn’t really bothering me that much. But if you Google “trouble swallowing,” one of the first results that comes up is “esophageal cancer,” and I am nothing if not a pessimist, so I asked my doctor about this. She didn’t seem too concerned but said I could have a swallowing study done if I wanted, and I said I did. So I went to an appointment where I swallowed some truly gross food and beverages laced with barium while they filmed the food traveling down into my stomach. The speech pathologist who was conducting the test said that she could see the food was sticking somewhere, but it was below the mouth and therefore outside her area of expertise, so she recommended that my doctor refer me to a gastroenterologist.

So after a lengthy waiting period to get an appointment, during which the swallowing problem actually got better and almost went away–such that even keeping the appointment seemed like a potentially pointless exercise, but I figured I might as well–I set off about a month and a half ago to a facility with a rather unpleasant logo involving a “G” drawn to look like an upper GI tract (just because it’s clever doesn’t mean you should do it) and met with the GE.

I didn’t like him very much. His intern was pretty nice, but the doctor himself was pretty abrupt and supercilious. He decided I probably had something called achalasia based on… well, I’m not totally sure why he thought this, to be honest… and generally seemed to think I didn’t know my own mind.

For example, his intern had asked me in the pre-appointment “information-gathering” phase if I had lost any weight unintentionally, and I said made a point of saying no. Because my primary care doctor hadn’t specified “unintentionally” when she asked me the same question, so I told her about the weight I’d lost over the past couple of years and then wanted to drop through the floor when it became clear that she was only asking if I had lost weight due specifically to not being able to swallow, and didn’t particularly care about the weight I had lost on purpose. (I reeaaaaalllly don’t want to be one of those people who will start yapping about Weight Watchers and telling people how much they’ve lost to the tenth of a pound at the slightest provocation.)

So when the GE came in, he asked the same question the intern had–had I lost any weight unintentionally–and I said no again. But then he asked if I had lost any intentionally, so I had to admit I had. Using an “aha” tone, he took this opportunity to lecture his intern about “asking the right questions” (at which point I of course felt like a total asshole, like I had tricked the hapless intern on purpose). He recommended an upper GI endoscopy because they tend to take swallowing problems seriously (OK, fair enough), and he “would like to give [me] credit for losing all that weight, but…”

Yeah, because I haven’t been on a diet writing down every bite and point that enters my mouth since August of 2006. (As my husband would probably put it since he enjoys this particular sarcastic construction, “If only we had some kind of written record so we could determine whether the swallowing problem has caused a decrease in food intake!”) Of course, seeing as I’m fat, we can pretty much assume I’d be lying about my intake, so all of those weekly trackers are probably useless anyway. Good thing I have paternalistic doctors to set me straight. Grrr.

In any case, I went in for the endoscopy, and the results looked fine; nothing to biopsy in my throat, no restrictions in my esophagus. The doctor did note a couple of areas of what he called “irritation” in my stomach, and once I woke up he returned to the room briefly to prescribe me Prilosec and give me a sheet with an “anti-reflux diet” to follow “indefinitely.” He gave us basically no other information, so I wasn’t totally sure what any of this was even for. I never have heartburn symptoms, the swallowing problem seems to be resolving itself, and honestly I have to wonder if the “irritation” he observed is pretty common, it’s just that most people never have color photos taken of the inside of their stomachs. I filled the Prilosec prescription, but I am really wondering if I should have because I fear that once I go off it, I really will have a heartburn problem (some say it can cause “rebound” reflux) whereas I never had one before.

But on to the anti-reflux diet. You guys, this diet is insane. Pick anything that:

  • brings pleasure to life (coffee/caffeine, chocolate, alcohol, frosting);
  • makes food flavorful (garlic, onions, peppers, black pepper, sweet and savory spices);
  • happens to be a juice (citrus, cranberry), favorite vegetable (brussels sprouts, cucumber, tomatoes, radishes, broccoli), or traditionally “healthy” food (popcorn, nuts, other high-fiber foods) that I eat or drink on a regular basis; or
  • corresponds to a habit that I have and enjoy (drinking more than 1/2 cup of liquid with meals)

and it is prohibited on this diet. The “fuck you” cherry on top is the “achieve ideal body weight” guideline tossed casually in among the other recommendations on the sheet. Wow, I’d never thought of that! You want to tell me not to come back until I lose the weight, too? That’s an easy way to get rid of a few pesky patients.

