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Throat Problem


twix38

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Tammi,

Thanks. Couple of points

Yes, I do have my tonsils and looking at them they are completely normal. My lump feeling is not in my mouth as such, but further down nearer the bottom of my neck, so I assume this excludes anything to do with Tonsils?? I would certainly assume so.

No bad breath smell either thankfully ;-) No ear pain and no sore throat or bad taste. Well worth mentioning and I am having a look and going to gargle with some salt water, just for the hel_l of it.

Actually, when I previously had my tonsilloliths (never knew the word) I had it rarely, but always in the same place and it was at the back of my mouth upper right hand side, but not on and not extremely close to my tonsils.

How are you feeling now? Have you heard back from Bumrungrad? Have they perhaps suggested you have an x-ray?

To summarise:

Difficulty swallowing for over a year; feeling that food gets stuck not always but often and happening much more recently.

Feels there is a small lump 'lower down' in the throat which cannot be 'washed away'.

Blocked throat needs clearing more than usual.

Whistling noise that comes and goes and UK doctor was concerned about.

Hiatus hernia

Acid reflux

Asthma

Has had white calcifications at back of throat. ? tonsilloliths.

No ear pain, no bad breath, no sore throat, no bad taste.

Prescribed omeprazole to reduce stomach acid and Xanax for globus hystericus.

Patient is concerned about continuing omeprazole for longer than 4 weeks and feels that Xanax is not helping and in fact night time symptoms have been worse last 2 nights.

Any pain on turning your head? Any pain anywhere? Dizziness? Sleep apnea, snoring?

Voice alteration, cough, sinusitis, bloodshot eyes? Increased salivation?

What are your night time symptoms?

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Tammy,

feeling a bit better thanks.

I have stopped all medication and just been gargling nightly with salt water.

I feel little different, but possibly and surprisingly just a little bit better. Too early to tell if it is real and it may of course be my medication working still. I have stopped it for now as it has to stop in about 1 week anyway. I can always resume for a while, if it gets worse again.

Your summary is correct and no pain or dizziness anywhere or any other symptoms you mention.

Night time symptoms were worse sleep pattern and on waking a slightly worse feeling of lump in throat when swallowing. As not improved, hence I stopped all medication for now. Stopping Xanax, as it may have effected my sleep pattern and Omeprazole as I only had about 1 week left until I needed to stop anyway and I wanted to see how I felt unmedicated, being as I was actually feeling a little worse.

No reply from Bumrungrad, so I will resend my email

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Tammy,

feeling a bit better thanks.

I have stopped all medication and just been gargling nightly with salt water.

I feel little different, but possibly and surprisingly just a little bit better. Too early to tell if it is real and it may of course be my medication working still. I have stopped it for now as it has to stop in about 1 week anyway. I can always resume for a while, if it gets worse again.

Your summary is correct and no pain or dizziness anywhere or any other symptoms you mention.

Night time symptoms were worse sleep pattern and on waking a slightly worse feeling of lump in throat when swallowing. As not improved, hence I stopped all medication for now. Stopping Xanax, as it may have effected my sleep pattern and Omeprazole as I only had about 1 week left until I needed to stop anyway and I wanted to see how I felt unmedicated, being as I was actually feeling a little worse.

No reply from Bumrungrad, so I will resend my email

Glad to hear you are feeling a little better. I will be surprised if you hear from Bumrungrad. Try phoning and asking for Customer Relations and ask for Marcia and put your case to her. I wouldn't bother speaking with any of the others in Customer Relations.

If lump in throat feeling persists it should be investigated further - at least that's what I would do. I had a condition for years that went undiagnosed - nothing could be found. God knows what was written in my medical record (this was in a western country with NH). Eventually I paid privately for MRI and bingo! Then would you believe specialist who had been seeing me for years refused to operate! So then I had to run around to find a surgeon quickly as I was due to go overseas. Only surgeon available was someone who had made a small error and was just back after being banned for 3 months. He found something 'the likes of what he had never seen before', and brought in another surgeon for advice (2 heads better than 1). They cut out the offending bit and that was that! Strange (rare) things do happen to our bodies and sometimes we have to be persisitent with the doctors whatever they might be thinking of us. But that said, doctors will/should look for sparrows first but have a list of differential diagnosis in their heads if the sparrow doesn't go away after treatment.

