Shotski's Ring, Revisited

February 09, 2006

Previously on zanshin I discussed my so-called shotski’s ring or or esophageal stricture. As I have recently been having very good luck with this malady I thought an update was in order.

A Brief History of Throwing Up Beginning about 1990 I began to have difficulty swallowing. Over time this issue became more and more pronounced and I started throwing up the contents of my throat after only one or two bites of food. Several trips to multiple doctors and I was told that I had three problems.

  1. Acid Reflux Stomach acid was getting past the upper (hiatal) valve into my throat and was burning the tissue there. Very painful and uncomfortable. Mine was strong enough to wake me up in the middle of the night and no amount of Tums would stop it.

  2. Hiatal Hernia A weakening in the diaphragm allowing part of the stomach to protrude into my chest cavity, distorting the shape of my throat and hiatal stomach valve allowing for acid reflux (see #1).

  3. An esophageal stricture or shotski’s ring A ring of tissue that continues to grow inside your esophagus, making the effective diameter smaller, if not closing it off completely, making swallowing difficult.

Apparently medical science cycles through two polar opposites on the relationships between these three conditions. At one pole we have the “they are all interrelated and connected” theory and at the other pole the, “you can have one without the other” theory. Prescription levels of Pepcid AC are given for the acid reflux (i.e., take double the over the counter dosage), nothing is done for the hiatal hernia, and a balloon endoscopy is performed as needed to deal with the shotski’s ring.

I had the balloon procedure preformed six times at five month intervals with no real relief from the condition. Initially I was getting perhaps several weeks of eased eating, but by the sixth procedure I was only get a week or ten days respite.

My wife, Michele, got me to take a homeopathic remedy for the acid reflux. Since I don’t eat vegetables she felt I didn’t have the enzymes necessary to properly digest my food and the result was excess acid. I took a vegetable enzyme extract and an enzyme re-builder for about 8 months. Before starting I couldn’t drink a glass of milk or eat ice cream without having an immediate and painful acid response. Since taking the product I haven’t had a problem. I still have a bout of indigestion once in a while, but a teaspoon full of baking soda washed down with a glass of water is an instant remedy.

Throughout the past fifteen years my eating issue has manifested like this: I take a bite, or two or three, of food and then my throat spasms and I can’t swallow. I feel as if I need to burp but can’t. Usually the spasm is low enough in my throat that I can breathe and I have time to go to the bathroom where I clear my throat by sticking my finger down my throat. Once my throat is cleared I am able to finish eating. On rare occasion the spasm is higher in my throat and I feel as if I can’t breathe. Those episodes are scary as I usually throw-up completely, and I feel like I’m going to pass out in the process. Even after one of these episodes I am able to finish eating.

Where I Am Today To my way of thinking, if I truly had a narrowing in my throat it would be narrow all the time and I would have trouble swallowing at every single meal. Even during those times when my condition was so bad I was throwing up at least once a day there were meals that passed with no difficulty. I don’t believe I have a true narrowing in my throat. I believe that I have a spasm that is released by the muscle contractions involved in throwing up. Kind of a hiccup in my throat.

For me the cause of the spasm appears to lie in unexpressed emotion. When I am carrying a lot of stress that I am not talking about, that I am in effect swallowing my body responds by not letting me swallow. If I am effectively dealing with stress, either by altering my life to not include it, or by openly dealing with it as it occurs, I don’t have much trouble eating. Since the beginning of 2006 I have only had two instances where I needed to visit the bathroom to clear my throat, and those were both minor issues.

I have altered my eating habits as a result of this condition. I cut my food into smaller bites, I chew slowly and thoroughly, and I drink lots of fluids throughout the day. A glass full of water taken before meal helps. Drinking continuously until I have swallowed five or six times in a row is very helpful. If fact, sipping a drink, i.e., taking one or two swallows only, is a bad idea. The start and stop nature of that kind of swallowing seems to bring on the spasm.

The Moral of My Tale Since the doctors in my case were unwilling or unable to provide a cure but rather only treated the symptoms (out-patient surgery every 20 weeks) I took matters into my own hands. I altered the way I eat, augmented my diet with enzymes to account for the lack of vegetables, and I learned to deal with my stress rather than suppressing it. In other words, I became an active participant in the treatment of my body. Too often, I think, we allow ourselves to become a bystander, merely watching as the doctor deals with our issues. Passive participation will never fully work, you have to want the change and work for it to make it happen.

I don’t think I’ll ever be completely free of my reaction to unexpressed emotion or stress, but I have learned better coping mechanisms that allow me to live without the embarrassment or fear of throwing up every time I eat.

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Mark H. Nichols

I am a husband, cellist, code prole, nerd, technologist, and all around good guy living and working in fly-over country. You should follow me on Twitter.