Throat Problem

[FBN]

looking like Bumrungrad, although a bit expensive from what I had previously been given to expect.

They replied to my email stating:

"Due to limited information, we can provide on the the cost of possible procedure. If Bronchoscopy is suggested by our doctor, the cost is ranged from 35,000-65,000 Baht** (outpatient basis)"

I had told them the details of my swallowing problems and hoped for rather less cost, going on previous posts here. Assuming I need this as I am not sure? The mere term Broncho, seems to infer lungs etc and my problem is only as far as my Throat/oesophagus/larynx/farynx area, as far as I know. Surely my swallowing problem does not get into the realms of lungs or is Bronchoscopy just a technical term for a look down my throat??

The Phyathai Hospital are to reply tomorrow, although the initial email received from Phyathai 2 Hospital in Bangkok has been forwarded to the Phyathai Sriracha hospital, presumably as I mentioned I am living near Pattaya. However, on their website it states clearly that Phyathai 2 is their ENT designated Hospital and I would rather go to the best rather than be directed to the nearest, if it does turn out to be the main reason for the selection of Phyathai at Sriracha.

All in all, looking like spending up to 65,000 Baht plus medication and sundry charges no doubt at Bumrungrad, but I am going to find out a little more from these 2 Hospitals in the next day or so before I book in for next week.

I am now starting to think I would have been better just delaying my flight and getting it done on the NHS. Treatment would have been acceptable to me without feeling that I needed to ensure the standards and Doctor first and costs zero.

Maybe tomorrow I will feel better.

Bronchoscopy is quite a different procedure; this involves putting a scope down the airways into the lungs and is much more complicated and invasive than a gastroscopy, hence the increased cost. Your problem seems to involve the upper throat area and it does seem unlikely that you will need this procedure.

First things first; see an ENT or Gastro-enterologist first and take it from there; we are merely speculating here at this point in time with the available information. Discuss further investigations with the physician and costs involved; obviously, urgency of any indicated investigations will determine further decisions..

[twix38]

My Doctor in UK was going to refer me and expected wait was around 1 month on NHS. That would have been fine and cost, of course, zero to me on the NHS.

I would have prefered that frankly to sorting it out here in light of the Hospital's email responses to date and the uncertainty that I would not have felt I needed to look into back home.

Unfortunately I had already cancelled my flight once and rebooked it and felt I did not want to cancel again to stay to wait for treatment, but on balance I now think it would have been easier and as free, also much more financially sensible than the cost being suggested in Thailand so far for an acceptable standard.

Question 1.

I realise Omeprazole should only be taken for a limited time, up to about 4 weeks. What I don't understand, as another poster here had worse symptoms than me, is what happens when I stop taking these tablets. Do I just go back to the same problem getting worse?

As for Bronchoscopy or Gastroscopy. It certainly sounds like my first email response from Bumrungrad falls below a high standard, as I clearly detailed my swallowing symptoms to them and I would agree that it most likely clearly has nothing to do with the lungs and airways. I have emailed asking for the cost of a Gastroscopy.

Meanwhile I will await responses for a day or 2 as my Omeprazole seems to be making my life normal again and I plan to chase up by phone midweek if not heard again from Phyathai and Bumrungrad, to book an appointment to see Doctor for next week.

Question 2.

Is there a chance that my Omeprazole tablets that are alleviating my problem could mask it when I see a Doctor??

Thanks to all

[zzdocxx]

A month is not too long, considering you might save alot of money.

At first blush it would seem the problem might be with the pharynx or esophagus, however . . . the funny sound when you breathe is sort of a wild card.

Yes this is alot of conjecture. The thing is, all those structures are in close proximity to each other, and if for example there is a mass originating in one structure, it could easily impinge on adjacent structures.

I hope that this all is nothing more than something minor having to do with reflux and/or a hiatal hernia.

But it is important to find out and the sooner, the better, just in case it is something more serious.

Good luck!