Edited by Tammi
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Twix,

If I understand correctly you do not actually have any troubkle swallowing (i.e. when you eat and drink, the food goes down OK, no choking or gagging or regurgitating), you just have the sensation of there being something stuck in your throat, especially at night. This is classic "globus sensation"and fairly common.

I suffered from it myself quite badly about 2 years ago so I know how disturbing it is. In my case I settled for just a visualization by an ENT and based on that (which saw nothing except some redness/inflammation consistent with GERD) assumed it to be GERD and treated accordingly. I can't tolerate any of the drugs that decrease acid production (headaches and insomnia from them) so I took simple antacids and also sucralfate, a drug that works topically on the stomach. At the suggestion of the ENT, added Motilium. All of these helped but only a bit.

Then (for other reasons, mainly a desire to lose weight) I did an 8 day fasting/detox program. To my surprise the globus was completely gone a few days intio the fast and stayed gone, I think mainly due to cutting out caffeine, plus of course sleeping on a virtually empty stomach.

Since then it has stayed gone except if I over indulge in either caffeine or food right before bedtime. In which case I take antacids and clean uop my act with regards to the caffeine and food.

Just my experience. Of course, neither I nor anyone else can give you a 100% guranatee there isn't some sort of very small mass in your esophagus (would have to be verysmall to have not shown up on the barium swallow); if you want to be totally assurrred on that point you'd have to under go esophagoscopy (same basic procedure as a gastroscopy but they really need only to look at esophagus and the sphincter between esophagus and stomach).

BTW your sleep problems could well be from the omeprazole, it's a common side effect.

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Thanks for the reply. The reason I haven't been to see the doctor is because this last month it seems to have improved slightly, I was hoping it would go away itself. I suppose a trip to the doctor wouldn't hurt though if the health insurance is covering all costs :o

An occasion of imbibing excessive amounts of alcohol at one sitting actually damages three organs; the liver, the pancreas and the stomach itself. First through direct toxic effects of ethanol and the second through "overuse"; enzymes supposed to "detoxify" alcohol gets used up and then the sustained higer blood alcohol level damages organs. The evidence of which we casually refer to as a "hangover".

Severe pancreatitis can be a very serious and potentially fatal condition.

Sustained or frequent vomiting after such an episode is due to an acute inflammation of the stomach which makes it really sensitive to any acid secreted after eating any food. It revolts and ejects the unwanted irritant. This can lead to vomiting blood, called the "Mallory Weiss syndrome" if not contained; caused by rupture of blood vessels in the lower end of the esofagus. Also potentially serious. The damage to the pancreas and the liver will result in nausea too.

These conditions take a while to resolve but usually leaves no permanent scars or tissue damage. (unless exposed to this kind of insult frequently..) More frequent in "binge" drinking than chronic alcoholism. (the liver gets better at managing alcohol; to a point...)

Unlikely that the doc will find anything abnormal in your case. Blood tests for acute pancreatitis and liver damage reverts to normal roughly at the same time as your nausea and other symptoms disappear.

If the symptoms persist beyond a week or two, it would be good to see a doc and get an "informed" opinion (or an educated guess, depends on who you see!!).

The treatment in the acute phase is usually a hospital admission, nothing by mouth, IV fluids, a nasty stomach tube and some symptomatic medication...

Hope the cause was worth the outcome...

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Tammi,

Your experience sounds rather exceptional I would hope, but must be a relief after that experience.

Thanks, I will perhaps phone Marcia, but right now I am becoming more convinced that it is/was a Globus and maybe my sleep was actually made worse by my medication.

It's difficult to know for sure as my lump in the throat feeling has all but gone, but the swallowing action is still sometimes rather deliberate and very slightly forced. I can live with this as it is right now without any issues, but I know even before I had god days and not so good days.

Sheryl,

That is correct. Actually, the feeling was bothering me more during the daytime until my 2 recent bad nights (since then I have stopped my medication, gargled with Salt water and feel better). Whilst I do not throw up food, I do occasionally have a reflux episode that brings up acid/bile/and a little food and do need to be especially carefull of bending over or down, after meals.