Now (I guess) I wouldn’t have a problem giving this a shot if I really thought I had a major problem with acid reflux. But seriously, I only ever have an instance of heartburn symptoms maybe every 6 months, if that. (I figure this is about the frequency that most people happen to get heartburn.) So I have had no recurring symptoms whatsoever in my torso or abdomen, only the slight swallowing issue (and I also have none of what I understand to be the other symptoms of acid damage in the upper esophagus, like hoarseness, coughing, or sore throat). I know symptoms can be felt in areas that are displaced from where the actual injury is occurring, but I just really don’t feel like this is the problem.

And furthermore, in poking around online to find out more about the anti-reflux diet (mainly to get some recipe ideas because again, everything I like to eat is on this stupid list), it’s kind of looking like weight reduction and elevating the head of your bed are the only typical anti-reflux recommendations that are actually associated with improvement of symptoms. So there really may be no evidence that any of the dietary recommendations on the Sheet of Doom even help. I am in fact suspicious that some of these recommendations may have initially been driven by moralistic “don’t drink, don’t smoke” origins, i.e. anything that tastes good or isn’t bland must be “bad” because it riles up your blood or something, rather than solid evidence; and now they are, like, codified into law because these are the directions that we’ve always given to heartburn patients. In fact, the review articles that I have come across suggest that proton pump inhibitor drugs (like the Prilosec that I am taking) are really the only reliable options, but given the funding relationships between doctors and drug companies that fat bloggers frequently question (described, for example, in Kate’s recent post), I’m not even sure whether to take that at face value.

This is frustrating to me because it seems like when people are talking about someone else, there is no limit to the dietary and “lifestyle” strictures they will enthusiastically endorse. If I took this to some kind of digestive issues forum, and expressed the slightest reservations about the strictness of the diet, I know “concerned” posters would be all over me in seconds going “Don’t you want to be well? This is the problem with America–people have no discipline.” etc. (I mean, they aren’t about to never consume a single fried item or pint of beer or tomato or recipe cooked with onions or garlic ever again, but fat people should just quit whining and suck it up.)

But honestly, I’m going to put myself out there and say that for me, there is a pretty high bar in terms of what would actually induce me to give up coffee, chocolate, and alcohol for the rest of my life, not to mention all the other stuff on the list. In particular, I love coffee. It makes my life better. Either regular or decaf is fine (so I don’t think it’s just that I’m hooked on caffeine, although really, I don’t necessarily care if I am–I’ve never seen much evidence that coffee is bad for you, so I can’t get too worried about it). In short, for me these recommendations are a non-trivial deal, if you haven’t figured that out from my angry ranting. 😛 In all seriousness, though, I wonder how many people actually successfully and permanently eschew everything on the anti-reflux list? Or do most people just spend their lives repeatedly trying and failing to cut out all of these major food categories, beating themselves up over it, and trying again? Kind of like a weight-loss diet?

I recognize that there are many situations where dietary changes are necessary for health–PCOS, diabetes, and food allergies come to mind–and who knows, maybe this is one of them. I also recognize that I am particularly cranky right now because this is the first day that I have actually tried to follow the diet, and I may have already screwed up (I went through the 4 or 5 types of breakfasts that I like and decided that an egg-white omelet–without the various features that actually make it enjoyable, such as seasoning it with pepper or having an accompanying glass of orange juice, of course–was about the only one that was “OK” as the rest were probably too high in fiber… and then I went online and saw that eggs were also off-limits according to many lists. Are you kidding me?). I didn’t get my coffee this morning, of course, and I guess I could have made some decaf herbal tea except that I don’t like tea. I can tolerate mint tea, but naturally that is the kind you can’t have on the anti-reflux diet.

(Also please note that while I am bitching and whining, there are probably those of you out there reading and going “at least you have insurance to partially cover these procedures if you need them, and at least you can get to and afford foods that fit in with the anti-reflux diet.” And I am also lucky that my health is very good overall. I do fully recognize these ways in which I am fortunate, and I apologize for the whiny rant.)

I’m not really sure what my overall point is; I’m going to try to follow the diet for as long as I can, and see if my swallowing problem goes away entirely (I still sometimes hiccup at the very start of an occasional meal, maybe once a week or even less often). I’m still worried about whatever is “wrong” with my neck at the same time as being reluctant to have it checked out further, because I feel like I have already wasted various people’s time and money by even having the scope, not to mention possibly messing up my perfectly fine digestive system by taking a medication that interferes with its natural functioning. (In many ways I wish I had just left well enough alone and never had this checked out to start with). And I’m worried that if they do a follow-up scope, the irritation will still be there and they will recommend drastic measures of some sort. I’m feeling pretty frazzled and frustrated about this whole thing even though ultimately I’m sure it’s not a big deal.