[FBN]

My Doctor in UK was going to refer me and expected wait was around 1 month on NHS. That would have been fine and cost, of course, zero to me on the NHS.

I would have prefered that frankly to sorting it out here in light of the Hospital's email responses to date and the uncertainty that I would not have felt I needed to look into back home.

Unfortunately I had already cancelled my flight once and rebooked it and felt I did not want to cancel again to stay to wait for treatment, but on balance I now think it would have been easier and as free, also much more financially sensible than the cost being suggested in Thailand so far for an acceptable standard.

Question 1.

I realise Omeprazole should only be taken for a limited time, up to about 4 weeks. What I don't understand, as another poster here had worse symptoms than me, is what happens when I stop taking these tablets. Do I just go back to the same problem getting worse?

As for Bronchoscopy or Gastroscopy. It certainly sounds like my first email response from Bumrungrad falls below a high standard, as I clearly detailed my swallowing symptoms to them and I would agree that it most likely clearly has nothing to do with the lungs and airways. I have emailed asking for the cost of a Gastroscopy.

Meanwhile I will await responses for a day or 2 as my Omeprazole seems to be making my life normal again and I plan to chase up by phone midweek if not heard again from Phyathai and Bumrungrad, to book an appointment to see Doctor for next week.

Question 2.

Is there a chance that my Omeprazole tablets that are alleviating my problem could mask it when I see a Doctor??

Thanks to all

Q1: Duration of treatment will depend on the diagnosis and follow-up. Hiatus hernia with resultant GERD is based on a mechanical defect in the diaphragm and symptoms tend to be recurrent. If very severe, surgical repair is sometimes done but likely that treatment will have to be repeated intermittently; depending on diet, weight management and other associated measures in the course of management.

Q2: If taken for longer than a week or two, it will mask signs at gastroscopy (reduced inflammation etc); be sure that the attending physician is fully aware of whatever medications have been taken and how long.

[Sheryl]

The email inquiries, to Bumrungrad and elsewhere, go to office staff who in turn make phone calls and then respond back. So what they tell you is their version of what a busy doctor told them based on what they told a doctor you had said...in other words, a game of "telephone" in which things get garbled. In my experience this is the case in all the hospitals....except that in some of them they don't have anyone speaking English reading the emails. It is not indicative of the caliber of the medical care but rather fo the quality of the email/international services.

The procedure I think you were advised to have is not a bronchoscopy and will not cost anything like that. It is just direct visualization of the pharynx and larynx by an ENT specialist. At least, that is what it sounded like from what you said.

If you decide to have this done in Thailand be sure to bring a copy of your medical records and prior test results, will definitely save time and expense. As I recall you already had an upper GI done with normal results, that's quite important.

You won't really know where you are until you've met with the specialist and he's had time to go over your records and get your history, but unless direct visualization fails to identify a probable cause of your symptoms, I doubt you are looking at a significant expense.

Far from worrying about quality, I would see Thailand as an opportunity to 1)choose your doctor and 2) be privately seen by one of the top specialists in the country, neither of which are easily done under NHS. (Also not possible under the Thai equivalent, i.e. at a Thai government hospital).

[twix38]

Sheryl (or anyone able),

Thanks I am looking seriously at booking my appointment at the Phyathai, Sriracha to see Dr. Somsak Sawetratanastein.

Do you have any recommendations or advice regarding this decision, by that I mean the Doctor mainly and the Hospital secondly - just as advised to do :-).

I plan to book an appointment later this week

Thanks

Edited October 8, 2007 by twix38

[Tammi]

just a quick note..if you decide to go with Bumrungrad you can choose the doctor and book and appointment slot online via their site. Its pretty much instant and they will send you a confirmation email.

Good luck.

Not so - at least not at the moment - they are fiddling with their site. After doing on-line and then emailing to info, and waiting 3 days, I had to phone them. Phoning is always best. And you should get a text message reminder day before appointment so make sure they have your mobile number.