Do you have details of your fasting/detox program. I mean just the bare bones or website, that I may like to try and benefit from? I generally only drink alcohol and Tea very moderately anyway and don't drink Coffee at all. I stopped drinking coffee many years ago, when even then, I had a blocked throat and after a holiday where I drank no Coffee at all and my throat was clear I stopped. Wish I could do the same with Chocolate. ;-)

I am back to only antacids (Pepsid 2) myself now, just as and when/if needed and as I type Globus free.

Thanks all

Edited by twix38
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Tammi,

Your experience sounds rather exceptional I would hope, but must be a relief after that experience.

Thanks, I will perhaps phone Marcia, but right now I am becoming more convinced that it is/was a Globus and maybe my sleep was actually made worse by my medication.

It's difficult to know for sure as my lump in the throat feeling has all but gone, but the swallowing action is still sometimes rather deliberate and very slightly forced. I can live with this as it is right now without any issues, but I know even before I had god days and not so good days.

Sheryl,

That is correct. Actually, the feeling was bothering me more during the daytime until my 2 recent bad nights (since then I have stopped my medication, gargled with Salt water and feel better). Whilst I do not throw up food, I do occasionally have a reflux episode that brings up acid/bile/and a little food and do need to be especially carefull of bending over or down, after meals.

Do you have details of your fasting/detox program. I mean just the bare bones or website, that I may like to try and benefit from? I generally only drink alcohol and Tea very moderately anyway and don't drink Coffee at all. I stopped drinking coffee many years ago, when even then, I had a blocked throat and after a holiday where I drank no Coffee at all and my throat was clear I stopped. Wish I could do the same with Chocolate. ;-)

I am back to only antacids (Pepsid 2) myself now, just as and when/if needed and as I type Globus free.

Thanks all

Try stopping chocolate! I am 'allergic' to chocolate. I get dreadful sinusitis and definitely caused by chocolate. Maybe stopping chocs will be the answer to a lot of your problems!!

Edited by Tammi
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zzdocxx,

The symptoms are about the same since taking Xanax and after 1 week, I have decided to stop taking them from today. If anything my nightime symptoms are slightly worse these last 2 nights and when I wake up it takes a few minutes swallowing, clearing my throat and water to feel better.

I would characterise my symptoms as not feeling urgent, but a persistent feeling that my swallowing process is a bit forced and no longer completely natural and at times either a feeling of food getting stuck and needing to be washed down or a small lump which does not swallow down even after 2,3 or 4 swallows.

For example, in the past I have had white deposits at the back of my throat, only very very occasionally, which I think is a Calcium deposit and it is common to just knock it out and away. They are hard. Well, the feeling much lower in my throat could be the feeling I imagine I would have if I had a white Calcium deposit at that place, stuck in my throat. However I am certain this is not the case, but the feeling is something similar that will not swallow down. I also have a blocked throat, which needs clearing more than usual. Maybe due to my asthma, though, as I think my Asthma as well as my Hiatus Hernia is linked into this issue.

I didn't really notice any symptoms or changes at all, that I could ascribe to Xanax, unless my last 2 worse night's - throat wise - has anything to do with it. My dosage is rather low at 0.25mg

Prior to starting Oemprazole about 2 weeks ago, I used to use Pepsid 2 just as and when needed. I will revert to that after stopping my Oemprazole.

I am about 76kg and 171 cm, I think (or in old money about 13 stone and 5 foot 8 inches)

We're not confusing Zantac and Xanax here are we? For me Zantac worked way better than the more expensive omeprazole.

I think it is still worth a GERD sufferer's while to experiment with reducing/eliminating alcohol and caffeine.

I agree, worth experimenting. I did give up both while I had GERD, also elevated my upper body, ate smaller meals and stopped eating three hours before sleeping. Med-wise I didn't notice any progress until I switched from omeprazole to Zantac (or rather generic ranitidine), after which progress increased dramatically. In 18 months the symptoms entirely disappeared and never came back, but I have no way of knowing which change(s) made the most difference.

Rantidine and omeprazole work in entirely different ways, the first being an H2-receptor blocker and the second a proton pump inhibitor.

H2-receptor blockers are a type of antihistamine. Histamine, in addition to its well-known effects in colds and allergies, also stimulates the stomach to produce more acid. The receptors (nerve endings) that respond to the presence of histamine are called H2 receptors, to distinguish them from the H1 receptors involved in causing allergy symptoms. The most common H2-receptor blockers are cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac). The proton pump inhibitors (PPIs) are drugs that block an enzyme called hydrogen/potassium adenosine triphosphatase in the cells lining the stomach. Blocking this enzyme stops the production of stomach acid. The PPIs include such medications as omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix) and rabeprazole (AcipHex).

