CHAPTER 1

1. ESOPHAGUS ATTACK? WHY DO I CARE?

Waves of severe chest pain.

Squeezing pain in the middle of my chest lasting three to six seconds.

Is this a heart attack? Should I call 911? Am I going to die?

But no pain radiating into my left arm, or my jaw, though I feel it in my lower neck, for sure.

Tension fills my shoulders, and I wipe my clammy hands on the napkin in my lap. I’ve never had pain like this before. Is there aspirin around?

Another wave of tearing pain hits my chest. I hunch forward slightly in my chair, and my legs push me back from the table. Deep exhale.

No, really, am I dying?

Stop. I ran a 5K in nineteen minutes this morning, and I’m a twenty-six-year-old medical student. This can’t be a heart attack.

Then what the hell causes waves of chest pain? Why do I feel like someone grabbed a lemon squeezer from the kitchen and squeezed the middle of my chest?

Aortic dissection? Is my aorta rupturing in my chest?

Stop. It happened right after I ate that piece of the turkey thigh. It must be that. I hope it is that. Could food stuck in my esophagus feel like a vise gripping my chest?

Is this reflux?

No way. I’ve only eaten a protein bar and Gatorade, and that was after the 5K, almost six hours ago. I’m starving—I could eat a horse. There’s nothing in my stomach. It’s not reflux.

What is this?

Oh, no—does cancer do this?

What if this is cancer?

I had my first esophagus attack eighteen years ago when I was a third-year medical student. Even with my medical training, I was unable to identify, much less solve the problem of having food stuck in my esophagus. Since then, I have studied this problem extensively, from both a personal and a professional perspective. I have diagnosed and supported thousands of patients with this dilemma.

Experiencing esophagus attacks—the way I think of them when they happen to me, if not when I’m in my doctor role—are not only physically painful but also come with a significant emotional load as well. You must eat to live. If you can’t eat food, you slowly die. Doctors can put tubes into parts of your body to help. Some need this, but the natural process of chewing and swallowing food is best. Eating represents a critical social gathering point around the world. Learning my steps to eating more comfortably and confidently solves the problem for most people. (Though if food does get stuck, you must see a medical professional).

This book will help you understand this problem and overcome it. You will learn about the esophagus. You will know you need to tell someone in the medical field about this problem. I will teach an easy 3-step process to help you eat more safely and confidently. I’ll write about my approach to getting food unstuck and help you decide if you need to go to the emergency room. You will learn about other esophagus problems where the 3-step process helps.

In my own life, I eventually sought medical help, but I put it off longer than you might think. Perhaps the best part about swallowing—ha!—my pride and consulting a colleague was being able to put the worst fears out of my mind. No, this wasn’t about my heart. No, I wasn’t going to choke. No, this wasn’t cancer.

Getting some basic answers from an expert lowered my stress level and allowed me to focus on doing what I could to understand and manage the way my body was working (and sometimes, not working so well).

My experience of how much fear esophagus attacks can instill is why I put so much emphasis in this book on addressing the many concerns, questions, and fears patients have brought me over the years. The list of fears can be long. It often includes:

Am I alone with this problem? No! Over 65,000 patients go to emergency rooms yearly in the US with food stuck in their esophagus. About 250,000 patients deal with problems with food impactions they can clear on their own each year in the US. Millions of Americans deal with gastroesophageal reflux disease (GERD), which we’ll explain in later chapters and, when inadequately managed, likely contributes to this problem.

Do kids or young adults get this problem? Rarely. Food gets stuck for kids, and they can have pain while eating, but my solution doesn’t apply to kids. I intend it only for adults. If you think food gets stuck for your child, please take them to their pediatrician, who may refer them to a pediatric gastroenterologist.

I’m so embarrassed about eating dinners with family or eating out with friends! I was, too! Steak houses used to be the worst for me. I’ll teach you the strategy I have used to eat with confidence and overcome this fear.

I’m afraid of going to the emergency room to get food removed. That used to be me, too. Just the thought of a gigantic emergency room and surprise emergency endoscopy bills terrifies many patients. And they are right about this part: healthcare fails to provide price transparency. Most patients cannot guess their out-of-pocket cost. I don’t have a clue, and I work in healthcare! In this book, you will learn how to discuss this with your healthcare provider and make a plan to avoid the emergency department and surprise medical bills.

What if I occasionally reflux? Can it progress to a bigger problem? We’ll discuss reflux and the nonmedical and medical solutions. Knowledge will reduce anxiety. When you understand the problem, you own your answer.

Does a heart attack cause pain after swallowing food? Usually no. For men, heart attacks have more typical presentations than this and often involve exertion. Women can have less obvious heart attack presentations. In chapter 3, you’ll learn about what to expect during the workup of chest pain during eating.

Is this esophageal cancer? For 99 percent of you, no. For 1 percent, unfortunately, yes. I cannot teach you how to spot the difference. Your doctor cannot tell without testing. You must see a medical professional, and you’ll read about that in chapter 3.

Where does it hurt? Point to your chest, to the fleshy part right above the breastbone in the midline, which doctors call the sternum. If you look at this book’s front cover, it is the top of the lightning bolt. If your pain is at this spot, or below it to where the chest ends at the abdomen, immediately after you eat, this is what I’m calling an “esophagus attack,” and this book is for to you.

This book does not help if your bowel is blocked. It is also not about choking or food going down the windpipe, known as the trachea. Choking on food in your windpipe is a different problem. If you are choking on food in your trachea, you need the Heimlich maneuver. You will suffocate and die if food sticks in your windpipe for more than a couple minutes. You can still breathe when food sticks in your esophagus rather than your trachea. Many patients confuse the two, so in this book, I’ll explain how these differ.

This is not a diet book. This book teaches safe eating habits—eating healthfully is about avoiding food blockages rather than which calories or macronutrients you need.

This book emerges from my own pain and fear, as well as eighteen years of learning about and helping people with this problem.

Why learn from me? I’m the rare physician who has studied and treated a condition for eighteen years—and has it. I’ve helped thousands of patients. It’s possible some others may know more than I do—I’m always learning. But I struggle with a problem you battle. I’ve had my own esophagus attacks. I want to help you manage, and even better, avoid them.

I am a diagnostic radiologist. This means I interpret medical imaging and perform image-guided procedures. In one typical scenario, I give patients a contrast called barium and take pictures of their esophagus. I help other doctors sort out their patients’ esophagus problems. In my career, I’ve done thousands of these exams.

I developed my 3-step process to eat more easily for myself as well as my patients. As I began sharing with patients, it wasn’t long before someone asked, “Will you write that down?” After that happened enough times, I searched Amazon to find a book to refer my patients to—and found nothing. So I bought The Esophagus, the esophagus medical bible. Eight hundred and thirteen pages dedicated to the esophagus. That must have chapters devoted to this problem and how to fix it, right? Well, esophageal strictures represent six pages of the book, mostly dedicated to pills, scopes, cameras, and balloons. Nothing addressed to the patient or what they can do.

Does this matter? Is food getting stuck in the esophagus a problem? Should I worry about my esophagus attacks? Remember the movie Rocky? Remember the song “The Eye of the Tiger?” Cue that song up in your head while you read the next paragraph.

You may battle fear, pain, self-loathing, shame, anxiety, and even depression from this...