[Sheryl]

Sheryl (or anyone able),

Thanks I am looking seriously at booking my appointment at the Phyathai, Sriracha to see Dr. Somsak Sawetratanastein.

Do you have any recommendations or advice regarding this decision, by that I mean the Doctor mainly and the Hospital secondly - just as advised to do :-).

I plan to book an appointment later this week

Thanks

The hospital is adequate for your needs. I don't know anything about the doctor. As previously mentioned, one of the things that limits the Phyathai group of hospitals is that you cannot review doctor qualifications on the web.

I can't see any problem with seeing him for a consultation at least; if favorably impressed, can proceed with tests, if not, consult someone else.

In any case, best of luck, and please let us now how it turns out, for future reference of anyone with similiar problem.

[twix38]

got Bumrungrad's Gastroscopy costs as outpatient at between 14,000 to 17,000 Baht

Compares to Phyathai, Sriracha at 15,000

Decided to book with Dr Khemchart at Bumrungrad, as little appreciable difference cost wise and Dr Khemchart recommended here. I do have confidence in Phyathai, but a visit to BKK is good.

Booked on their website yesterday for app't next Tuesday and awaiting reply. Will phone if not heard on Thursday

Will keep progress up to date here

Edited October 10, 2007 by twix38

[Guest jonzboy]

my twopenneth on the esophagitis issue

i started getting these symptoms about six years ago and stoopidly did nothing, like other posters, except struggle through the horrible experiences of having the food stuck in my gullet

finally went to the doc and got diagnosed, and have been using NEXIUM (esomeprazole) since then, initially on a daily basis to get the inflammation down, and now only take it when i need it (this is POM in UK, but can be bought in Boots and other pharmacies in Thailand, and much cheaper than Bumrungrad dispensary by far)

my take on this is that it is very much stress induced, but also exacerbated by spicy food, coffee, red wine, and bread, especially if eating late at night and sleeping to soon afterwards

needs a lifestyle change for long term relief w/o medication

my doc also suggested elevating head of my bed by six inches

he also reckons there's an increased risk of a cancer (Crohn's) as a result of the scarring, so I am having follow up endoscomies (not my favourite pastime)

will retire in two year's time (possibly to LOS) so hope the reduced stress will help

[twix38]

Jonzboy,

Thanks for info

I am taking Omeprazole. Can I assume this is exactly the same as your quoted esomeprazole?

I take 1 a day (20mg) prescribed by my UK Doctor. I am now in Thailand.

I read somewhere that Omeprazole should only be taken for a short period (2 weeks) and perhaps a maximum of 4 weeks. Is this right? Why is this?

I go to Bumrungrad hospital for a check up with Dr Khemchart this Tuesday morning.

Are your symptoms of food getting stuck all history now or how often do you have to resort back to Omeprazole and for how long, please?

I read somewhere that the damage to the throat from the acid reflux would ordinarily make the Oesophagus a complete mess, but special cells called Barrett cells help to repair. The fact that these Barrett cells divide MUCH quicker than ordinary cells is one (main) reason for the increased risk of cancer as it allows for mistakes in the copied DNA over a relative shorter time period than would otherwise be the case.

Many thanks

Edited October 14, 2007 by twix38

[Guest jonzboy]

Twix

the two drugs are similar, but not the same, nexium is a newer version and not yet available in generic form like omeprazole, see...

http://en.wikipedia.org/wiki/Omeprazole

nexium is therefore more expensive

i started treatment about two years ago and I still get supplies of nexium from my doc to take when i feel the need, so the 4-week thingy seems to be hogwash imo

i understand the scar tissue never really goes away, so i believe there is a residual narrowing of the esophagus, this might explain the odd occurence of difficulty swallowing when i forget myself and try and swallow a larger bolus than normal, usually occurs with dry bread or pithy green vegetable like undercooked brocolli

i must admit i am not a good patient, but as the doc had basically asked me to stop doing all the things i treasure most (except sex), and as the drugs have alleviated the symptoms, it's hard not to revert back to old habits, but i guess i have been more alert to some of the causes of the reflux, like the types of food i eat , and i steer clear of coffee, red wine and crusty french bread, especially later in the evening

but like i said, stress is a major factor in my case. I just got back from a three week trip and whilst away never felt any problems with reflux despite indulging myself in the food and drink

hope it all works out for you, i like the Bumrungrad, great service there

[sabaijai]