(from http://www.surgeryencyclopedia.com/Fi-La/G...nhibitors.html)

There's another theory that says GERD may be caused by a bacterium, Helicobacter pylori. No definitive studies yet but when my brother-in-law suffered from GERD, he followed a regimen to vanquish h. pylori and when he tested negative for h. pylori, his GERD had also vanished. I chose not to try that route as the antibiotic regimen for GERD is somewhat fierce and the link between h. pylori and GERD has yet to be firmly established. (However for anyone out there who doesn't already know, the majority of peptic ulcers are now definitively linked with h. pylori infection -- not stress, spicy foods, etc).

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I have elevated my bed, so my head is about 6 inches hiher now.

I'll cut down on chocolate, maybe cut it out later. Not sure I can just stop and lump in throat feeling gone now without cutting down.

No, I was not getting Zantac and Xanax confused. The Doctor at Bumrungrad said it was Globus and prescribed Xanax. I later found it was mainly for anxiety.

I have stopped all medication now anyway (Xanax and Omeprazole).

I would look at Zantac rather than Omeprazole, if I need to resume any medication in future.

Another day and still no return of the "Lump in throat" feeling, on swallowing, so fingers crossed.

Edited by twix38
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Sheryl,

That is correct. Actually, the feeling was bothering me more during the daytime until my 2 recent bad nights (since then I have stopped my medication, gargled with Salt water and feel better). Whilst I do not throw up food, I do occasionally have a reflux episode that brings up acid/bile/and a little food and do need to be especially carefull of bending over or down, after meals.

Do you have details of your fasting/detox program. I mean just the bare bones or website, that I may like to try and benefit from? I generally only drink alcohol and Tea very moderately anyway and don't drink Coffee at all. I stopped drinking coffee many years ago, when even then, I had a blocked throat and after a holiday where I drank no Coffee at all and my throat was clear I stopped. Wish I could do the same with Chocolate. ;-)

I am back to only antacids (Pepsid 2) myself now, just as and when/if needed and as I type Globus free.

Thanks all

I went to Health Oasis in Koh Samui. Have since made it an annual event. Their website is www.healthoasisresort.com Click on "health services". I did the 8 day standard fasting program. I note that their new website no longer described the programs so you may have to email them for details.

The problems you report of acid/bile/food reflux esp when bending down are typical of both GERD and hiatus hernia (hiatus hernia itself can cause GERD).

Good luck!

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The problems you report of acid/bile/food reflux esp when bending down are typical of both GERD and hiatus hernia (hiatus hernia itself can cause GERD).

Good luck!

Sheryl,

Thanks for detox info. I will take a look

Does the GERD (whether resulting from my Hiatus Hernia or not), have anything to do with the feeling of a lump in my throat and my difficulty in swallowing food down?? If so how? and why have these 2 symptoms largely now dissapeared?

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Received a reply from my Doctor at Bumrungrad, as below...

"Dear Mr. Martin Richard Wickham,

According to your previous message to us, please see our doctor’s reply below;

I did not see anything wrong in your throat. Base of your history that you ever did barium swallow before seeing me.

I believe you have no tumor on your throat."

Is that what medical records look like?? (as I had asked for them).

What about my original email question of..."I would also like to know if he saw any redness or inflammation consistent with gastric reflux?"

Anyway, for the simple reason that I do feel better after stopping all medication prescribed, I am going to leave it there unless anyone thinks better of that decision?

Edited by twix38
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twix,

1) The presumed mechanism for GERD and hiatus hernia creating the feeling of a lump is that the stomach acid irritates the lining of the throat and this irritation creates a foreign body sensation. The hiatus hernia effect is that it promotes GERD. If you've ever had an inflammation in your eyes you will recall feeling like there was something in your eye even if there wasn't same idea. The difficulty swallowing is just a function of the same itrritation, as you were in fact able to swallow, it just felt difficult.

