• douglakemd

Flushing with liquid

Consider your esophagus as a vertical pipe in your chest. When something blocks a pipe, liquid pushes at the blockage. Water adds pressure and lubricates the blockage in the tube to help it pass. The same is true for your esophagus.


Flush with liquid applies to easy solids and difficult solids. Flush every solid bite with liquid.


Tim's story:

“It was a diabetic dinner, all right: salmon and steamed vegetables. I miss dinner rolls! And steak! I know it’’s what’’s best for me, though. My doctor checked my HgA1C and it was high again (twelve12). And I can’’t feel my toes, also not a good sign. I’ve got all the rules! Diabetes rules, blood pressure rules, weight loss rules. And now eating rules, too, just for swallowing! But I was doing the thing, sipping water for a warm-up, and starting out with carrots first. That was going fine for a few bites and then, bam! The pain in my chest came on strong enough, it made me curse over the dinner table with my wife.”


Tim is a fifty-seven-year-old gentleman I met a few years ago. He has type 2 diabetes. HgA1C (hemoglobin A1C) measures how well Tim controls his blood sugars. Six to6 -eight8 is ideal. Eight to8 -ten10 means fine-tuning is in order. Over ten10, like Tim'’s twelve12, is too high. Tim knows better. Diabetes has haunted Tim for more than fifteen years. He'’s fifty pounds overweight. Tim suffers from high blood pressure, high cholesterol, and gastroesophageal reflux disease (GERD). Food getting stuck caused Tim to seek medical help once again. I found moderate reflux esophagitis during his esophagram. Tim actively refluxes contrast from his stomach to his throat. I give patients a 12.7 mm (1/2 inch) barium tablet during the exam. (tThe bBar test, from chapter 3.). Many patients tell me it gets stuck, and I can see where it gets stuck.


The bBar tTest helps GI doctors decide when to re-dilate their patients. When Tim swallowed the tablet, it got stuck in his distal esophagus. Curiously, though, Tim couldn’t tell. I even had him take a couple more swallows of water. He still didn’t sense the pill blockage.


For Tim, this relates to diabetes. Diabetes damages nerves—that’’s why he can'’t feel his toes.


He can'’t feel his esophagus either.


Tim doesn’t notice the first piece of food stick because diabetes damaged the nerves. Tim has to pile up two, three, or four pieces of food before he notices it. It'’s much easier to get one bite of food unstuck than three.


My third rule outlined in Esophagus AttackFlush with Liquidapplies to everyone, but it has particular significance to Tim. You must flush every solid bite with a sip or gulp of liquid.


The liquid does three critical things.

First, liquid flushes solid bites through your esophagus.

Second, liquid re-lubricates the esophagus for the next bite.

Third, liquid challenges your esophagus. Tim doesn’t notice the first piece of food getting stuck. But when


Tim challenges his esophagus with liquid, it flushes the solid through the narrowing. Or, the stuck food alerts Tim, he drinks more liquid, and he holds off on more solid food.


The Flush-With-Liquid rule saves me all the time. It helps difficult solids pass daily. It will help you, too.


An example from medical school illustrates flush with liquid. I went to eat at a fast-food Mexican restaurant with friends. We sat down with our burritos and ate.


You can guess what happened next.


Yep, a chunk of chicken. Stuck.


In medical school, I knew some anatomy, but I was still pretty clueless. It wasn’t the lightning strike of turkey at Thanksgiving; it was more of a fullness in my lower chest.


I gulped diet soda.


PAIN for about two seconds! Then instant relief.


“Flush each bite with liquid,” might be my most critical step.





 

Photo by Eugene Chystiakov on Unsplash


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