Twix,

As FBN indicated one issue is whether to start with a GI or ENT specialist. Since you were already examined and tested by GI specialist in UK who then referred you to ENT I would start there. You have a first-hand recommendation from one poster for Dr. Khemchart at Bumrungrad; I looked him up and he is an Associate Professor at Chula (one of the country's 2 best medical schools) so sounds like a good bet.

ALtho costs have recently increased it is still not likely to exceed 3-4,000 Baht which is hardly excessive for exclusion of potentially life threatening problems by a top notch specialist.

If as is probable and to be hoped, it turns out your problem is due to GERD:

1) Don't buy meds at the hospital. As one poster mentioned Motilium is often helpful. It's readily available at all pharmacies at much less cost than at the hospital. Ditto any other drug I can think of that might be prescribed for GERD.

2) Minimize your caffeine intake. Caffeine is a major culprit in GERD as it weakens the gastrro-esophageal sphincter. I find Thai doctors seldom mention this, maybe because Thais are not as prone to heavy caffeine intake as westerners (also they seem in general less willing to suggest life style changes). I had the same symptoms you mention (minus the whistling) as a result of GERD and nothing helped until I cut my caffeine intake by about half (can give lots of hunts on doing this painlessly if you like). Remember that in addition to tea and coffee, colas and some other soft drinks have a lot of caffeine.

3) If you haven't already, read up on/google other eating habit/life style modifications that help GERD, there are a number of them and they do help.

This advice of course is assuming it proves to be only GERD and not anything more serious, and you should still have that possibility evaluated.

Good luck

The latest research on GERD causes are finding little or no causative correlation with caffeine.

Reflux Diet Myths

Myth 2: Avoid coffee, citrus fruits and Spicy food

We have been told for years that coffee, acidic fruit as well as spicy foods can aggravate acid reflux. Therefore, we should avoid these in our daily diet in order to reduce acid reflux. A recent study published in the Archives of Internal Medicine in May 2006 showed that none of these myths hold true. Researchers from the Stanford University found that the only two behavioral changes can reduce symptoms of acid reflux - eating less and elevating your head while sleeping.

Having suffered from GERD in the past myself, I found that those two behavioral changes seemed to make the most difference. If you follow the idea that foods and beverages that promote stomach acid are a cause, then beer should also be avoided.

Surprisingly, a lot of beverages stimulate acid secretion such as beer, wine and pop. The worst of all is beer. It could double your stomach acid within an hour.

[Sheryl]

"The latest research on GERD causes are finding little or no causative correlation with caffeine.

"Myth 2: Avoid coffee, citrus fruits and Spicy food

We have been told for years that coffee, acidic fruit as well as spicy foods can aggravate acid reflux. Therefore, we should avoid these in our daily diet in order to reduce acid reflux. A recent study published in the Archives of Internal Medicine in May 2006 showed that none of these myths hold true.""

I looked up the actuial article in the Archives of internal Medicine as this contradicts my own experience and found that, as is often the case when the egneral media reports on scientific articles, this is misleading. The article first of all does not report on any nerw study findings. Rather, it is a review of existing studies to determione what has and has not been adequatley proven to datye. There is a huge difference beteen not adequately proven and disproven.

Results of the review were that physiologic effecst of alchohol on esophagus (in ways that would be expected to contribute to GERD) have been proven but studies showing the benefit of reduced alcohol on symptoms are either lacjking or conflicting. With respect to caffeine, studies on physiologic effects were cionflisting or had methodologicval limitations.

this hardly means that the effect was disporiven. in fact just a month after thie cited article, a clinical study was published showing a physiological effect of caffeine on the esophagus in healthy Thais, albeit with a small sample.