2) No, response from Bummers is not appropriate. What you want is an actual copy of the medical record, not an exchange of emails with some clerk paraphrasing what a doctor said on the phone in response to what the clerk told the doctor you said in your email. If you feel like pursuing it just request a full copy of your medical record and don't say anything more than that.

As to why you are now feeling better, most likely due (1) to the meds you took which decreased stomach acid and (2) elevation of your head at night. The two together gave your throat a break from exposure to stomach acide, allowing the throat to heal.

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Received a reply from my Doctor at Bumrungrad, as below...

"Dear Mr. Martin Richard Wickham,

According to your previous message to us, please see our doctor's reply below;

I did not see anything wrong in your throat. Base of your history that you ever did barium swallow before seeing me.

I believe you have no tumor on your throat."

Is that what medical records look like?? (as I had asked for them).

What about my original email question of..."I would also like to know if he saw any redness or inflammation consistent with gastric reflux?"

Anyway, for the simple reason that I do feel better after stopping all medication prescribed, I am going to leave it there unless anyone thinks better of that decision?

Medical Records:

Will not, and should not be sent by e-mail for legal medical confidentiality reasons. You will have to go to the hospital; same clinic where the doctor saw you, present your hospital number to the admin person at the nursing station and then make a formal request to have copies. The hospital may, and should, ask you to provide an ID as well as ask you to sign a form. The doctor will also have to sign on the same document before records are handed over. You have legal right to them but the hospital also has a legal obligation not to release confidential medical information to other than the patient unless you have authorised them to do so.

Do not try and engage the hospital in e-mail communications other than getting quotes or making appointments; these departments are not set up do accommodate this.

Redness/inflammation:

Did the doctor do a formal gastrocopy or just and upper respiratory tract inspection? I think the latter as you would have had to be fasting for a gastroscopy. There would be no redness in the upper throat area only in the lower esofagus/upper stomach. (only seen at gastroscopy..)

Your symptoms of GERD/hiatus hernia (the same thing; the first is the formal diagnosis, the second term describes the underlying anatomical defect or reason), will respond to this treatment; the improvement may last a few weeks or less but will probably return as you did not take the medication long enough for significant healing to occur.

In my humble opinion; you have not progressed much further than square one when this thread was started apart from confirming that there was nothing wrong with the "upper throat" area. Even this is not clear.

You have, in my opinion, only 2 choices:

  1. Stay off treatment as you do feel better at the moment and implement all the other good measures advised in this forum. You may need to do it all over again in a few months.
  2. See a good gastro-enterologist and have a gastrocscopy done or other investigation as directed by the physician. Don't be agressive and prescriptive in you communications with Thai docs; they shut down and you will not get the full benefit of your consultation. Be gentle and polite but insistent.

Good Luck...

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fbn,

short on time right now so just a quickly

You mention that I did not give my medication enough time to fully heal and lump feeling may return and then if I do choice 1

I took Omeprazole for about 3 weeks and Xanax for about 1 week. The Xanax was prescribed by Bumrungrad and as I understand it is for anxiety and so has absolutely no relevance on healing the underlying damage. Therefore, if my symptoms return, I need to take Omeprazole for how long to give my throat time to heal properly under choice 1, having done it for 3 weeks before and understanding that 1 month is the maximum time to take Omeprazole?

On my experience so far, I think I am inclined to wait for choice 2 until I get back to England, as my symptoms are now gone and can be controlled it would appear, if they return. Not had the best feeling of service, treatment or explaination so far here in Thailand from Bumrungrad.

Sheryl, thanks again. I hope it lasts and did have time to heal sufficiently, but time will tell and I hope to remedy if it does come back by restarting Omeprazole. Very strange coincidence that my symptoms went only on stopping my medication. Must be coincidence I guess.

Edited by twix38
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EDIT

Actuaqlly I seem to have my symptoms starting back again, so I am going to recommence my Omeprazole at 1 a day for 2 or 3 weeks.

What's the best course of action, as I would rather wait until back in UK for any mre Hospital stuff and I was very comfortable this last week with how my throat was feeling??

Thanks in advance

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I need to take Omeprazole for how long to give my throat time to heal properly under choice 1, having done it for 3 weeks before and understanding that 1 month is the maximum time to take Omeprazole?

I have been prescribed Omeprazole for almost 4 years now! One daily in the morning. I have looked all over the internet on the medical sites and drug info sites, and couldn't find any that specifically set exact time limits on how long it can be taken for. Many suggestions for different symptoms, but can't remember any being more than about 6 months?

