How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask jbmd Your Own Question

jbmd
jbmd, Board Certified Physician
Category: Pediatrics
Satisfied Customers: 615
Experience:  Board Certified physician in Internal Medicine - 30+ years experience
Type Your Pediatrics Question Here...
jbmd is online now
A new question is answered every 9 seconds

Today is the first day that my son has no lump in throat

Customer Question

Today is the first day that my son says his throat feels normal and the "tic" like symptoms are gone. Could this be from allergies? I have a EGD Scope set for Tuesday and I'm wondering if I should go through with it considering that he doing better. I am afraid of him being placed under anesthesia and him being able to breath with no problems doing surgery. you know he is an asthmatic. I guess fear is taking over me but I would like answers. What do you think I should do now. I'm planning to have the procedure done at ST. Mary's Childrens Hospital in Indiana. I am wondering should I still continue with the scope even though symptoms have subsided?

Submitted: 1 year ago.
Category: Pediatrics
Expert:  jbmd replied 1 year ago.
Hi--I'll answer your questions. I can't examine or treat your son and can't replace local medical care.

Of course you are afraid of him being under anesthesia. That's a wise thing to be cautious about. If his symptoms are gone, I'd be inclined to not have the EGD, especially as he is asthmatic. Have the doctors done a soft-tissue lateral x-ray of his throat to look at his epiglottis? I always did that in the ERs when I covered there to make sure the epiglottis, the little flap of tissue that covers the airway when we swallow, wasn't swollen. A soft-tissue lateral could also disclose a foreign body if one were present. (Yes, he's 13, but my 13 year old swallowed his little sister's Lego piece, sucking on it for unknown reason while watching TV, so...)

Is this a recurrent issue--the "tics," coming and going or a one-time thing? Was he sick with a cold or other illness/sore throat this time?

Can it be an allergy? Of course--an allergy could cause drainage of mucus into the throat or direct irritation--leading to spasm--of the throat. Some people have extra sensitive throats and spasm easily, which is another good reason you're so smart to be cautious. Does he choke/gag easily now or when he was younger?

If his symptoms return suddenly--get him emergent care. If his symptoms come and go, I'd talk to the ENTs about a fine little fiberoptic scope rather than an EGD unless the spasm is down further in the esophagus. If the symptoms are gone, I'd be inclined to do something non-invasive rather than risky.

If he keeps having spasms and no foreign body or other disorder is found but just hyperactive muscles, I'd treat that medically.

Do you have any other questions?
Customer: replied 1 year ago.

this is the below conversation between the doctor and myself. what do you think about this? Today has been a very interesting day for the family. Michael has not complained at all today about feeling something in his throat. He actually said his throat feels normal and the "tic" has totally disappeared. His doctor here is telling us that she feels it is allergies that are causing the problem. We really need to know what we should do moving forward because my husband really hates the idea of him being put through the procedure and he's afraid of the anesthesia. I don't know what to think or do at this time. I want to know if there is anything wrong but I don't want to put him through things that may be unnecessary. I know he's older now but what do we have to worry about from the procedure? He is afraid he may injury his vocal cord being that he is a singer. My husband is concerned of him having breathing problems etc doing the procedure.

I just need to know, what you really think we should do knowing all the information? Thanks for everything! Doctor stated:Well, if Michael remains symptom-free, then there is no need to proceed with any invasive procedure. However, if his symptoms return, I would proceed.

Endoscopy is safe, especially in otherwise healthy children. Michael has outgrown his tracheomalacia, so unless he has other breathing issues, I don't think there would be any problem with anesthesia. Injury to voacl cords is rare, and many endoscopies are performed without a breathing tube in the first place.

In the nearly 20 years that I have been in pediatrics (including residency and fellowship), I have never seen a patient admitted with significant problems after endoscopy.

I doubt that allegies are/were the cause of the problem, but if Michael remains asymptomatic, I guess you'll never know (and that's OK, as long as *he's* OK!).