Bottom line: elevating the head and not eating before bed have nmet righiorous scientific stabndards in being of proven benefit. There is physiological evidence to suggest that reductions in alcohol and caffeine intake would be of benefit but this has yet to be proven, and may never be, since it is difficult to get funding for studies on lifestyle modifications as there is no money to be mnade from the results (unlike pharmaceutical trials).

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

[twix38]

back from Bumrungrad Hospital visit.

Saw Dr Khemchart. Rather had the feeling he wanted me in and out as fast as possible, but also felt he did enough to be worthwhile.

Told him my symptoms and medication (Oemprazole at 1 a day 20mg and food gets stuck in my throat and have to wash it down frequently and uncomfortable. Have Hiatus Hernia and Asthma. Don't have swallowing symptoms always, but often and much more recently. Had Barium Swallow in Uk and result was ok).

I also asked him to visualise my Larynx and farynx, thanks to advice here or I never would have asked. For a minute I thought he was going to sit there meditiate and visualise, but luckily next......

He asked me to sit on a chair behind him and sprayed both nostrils and the back of my throat. He told me he would look down my throat, so I opened my mouth and he told me to shut it. Charming

He then passed the tube down my nostril and eventually I helped to swallow it down. This was on the 3rd attempt as disconcertingly he had to remove it out of my nostril 2 times and clean the lens, so it was 3rd time lucky, as the nurse rubbed my arm to comfort me. This was surprisingly good at taking my mind of the discomfort.

Now a question. there was no picture on a screen. He just looked down one end of the tube and the other end, with a light on it, was down my throat, so this was not, I presume a Gastroscopy or anything more than just a look down a tube with a light on the end?? Can this test diagnose any narrowing of my lower esophagus/Esophageal narrowing (stricture) or Achalasia etc?

After this the Doctor said a word which I now know to be globus and prescribed me a months worth of Xanax and a total cost of 1,620 Baht and that was it. the end of my 20 minute appointment and no need to return.

Three points

1. the cost (and the testing) were both lower/less than pressumed.

2. I still have some very mild discomfort swallowing. The Oemprazole has indeed helped over the past 10 days or so, before my doctor visit.

3. My diagnosis is explained below (looked up by me on the internet, as I had no idea what the word meant). I don't really agree with it, but I guess it could be right, so I am taking the pills, which are for anxiety, although I don't feel anxious, have not worked for the last few months and simply felt my food got stuck in my throat and first noticed it nearly 1 year ago and ever since on occasions, getting rather worse recently. Could he have missed something or not checked something. I plan to just wait and see how I feel.

oh well, I may just report the problem has vanished on my 2 medications (Oemprazole and Xanax), so never say never.

Thanks for all the help offered here. Really appreciate it.

Lump in your throat (globus). Some people feel the sensation of a foreign body or lump in their throats when, in reality, no foreign body or lump exists. Stress or excitement may worsen this sensation. Oftentimes, resolving the stress alleviates the problem. Actual difficulty swallowing usually isn't present.

Edited October 18, 2007 by twix38

[twix38]

Couple links to interesting info on GERD and difficulty swallowing

http://www.mayoclinic.com/health/gerd/DS00967/DSECTION=2

http://www.mayoclinic.com/health/difficult...0523/DSECTION=2

Follow through each NEXT page, through each article section and related links at the bottom of each page

Edited October 18, 2007 by twix38

[Tammi]

back from Bumrungrad Hospital visit.

Saw Dr Khemchart. Rather had the feeling he wanted me in and out as fast as possible, but also felt he did enough to be worthwhile.

Told him my symptoms and medication (Oemprazole at 1 a day 20mg and food gets stuck in my throat and have to wash it down frequently and uncomfortable. Have Hiatus Hernia and Asthma. Don't have swallowing symptoms always, but often and much more recently. Had Barium Swallow in Uk and result was ok).