I had very bad acid problems ever since around 1966 (my time in Vietnam with the Marine Corps) and also developed symptoms of GERD about 15 or 20 years ago. I was eating about 20-25 antacid tablets a day all those years, combined with liquid antacids. Ever since I've been taking Omeprazole, I have had very little problem at all with the acid problem.

I have asked 9 doctors here in Thailand and the Philippines about maximum time to take Omeprazole, and none of them seem distressed that I have been taking it for such a long time, and keep prescribing it. I have tried to stop taking it off and on, but after one day or max 2 days, I have to start taking them all over again.

I've seen it mentioned quite often in this thread about the maximum time to take the medication. All being less than 6 months. I hope Sheryl or some Medico's out there may be able to set me straight about any long term adverse affects of taking the medication long term? And if there is an absolute maximum safe period to take it, then alternatives? :o TIA

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There is no hard and fast rule on how long to take omeprazole and to further complicate matters studies on its adverse effects have been limited to relatively short term use, although there have been some people followed for as much as one year.

Recommended duration of use as well as dose depends upon the problem.:

20mg a day for 4 to 8 weeks to heal a duodenal ulcer*

40mg a day for 4 to 8 weeks to heal a gastric ulcer *

20mg a day for 4 to 8 weeks for erosive esophagitis; some people need to take 20mg on a mainatiance basis to prevent recurrence, altho the safety of this beyond one year has not been studied.

20mg for up to 4 weeks for GERD without esophageal lesions.

A fair number of people with GERD take it on an occasional basis as needed, altho this approach has not been systematically studied, but no reason to expect it to be dangerous.

Now Twix, your problem is that you are not 100% sure whether or not you have any esophageal lesions. Altho apparently nothing showed on the upper GI, erosive esophagitis can only be definitely ruled out by endoscopy. In either case you will need to take omeprazole for at least 4 weeks, but you might need it for up to 8 and possibly even on a maintainence basis (especially if you do not get the hiatus hernia repaired).

I don't know how soon you return to the UK? And the other issue is how well you tolerate the omeprazole? As I recall you were having sleep disturbances, which is a common side effect (another is headache).

If you cannot tolerate omeprazole you could try Zantac. The dosage varies with whether or not it is GERD alone (150mg twice a day) or erosive esophagitis (a more severe condition resulting from prolonged GERD) (150mg 4 times a day). Zantac may also cause sleep disturbances.

Besides what I have mentioned,both of these drugs have other contraindications and other side effects (as all medications do) so you should read up on this (as you should with any medication).

The other issue for you Twix is whether to have an esophagscopy. You can certainly arrange to have one in Thailand, altho it will cost you, and if you select a doctor trained in the west you may find the level of communication more satisfactory than what you experienced with the ENT. If you wait until you return to the UK you may be able to get it for free under NHS and of course communication will be a lot better. However if under NHS they may not approve the procedure (I note that your doctor there recommended only the ENT visualization as next step, not endoscopy) and instead just treat presumptively, reserving endoscopy for if you don't respond to treatment...because it is a costly procedure requiring anesthesia. It's not a wholly unreasonable thing to do since an upper GI has already ruled out a mass, and the only difference in treatment is how long the medication is taken for....but going by the book, endoscopy is advised before opting for the longer course of medication.

You will feel better earlier on since acidic reflux touching the eroded lining of the esophagus causes much more discomfort than less acidic reflux, but for actual healing will need 4-8 weeks.

The other point you want to consider (on a non-urgent basis) is whether to repair the hiatuis hernia. That decision involves a lot of factors including your age, overall health and other surgical risk factors, so leave that till you get home to your usual doctor.

:

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  • 2 months later...

I'd like to report that I have had some 6 weeks or so without symptoms or medication until yesterday when the swallowing difficulty was just noticable again, barely.

I have started oemprazole and intend to continue for 2 to 3 weeks, as the previous 6 weeks have been great.

Should I continue for longer or is 2 to 3 weeks oemprazole with barely noticable symptoms fine?

I just want to nip it in the bud and then get the checks in UK when I return in a couple of months as Bumrungrad Doc and barium swallow have already given me the all-clear, as described.

Edited by twix38
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