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Acute tightness of throat
soldierservices posted:
Dr. Moser,
Just joined WebMD looking for direction. I saw an old discussion of yours that was very close, but, that person had not started common consultations ... and that was your recommendation.
My wife is 50, 5'8" 125, on the go sun up to down. We are a recently retired military family... mentioned only in that we've had consistent ongoing care for over 20 years.
About six months ago, she awoke in the night feeling as though she had something stuck in her throat... or as if you were putting pressure on the left side of her neck to constrict her breathing. It took hours to stop. It happened again the following day while driving.. she diverted to a nearby ED (she hasn't gone to an ED in 25 yrs). Nothing was found, she was sent to her Primary Care provider, who sent her to ENT. She had a Nasal Endo, extended lab panels, and was ultimately given a course of antibiotics. The symptoms seemed to subside.... but, they have come back repeatedly. She can go for 2-3 weeks without any, then the start again.
Anxiety has be communicated by providers..... she has taken Zanax .5 PRN for years. She hadn't really taken it often... until this new thing started. I guess the confusing part about that is these symptoms come without warning and with zero consistency as to whether she is stressed or not. She can be watching a Doris Day moving on a pajama Sunday...and, boom, suddenly her throat starts to feel constricted, she feels like she can't move air normally etc. She says it feels just like if she was being choked on the left side specifically.
Anyway, we just don't know where to go next. Nothing anytomical can be found, no real explanation for these situations. She has never had them before.
We've got it that... all else fails it must be anxiety.... but, because it happens when she's relaxed and absolutely not stressed... we feel we need to continue to look.
Could it be some kind of hidden poisoning, something odd like you hear about problems that can come from cat litter handling, something in a household chemical that she's ultimately allergic too or ? We've tried to evaluate our surroundings... what's new ....etc. The only new medication she has been taking is an Estrogen patch... however, she started that six months before these symptoms showed up. She eats normally, drinks a half gallon of ice water daily, takes a mult-vitamin, B-complex, calcium, ... don't think she's nutrient deficient.
From what specialty do we request the next consult ? We have good medical care thanks to our military affiliation so we can continue to search for a answer, but wonder where do we look from here ?
Just joined WebMD looking for direction. I saw an old discussion of yours that was very close, but, that person had not started common consultations ... and that was your recommendation.
My wife is 50, 5'8" 125, on the go sun up to down. We are a recently retired military family... mentioned only in that we've had consistent ongoing care for over 20 years.
About six months ago, she awoke in the night feeling as though she had something stuck in her throat... or as if you were putting pressure on the left side of her neck to constrict her breathing. It took hours to stop. It happened again the following day while driving.. she diverted to a nearby ED (she hasn't gone to an ED in 25 yrs). Nothing was found, she was sent to her Primary Care provider, who sent her to ENT. She had a Nasal Endo, extended lab panels, and was ultimately given a course of antibiotics. The symptoms seemed to subside.... but, they have come back repeatedly. She can go for 2-3 weeks without any, then the start again.
Anxiety has be communicated by providers..... she has taken Zanax .5 PRN for years. She hadn't really taken it often... until this new thing started. I guess the confusing part about that is these symptoms come without warning and with zero consistency as to whether she is stressed or not. She can be watching a Doris Day moving on a pajama Sunday...and, boom, suddenly her throat starts to feel constricted, she feels like she can't move air normally etc. She says it feels just like if she was being choked on the left side specifically.
Anyway, we just don't know where to go next. Nothing anytomical can be found, no real explanation for these situations. She has never had them before.
We've got it that... all else fails it must be anxiety.... but, because it happens when she's relaxed and absolutely not stressed... we feel we need to continue to look.
Could it be some kind of hidden poisoning, something odd like you hear about problems that can come from cat litter handling, something in a household chemical that she's ultimately allergic too or ? We've tried to evaluate our surroundings... what's new ....etc. The only new medication she has been taking is an Estrogen patch... however, she started that six months before these symptoms showed up. She eats normally, drinks a half gallon of ice water daily, takes a mult-vitamin, B-complex, calcium, ... don't think she's nutrient deficient.
From what specialty do we request the next consult ? We have good medical care thanks to our military affiliation so we can continue to search for a answer, but wonder where do we look from here ?