I also asked him to visualise my Larynx and farynx, thanks to advice here or I never would have asked. For a minute I thought he was going to sit there meditiate and visualise, but luckily next......

He asked me to sit on a chair behind him and sprayed both nostrils and the back of my throat. He told me he would look down my throat, so I opened my mouth and he told me to shut it. Charming

He then passed the tube down my nostril and eventually I helped to swallow it down. This was on the 3rd attempt as disconcertingly he had to remove it out of my nostril 2 times and clean the lens, so it was 3rd time lucky, as the nurse rubbed my arm to comfort me. This was surprisingly good at taking my mind of the discomfort.

Now a question. there was no picture on a screen. He just looked down one end of the tube and the other end, with a light on it, was down my throat, so this was not, I presume a Gastroscopy or anything more than just a look down a tube with a light on the end?? Can this test diagnose any narrowing of my lower esophagus/Esophageal narrowing (stricture) or Achalasia etc?

After this the Doctor said a word which I now know to be globus and prescribed me a months worth of Xanax and a total cost of 1,620 Baht and that was it. the end of my 20 minute appointment and no need to return.

Three points

1. the cost (and the testing) were both lower/less than pressumed.

2. I still have some very mild discomfort swallowing. The Oemprazole has indeed helped over the past 10 days or so, before my doctor visit.

3. My diagnosis is explained below (looked up by me on the internet, as I had no idea what the word meant). I don't really agree with it, but I guess it could be right, so I am taking the pills, which are for anxiety, although I don't feel anxious, have not worked for the last few months and simply felt my food got stuck in my throat and first noticed it nearly 1 year ago and ever since on occasions, getting rather worse recently. Could he have missed something or not checked something. I plan to just wait and see how I feel.

oh well, I may just report the problem has vanished on my 2 medications (Oemprazole and Xanax), so never say never.

Thanks for all the help offered here. Really appreciate it.

Lump in your throat (globus). Some people feel the sensation of a foreign body or lump in their throats when, in reality, no foreign body or lump exists. Stress or excitement may worsen this sensation. Oftentimes, resolving the stress alleviates the problem. Actual difficulty swallowing usually isn't present.

Thank you for updating us. Keep us posted - will be interesting to know if the Xanax works. I am amazed at how many things 2 mgs of Valium sorts out for me!

If I need a doctor I usually scour Bumrungrad site for a doctor who has had overseas (western) experience. I have used Dr. Virasak for gastroenterology problem.

[zzdocxx]

Very interesting twixie, thanks for the update!

[taxexile]

I don't really agree with it, but I guess it could be right, so I am taking the pills, which are for anxiety, although I don't feel anxious, have not worked for the last few months and simply felt my food got stuck in my throat and first noticed it nearly 1 year ago and ever since on occasions, getting rather worse recently. Could he have missed something or not checked something. I plan to just wait and see how I feel.

taking tablets to relieve your symptoms might reduce the symptoms , but do nothing to treat the underlying cause.

symptoms of indigestion , bloating , etc. in someone over 40years old should be thoroughly checked before taking relieving medication.

if you are not happy with the diagnosis , or dont think you were checked thoroughly enough before , then ask for an endoscopy , this is where the camera is passed down the oesophagus and into the stomach. it is painless and normally done under sedation and will reveal any abnormalities if present.

dr. nusont ( uk qualified , teaches at the medical school ) at bumrungrad digestive diseases centre is another recommendation for you.

[madjbs]

Imp not sure if I have GERD but I have some similar problems. About 3 months ago I had a bit of a binge drinking session (very silly I know), this lead to an awful hangover where I couldn’t eat anything for 2 days without throwing up (very embarrassing). Anyway, I vomited quite a number of times and ever since then I have been getting food stuck in the top back of my throat, almost like its stuck in my sinuses. It usually happens when eating stuff like rice, it goes away after a day or two but by then I have usually eaten something else which gets stuck. Even if I drink lots of water or try and dislodge it, it won’t budge, I have to wait for it to break down. Is this a result of scar tissue as well?