Hope you're enjoying the beautiful Spring weather! My comments:


We have already gotten everything "Approved" with the insurance company and he is scheduled to see the doctor on Monday and have the procedure on Tuesday. We just want answers and I guess the fear of the unknown is got me wondering so many different things. When he had the procedure back in 2005 or so I really can't remember step-by-step how things went but obviously good. Michael also wants to know what's going on with his throat badly. I'm glad that you have explained things more for me because when I read things online about the procedure it can be very scary! Hopefully, when the scope is performed it may shed light also on why he stays in the restroom so long. Doctors comments:I would definitely keep the Monday appointment and see Dr. Sampson, and she will guide you from there. The risk associated with the endoscopy is very minimal, and if it gives you the answers you need (or a clean bill of health), then it is worth the minimal risk.

Why aren't you enjoying your family out at the beach etc????Lol

What do you think?


Expert:  jbmd replied 1 year ago.
So it would seem he is having ENT-type endoscopy rather than EGD, right? A smaller scope? or a bronchoscope? Since he had tracheomalacia and it is his throat/airway spasm not his esophagus.

I think that if he remains symptom free, endoscopy is unlikely to find the exact cause of the problem. If it were a mass in the airway or something fixed, it would bother him all the time. So I think that, yes, damage to the vocal cords or problems with anesthesia are unlikely but I wouldn't take the risk if he is fine now and is mostly fine all the time.

Since he is asthmatic, the chance of tracheomalacia being serious if he only RARELY has symptoms is unlikely as the strain of breathing with asthma attack would likely cause collapse down of the airway.

The best time to scope him would be when he was symptomatic, with standby if the airway spasmed shut. If he were my child, I wouldn't do it now. I know you want answers but I bet you won't get them when he's feeling good unless they give him something to cause spasm.
Expert:  jbmd replied 1 year ago.
Can they do a non-invasive MRI of the neck/throat to look at the soft tissue?
Customer: replied 1 year ago.

They feel because of his medical history of the prematurity, double aortic arch, asthma and tracheamalacia and since he had a EDG (Bronchoscopy) done that they only way to be 100% sure of what's going on with him is to do the EDG. I don't know, I am becoming more and more frustrated. For the last past four years my child has been the same weight of 100 pounds and he is 13 years old. He has gotten taller but not heavier and eats like a horse. He never gets choked on any food and never has to clear his throat. I want answers but I don't know what to do. His asthma is controlled with Qvar 40 twice a day and he recently say the pulmonologist and was given a wonderful bill of health other than taking Atrovent right before exercise. His cardiologist says there is nothing wrong with his heart either. I am in a state of confusion because the gastroenterologist swears that allergies would not cause him to feel this way or have the tic....

Customer: replied 1 year ago.

They feel because of his medical history of the prematurity, double aortic arch, asthma, acid reflux and tracheamalacia and since he had a EDG (Bronchoscopy) done that they only way to be 100% sure of what's going on with him is to do the EDG. I don't know, I am becoming more and more frustrated. For the last past four years my child has been the same weight of 100 pounds and he is 13 years old. He has gotten taller but not heavier and eats like a horse. He never gets choked on any food and never has to clear his throat. I want answers but I don't know what to do. His asthma is controlled with Qvar 40 twice a day and he recently say the pulmonologist and was given a wonderful bill of health other than taking Atrovent right before exercise. His cardiologist says there is nothing wrong with his heart either. I am in a state of confusion because the gastroenterologist swears that allergies would not cause him to feel this way or have the tic....

Expert:  jbmd replied 1 year ago.
As a parent, I completely understand your desire for answers but also really think you have to assess what information you will gain and what good it will do you and him. If he never chokes, never clears his throat, his asthma is well controlled on not too much medicine, what treatment option would you take if offered to you? (I hope he's still taking acid reflux meds if he needs them as acid can trigger the "tic.")

It sounds as if he's doing remarkably, wonderfully well but it's easy to see how traumatizing it must have been for you when he was little.

Allergies can cause drainage from the sinuses and that can drain down into the throat and cause irritation of the area around the larynx and also into the airway and cause spasm. So I kind of disagree with the doc who said no and if he were still having the tic, I'd have him take something like Mucinex (guaifenesin/Robitussin) to see if thinning any mucus helped. Also, I have all my patients with asthma wash their noses with neti pots or NeilMed bottle buffered salt water to make sure mucus doesn't accumulate.