3 Replies |Watch This Discussion | Report This| Share this:Acute tightness of throatDr. Moser,<br />Just joined WebMD looking for direction. I saw an old discussion of yours that was very close, but, that person had not started common consultations ... and that was your recommendation. <br /> <br />My wife is 50, 5'8" 125, on the go sun up to down. We are a recently retired military family... mentioned only in that we've had consistent ongoing care for over 20 years. <br /> <br />About six months ago, she awoke in the night feeling as though she had something stuck in her throat... or as if you were putting pressure on the left side of her neck to constrict her breathing. It took hours to stop. It happened again the following day while driving.. she diverted to a nearby ED (she hasn't gone to an ED in 25 yrs). Nothing was found, she was sent to her Primary Care provider, who sent her to ENT. She had a Nasal Endo, extended lab panels, and was ultimately given a course of antibiotics. The symptoms seemed to subside.... but, they have come back repeatedly. She can go for 2-3 weeks without any, then the start again.<br /> <br />Anxiety has be communicated by providers..... she has taken Zanax .5 PRN for years. She hadn't really taken it often... until this new thing started. I guess the confusing part about that is these symptoms come without warning and with zero consistency as to whether she is stressed or not. She can be watching a Doris Day moving on a pajama Sunday...and, boom, suddenly her throat starts to feel constricted, she feels like she can't move air normally etc. She says it feels just like if she was being choked on the left side specifically. <br />Anyway, we just don't know where to go next. Nothing anytomical can be found, no real explanation for these situations. She has never had them before. <br />We've got it that... all else fails it must be anxiety.... but, because it happens when she's relaxed and absolutely not stressed... we feel we need to continue to look. <br />Could it be some kind of hidden poisoning, something odd like you hear about problems that can come from cat litter handling, something in a household chemical that she's ultimately allergic too or ? We've tried to evaluate our surroundings... what's new ....etc. The only new medication she has been taking is an Estrogen patch... however, she started that six months before these symptoms showed up. She eats normally, drinks a half gallon of ice water daily, takes a mult-vitamin, B-complex, calcium, ... don't think she's nutrient deficient.<br />From what specialty do we request the next consult ? We have good medical care thanks to our military affiliation so we can continue to search for a answer, but wonder where do we look from here ?
Rod Moser, PA, PhD responded:
This could, indeed, be a condition that we would call hysterical dysphagia -- a feeling of chocking or something caught in the throat due to anxiety. It is not a good name for a disease, since the Latin root of "hyster" refers to women. This can happen to men as well.
No one should blame anything on a psychological reason until ALL, and I mean ALL organic possiblities have been investigated. Has she had a thyroid scan, and a bank of thyroid tests? How about a CT or MRI of the neck?
I guess it is possible that she could be having an allergic response, like a laryngeospasm, but this would not be high on the list. Poisoning? This is not my area of expertise, but I did say "ALL" things should be considered.
Does you wife have reflux? Medications, even vitamins, taken at bedtime can trigger reflux. If this primarily happens while she is sleeping, it could be related to a stressful dream -- one that she cannot recall.
You are a good spouse to be concerned. I think there may be a few more diagnostic stones to overturn, so please keep me posted.
No one should blame anything on a psychological reason until ALL, and I mean ALL organic possiblities have been investigated. Has she had a thyroid scan, and a bank of thyroid tests? How about a CT or MRI of the neck?
I guess it is possible that she could be having an allergic response, like a laryngeospasm, but this would not be high on the list. Poisoning? This is not my area of expertise, but I did say "ALL" things should be considered.
Does you wife have reflux? Medications, even vitamins, taken at bedtime can trigger reflux. If this primarily happens while she is sleeping, it could be related to a stressful dream -- one that she cannot recall.
You are a good spouse to be concerned. I think there may be a few more diagnostic stones to overturn, so please keep me posted.
Report This| Share this:Acute tightness of throatThis could, indeed, be a condition that we would call hysterical dysphagia -- a feeling of chocking or something caught in the throat due to anxiety. It is not a good name for a disease, since the Latin root of "hyster" refers to women. This can happen to men as well.<br /> <br />No one should blame anything on a psychological reason until ALL, and I mean ALL organic possiblities have been investigated. Has she had a thyroid scan, and a bank of thyroid tests? How about a CT or MRI of the neck?<br /> <br />I guess it is possible that she could be having an allergic response, like a laryngeospasm, but this would not be high on the list. Poisoning? This is not my area of expertise, but I did say "ALL" things should be considered.<br /><br />Does you wife have reflux? Medications, even vitamins, taken at bedtime can trigger reflux. If this primarily happens while she is sleeping, it could be related to a stressful dream -- one that she cannot recall.<br /> <br />You are a good spouse to be concerned. I think there may be a few more diagnostic stones to overturn, so please keep me posted.
soldierservices replied to Rod Moser, PA, PhD's response:
Thank you for your reply.
She has had Thyroid Ultra Sound, Barium Swallow, Neck CT, and extensive labs from ENT, Endocrinology, and even a Cardiology review. The only item of note after all those reviews, was that her secretion of Bile was slow.
She does have reflux controlled by Prilosec I think.
One major issue i didn't mention was that she has been simultaneously suffering from Geograhic Tongue. She's never had any oral issues previously ... and the Geographic Tongue appeared virtually at the same time as the throat tightness. The tongue issue has evolved to over 50percent of her tongue and looking pretty aggressive...then back to much less .