Thanks for any help.

[Sheryl]

OK he visualized the epiglottis and larynx, the question is -- what did he find? If he did not tell you then I suggest you request a copy of the medical record from the hospital (by law they have to provide it), doctor will have jotted down what was observed durin the visualization.

Obviously from his treatment he did not see any mass or anything else of concern, but would like to know if he saw redness or inflammation consistent with gastric reflux. If so and taken toigether with a normal upper GI, then this would tend to confirm a diagnosis of GERD. Treatment for which is:

- lifestyle modifications :

(1) don't eat 2 hours beforee sleeping or lying down for any reason, keep your head as high as you comfortably can (extra pillow etc), keep the last meal of the day light. (Light meaning modest in quantity and not too much fat, as fat delays stomach emptying time). If you are in the habit of naping or otherwise lying down during the day same would apply for any food taken prior to that.

(2) reduce caffeine and alcohol intake. Might help to first experiment with omitting each of these altogether for at least a week tio see if it helps. If it does then with trial and error you can determine how much, if any, you can take without becoming symptomatic.

- medications to decrease stomach acidity. These do not correct the reflux, they only make the contents that reflux less acidic and hence less irritating. Stomach contents are acidic for a reason (kills bacteria, helps breakdown nutrients) so these should be used either temporarily or intermittently. Drugs that can be used include ones that are not absorbed and just work topically (antacids like Maalox, Pept-Bismal; sucralfate) and ones that actually decrease acid production (cimetidine, zantac, omeprazole and related drugs). Since these drugs do not stop the reflux, still need the life-style modificatins mentioned above.

- medications that increase the speed of digestion (so that the stomach empties more quickly and efficiently), e.g. motilium.

Globus sensation is a very common problem and usually does not indicate serious pathology. Things that need to be excluded are a tumor or other mass in the throat or esophagus, or scarring/narrowing of the esophagus. Between the upper GI and the ENT visualization it seems like you have adequately excluded these, but do get the exact findings of the ENT exam.

If it didn't show any redness/inflammation at all, then the sensation must be coming from the esophagus. With a normal upper GI most people would be comfortable just assuming GERD but if you want to be extra careful then esophagoscopy (direct visualization of the esophagus) can be done.

I'd skip the xanax if I were you, oir reserve it for rare occasions when you are especialy tense at bedtime. It's not a long term solution even if it helps. At it is addictive.

[Tammi]

Twix38, Sheryl is right - be careful not to get hooked on Xanax. When I said 2 mgs of Valium can sort a lot of things out for me I should have said that I take 2 mgs maybe 6 times in a year!! No way I want to get hooked. But that said, doctors will prescribe for a short time to see if it will settle the patient. If it doesn't then further investigations need to be done.

What happened to the whistling noise you were complaining about?

Edited October 21, 2007 by Tammi

[Tammi]

Imp not sure if I have GERD but I have some similar problems. About 3 months ago I had a bit of a binge drinking session (very silly I know), this lead to an awful hangover where I couldn’t eat anything for 2 days without throwing up (very embarrassing). Anyway, I vomited quite a number of times and ever since then I have been getting food stuck in the top back of my throat, almost like its stuck in my sinuses. It usually happens when eating stuff like rice, it goes away after a day or two but by then I have usually eaten something else which gets stuck. Even if I drink lots of water or try and dislodge it, it won’t budge, I have to wait for it to break down. Is this a result of scar tissue as well?

Thanks for any help.

Doctors were put on Earth to sort out our medical problems. 3 months is long enough to have a problem. Go see a doctor. Start with ENT who will hopefully direct you to gastroenterology if he/she thinks your problem warrants. Best that you should ask if you should see a gastroenterologist - I like Dr. Virasak.

If you decide to go to Bumrungrad Hospital you'll find plenty of otolaryngologists (ENT) - the hospital is awash with them. I have no experience of this department but would probably choose Dr. Prayuth Tunsuriyawong because he's got western experience and is at the hospital every weekday.