One way to think about could it be allergies is to map out when it occurs--or even where. Every spring when things start to bloom? When a visit to a farm or family with a cat? Stuff like that.

Many boys of 13 stay the same weight but grow taller as hormones are coming and they are pushed to grow. They don't put on weight until they stop growing, hair starts sprouting and voice gets deeper. Think about all the skinny, skinny young male teens who wish they could put on muscle and take all kind of OTC protein and carb drinks to try and bulk up--but can't. To us women, lucky time of life to eat whatever you want and not gain. As long as he's not losing and the docs say he's healthy, just feed him all he'll eat and wait.

I was confused with the EGD as that stands for esophago-gastro-duodenoscopy: looking into the esophagus, stomach and duodenum (first part of the small bowel.)

What you're contemplating is low risk but nothing's no risk and what you, your son, and his father need to figure out is what will be gained?

Do you have any further questions?
Customer: replied 1 year ago.

You are awesome for your patience and knowledge. Ok, now you understand that it is an EGD that they swear is not bad for him to undergo. They feel it will give us some answers. So, now that you understand it's an EGD do you think I will be ok with allowing them to perform the procedure? Yes, he has been on 30mg Prevacid once a day for the last 7 years. He has also been on Zyrtec 10mg & Singular 10 mg once a day for the past about 7 years also and takes allergy shots monthly. I promise you I have gotten gray hair over the last week.

Expert:  jbmd replied 1 year ago.
Gray hair is IN now! It's the new blond!

Ask them exactly what they think them MIGHT find and how it would help--are they checking for stomach-lining cells growing up in the esophagus? Are they checking for something outside the esophagus putting pressure on the esophagus (but then why doesn't he have trouble swallowing ALL the time, if it's a fixed bump?)

You described a tic in his throat, not a swallowing problem. As a doctor, I'd start with really ratcheting down his symptoms: WHERE in throat and WHEN does it occur.

He's been on Prevacid for a long time so I guess it's good to occasionally look for acid erosion of the esophagus that's not really giving symptoms (reflux-caused) but I'd look more when he had symptoms than when he was fine. Still that's a reason.

Remember also that Prevacid chronically used can somewhat interfere with bone so he needs to have his vitamin D measured (as 25-OH vitamin D) and his calcium, too. He needs to get vitamin D from sunlight and green vegetables.)

I sense you will have trouble resting without him having it but the rationale seems kind of meh/iffy to me without a clear explanation of what's to be gained.

An EGD is less risky for an asthmatic but they still go by the airway to look down and that can trigger airway spasm (unlikely though--the spray to numb the throat can too). It takes a clumsy endoscopy doc to damage the vocal cords doing an EGD.

So, it's ultimately his benefit vs your anxiety (which I completely understand.) Always a tough place to be.
Customer: replied 1 year ago.

I am sorry that I did not say to you before that yes, they want to check his esophagus to make sure there are no issues with it also being that the double aortic arch was wrapped around his trachea and his esophagus at birth. These doctors have never tested his Vitamin D or calcium levels at all. I really don't want to do it but I want my son to have the best quality of life medically as well. I don't want to be selfish just because of the fear of the unknown either. He has been fine now for the last two days but he did have that feeling of a lump in his throat for at least three weeks. There was never a tic in his throat. He said he had to gulp often and the gulping was causing him to do a tic like movement with his neck and head. Like a jerking of some kind to the neck area with lowering the head while doing it. He told us he felt when he could stop gulping the tic movement would disappear and not all of it has so I am so confused by all of this...

Expert:  jbmd replied 1 year ago.

Well, both (all three of you) are probably getting a little burned out on the medical issues--you know they're necessary to follow up on, but it is wearing on one, especially a teenager. They're notoriously resistant to being different and doing medical procedures.

 

It may be from something like extra reflux or from mucus he was clearing out of a spot in his throat (think what it's like at the tail end of a juicy cold when the nose isn't running anymore but the throat feels thick and it's hard to swallow especially cold foods.) Allergies are like that, too. hOr it could be something he started doing and then couldn't quit for worry that something would accumulate.