She also had a short bout with Bells Paulsey following the birth of our last child 8 years ago. But that has never returned. Last year, she was given an oral anti-fungal due to unusual changes in a couple toe nails.
Where would you look next?
One provider recommended stopping all meds for a period and then adding them back in one at a time. However, she is concerned about stopping maintenance meds and the length of time it would take to get back on them... especially since she has been a year now getting settled on HRT products.
Thank you for your time to help to so many people with their questions.
She has had Thyroid Ultra Sound, Barium Swallow, Neck CT, and extensive labs from ENT, Endocrinology, and even a Cardiology review. The only item of note after all those reviews, was that her secretion of Bile was slow.
She does have reflux controlled by Prilosec I think.
One major issue i didn't mention was that she has been simultaneously suffering from Geograhic Tongue. She's never had any oral issues previously ... and the Geographic Tongue appeared virtually at the same time as the throat tightness. The tongue issue has evolved to over 50percent of her tongue and looking pretty aggressive...then back to much less .
She also had a short bout with Bells Paulsey following the birth of our last child 8 years ago. But that has never returned. Last year, she was given an oral anti-fungal due to unusual changes in a couple toe nails.
Where would you look next?
One provider recommended stopping all meds for a period and then adding them back in one at a time. However, she is concerned about stopping maintenance meds and the length of time it would take to get back on them... especially since she has been a year now getting settled on HRT products.
Thank you for your time to help to so many people with their questions.
Report This| Share this:Acute tightness of throatThank you for your reply.<br />She has had Thyroid Ultra Sound, Barium Swallow, Neck CT, and extensive labs from ENT, Endocrinology, and even a Cardiology review. The only item of note after all those reviews, was that her secretion of Bile was slow.<br />She does have reflux controlled by Prilosec I think. <br />One major issue i didn't mention was that she has been simultaneously suffering from Geograhic Tongue. She's never had any oral issues previously ... and the Geographic Tongue appeared virtually at the same time as the throat tightness. The tongue issue has evolved to over 50percent of her tongue and looking pretty aggressive...then back to much less . <br />She also had a short bout with Bells Paulsey following the birth of our last child 8 years ago. But that has never returned. Last year, she was given an oral anti-fungal due to unusual changes in a couple toe nails.<br />Where would you look next?<br />One provider recommended stopping all meds for a period and then adding them back in one at a time. However, she is concerned about stopping maintenance meds and the length of time it would take to get back on them... especially since she has been a year now getting settled on HRT products.<br /> <br />Thank you for your time to help to so many people with their questions.
Every so often...don't ask me why....I post a reply and it never shows up. Oh well, I will try and remember what i said in case it shows up later...
The most important thing to do is to remain under the care of an ENT and see this person regularly until this issue is solved. I don't believe that the geograhic tongue is clinically relevant to her symptoms, but that would be up to her ENT to determine.
Just because nothing organic was found, does not mean that her clinical findings and lab test will not change over time. Before blaming any symptom purely on psychological reasons, one has to rule out EVERYTHING. I really do not have enough specific information about her case to know what the next step would be. This is why she needs to remain in care and not simply dismissed.
Bell's Palsy eight years ago should not be related. This is a facial nerve and would not be related to anything in her throat. I don't know what anti-fungal medicine she was taking, but you can check with her doctor or the pharmacist to see if there is an issue.
The most important thing to do is to remain under the care of an ENT and see this person regularly until this issue is solved. I don't believe that the geograhic tongue is clinically relevant to her symptoms, but that would be up to her ENT to determine.
Just because nothing organic was found, does not mean that her clinical findings and lab test will not change over time. Before blaming any symptom purely on psychological reasons, one has to rule out EVERYTHING. I really do not have enough specific information about her case to know what the next step would be. This is why she needs to remain in care and not simply dismissed.
Bell's Palsy eight years ago should not be related. This is a facial nerve and would not be related to anything in her throat. I don't know what anti-fungal medicine she was taking, but you can check with her doctor or the pharmacist to see if there is an issue.
Report This| Share this:Acute tightness of throatEvery so often...don't ask me why....I post a reply and it never shows up. Oh well, I will try and remember what i said in case it shows up later...<br /> <br />The most important thing to do is to remain under the care of an ENT and see this person regularly until this issue is solved. I don't believe that the geograhic tongue is clinically relevant to her symptoms, but that would be up to her ENT to determine.<br /> <br />Just because nothing organic was found, does not mean that her clinical findings and lab test will not change over time. Before blaming any symptom purely on psychological reasons, one has to rule out EVERYTHING. I really do not have enough specific information about her case to know what the next step would be. This is why she needs to remain in care and not simply dismissed.<br /> <br />Bell's Palsy eight years ago should not be related. This is a facial nerve and would not be related to anything in her throat. I don't know what anti-fungal medicine she was taking, but you can check with her doctor or the pharmacist to see if there is an issue.
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