Dr. will probably start you off on Xanax or similar! Couldn't resist.

Good luck!

[madjbs]

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

[twix38]

thanks all,

Sheryl, I have asked Bumrungrad to provide my medical records and I will let you know how I get on. Thanks

Tammi, the whistling noise comes and goes and may well be due to my Asthma, as I had accepted it as a wheeze come whistle sound present on occassions, such as physical exersion or a cold etc, but my Doctor in the UK made an issue of it on my last visit, just before flying out here to Thailand and it then had me even more concerned. I told Dr Khenchart and assuming he knows something of his art, he didn't seem particularly bothered and I suspect he took everything from his examination rather than my statements.

To think I am only 46, at this rate i'll be doing myself a favour not to have to suffer into old age ;-)

So, I will come off the Xanax after giving it another few days (it's a low dose, I believe, at 0.25mg) and I expect I need to stop my Oemprazole in about 2 weeks time??, after a total of a month. What then, just left with lifestyle modifications and ad-hoc medications to decrease stomach acid as necesary??

I do have to repeat that I wish I had had time to sort this out in the UK. I felt like I was being a pest asking questions as he was busy and he told me I was okay. You have Globus, no problem, take this medicine.

I would have got to the bottom of it and importantly known what was going on, what it meant, what any other options/tests were, next steps, complete diagnosis etc etc so much easier and clearer back home.

This BB and the internet has been a great help on those issues above.

Edited October 22, 2007 by twix38

[twix38]

A copy of my email to Bumrungrad

"Hello,

I attended my appointment (as shown below) and saw Dr Khemchart on 16th October.

I told Dr Khemchart that I had been taking Oemprazole for 2 weeks and have a Hiatus Hernia.

After the Doctor performed a visualisation of my Epiglottis and Larynx, by a tube down my nose, I was told that my diagnosis was "Globus" and Dr Khemchart prescribed Xanax, which I have been taking for 1 week now.

I understand that the Doctor's diagnosis is that he believes I do not have any foreign body or lump in my throat and I have since found out that Xanax is for anxiety. I do not feel anxious and I have had the feeling of swallowing problems and food being stuck in my throat for over a year, although it has been worse these last 2 months.

I would like to request you to send me a copy of my medical record, which will tell me what the doctor observed during his visualisation?

I need to have confirmed that there is no tumor or other mass in my throat or esophagus, or scarring/narrowing of my esophagus and that he did not see anything of concern?

I would also like to know if he saw any redness or inflammation consistent with gastric reflux?

Thank you very much"

_________________________________________

I also told the doctor at the time about my Barium Swallow, done in UK, being fine and the whistling sound occasionally on breathing, but left it out in my above email.

Edited October 22, 2007 by twix38

[zzdocxx]

Hmmm......

Thinking this one over. . .

Maybe you have stated this already -- has the symptom gone away since you are taking the Xanax?

Do you notice any other effects from the Xanax? (Sedation, etc.)

Could you refresh my memory, did you try any of the medications for reflux?

Nice letter.

BTW curious, your height and weight?

[twix38]

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)

Edited October 23, 2007 by twix38

[Tammi]

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)

Do you still have your tonsils? You seem to be describing tonsilloliths, aka tonsil stone or caculus of the tonsil. You probably will feel that you have a foreign body in the back of the throat. Do you know if you have bad breath? Any pain in ear(s)? Sore throat? Bad taste in back of throat? If tonsil stones you can prevent by gargling with salt water or cider vinegar. But if you do have a stone that you can't see and 'knock away' then you need to get an ENT to do it. And he should also consider what it could be if not a stone. It is usual for doctors to start with the most common diagnosis and work their way up to the rarer. It is also common for both patient and doctor(s) to let existing disease(s) get in the way of a proper diagnosis of a new complaint.

[twix38]

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.

Edited October 23, 2007 by twix38