Michael was having
MEDICAL MYSTERY FOR CHAPTER 8
HIS STORY:
For months, Michael was having trouble swallowing, and he often felt as if he had a lump in his throat. His voice sounded hoarse, and he had a dry cough, which he attributed to smoking. Even more troubling, Michael was plagued by mild chest pain. He was especially worried because his dad died of heart disease. Michael managed a retail store, and on the nights when he worked late, he often ate dinner right before bed. This led to indigestion and insomnia. Taking antacids usually helped his stomach and the pyrosis—but not the pain in his chest. One night, the pain was especially severe; though it eased a short time after it started, he was still having trouble swallowing. Concerned, Michael went to see his physician’s assistant the next week. Because of Michael’s concern about his heart, his PA ordered an electrocardiogram (EKG). When the results turned out to be normal, Michael wondered if his symptoms—especially the trouble swallowing—might be due to a gastrointestinal problem. His PA agreed and gave him a referral to our clinic.
THE EVALUATION:
In taking Michael’s medical history, I learned that he had an irregular eating schedule. I asked about his diet, and Michael told me that he had a passion for chocolate, spicy foods, and coffee. I performed a physical exam and did not find any abnormalities. Because Michael reported having trouble swallowing, I wanted to make sure that there was no serious damage to his esophagus from his digestive problems. I had him undergo an esophagogastroduodenoscopy, a test that involves being sedated while an endoscope is inserted into the mouth and down the stomach. The endoscope allowed me to check for a hiatal hernia. Hiatal hernias can also cause reflux and pyrosis.