 

It's a tough decision, I know, but I think it's a family decision now. However, do they think the double aortic arch problem would come and go? Wouldn't an MRI show that better--what's where in the chest? Maybe they would find something out--decide jointly best on which way you'd kick yourselves more later--if he had it or he didn't. It doesn't sound like an emergency procedure, though, but something that could wait for consensus as long as you tell the doctors ahead of time.

Expert:  jbmd replied 1 year ago.

Not to scare you but to make sure your docs stay on top of this nutritionally in a growing boy: http://well.blogs.nytimes.com/2012/06/25/combating-acid-reflux-may-bring-host-of-ills/

 

Supplementation as needed would eliminate worries with a medication he needs, possibly--say, that might be a reason to do the test--see if he can be weaned off the PPI.

Customer: replied 1 year ago.

Ok. Well I am going to go ahead and do the test and see what it will show us. I pray all is ok and we will receive answers. I was only afraid of him being sedated with the asthma. I don't do well with anesthesia so I always think the worse. I know it's not right but it's forever in my head. He wants badly to come off of some of these medicine and I pray he will be able to because he has been on meds since he was born.

Expert:  jbmd replied 1 year ago.

Good. Glad you came to a decision and one that has a benefit for him quite possibly. Keep me posted--I'll schedule a follow up in 3 days.

 

Please rate the question so it closes and good luck to you all (and the anesthesia is usually conscious sedation rather than full anesthesia so he should do fine.)

 

 

Customer: replied 1 year ago.

Thank you so much. Remember the procedure will be early Tuesday morning. Cast a prayer for my child and please contact me afterwards.


 


Thanks again

Expert:  jbmd replied 1 year ago.
I will!
Expert:  jbmd replied 1 year ago.
Tell me how it went. I had the followup scheduled for tomorrow so if you don't get answers today, maybe then.
Expert:  jbmd replied 1 year ago.
How did the test go? I'm sure well but did they find anything to help your decision processes?

Hope he's glad he had it.

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
< Last | Next >
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Yogindra Vasavada

    Pediatrician

    Satisfied Customers:

    2507
    M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/Dr. Yogindra Va/2012-6-10_2618_DSC0039.64x64.JPG Dr. Yogindra Vasavada's Avatar

    Dr. Yogindra Vasavada

    Pediatrician

    Satisfied Customers:

    2507
    M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
  • http://ww2.justanswer.com/uploads/GA/GauravMD/2012-6-9_62959_gaurav.64x64.JPG Dr. Gupta's Avatar

    Dr. Gupta

    Pediatrician

    Satisfied Customers:

    1442
    MD, practicing Pediatrician with 19 years of experience. Member American Academy of Pediatrics.
  • http://ww2.justanswer.com/uploads/edkulich/2010-08-17_171809_doctor.jpg Dr. K.'s Avatar

    Dr. K.

    Board Certified Pediatrician

    Satisfied Customers:

    819
    Board Certified, Ivy League educated Pediatrician.
  • http://ww2.justanswer.com/uploads/cbellmd/2009-11-19_013247_CB_PHOTO_2.jpg Raymond B., M.D.'s Avatar

    Raymond B., M.D.

    Doctor

    Satisfied Customers:

    422
    I provide medical care for newborns, children, adolescents and young adults up to age 21 years.
  • http://ww2.justanswer.com/uploads/DA/davhill1/2012-6-6_17340_DLHSittingCropped.64x64.jpg David L. Hill, MD, FAAP's Avatar

    David L. Hill, MD, FAAP

    Doctor

    Satisfied Customers:

    414
    Adjunct Assistant Professor of Pediatrics, UNC Medical School. Vice President, Cape Fear Pediatrics.
  • http://ww2.justanswer.com/uploads/josho33/2009-12-16_0435_php4n8fiy_c2PM.jpg Dr. Davidson's Avatar

    Dr. Davidson

    Board Certified Pediatrician

    Satisfied Customers:

    408
    Board Certified Specialist in Pediatrics, Allergy, Asthma & Immunology
  • http://ww2.justanswer.com/uploads/FA/fabiola.caracseghi/2012-4-12_204829_foto2.64x64.JPG Dr.Fabiola.MD's Avatar

    Dr.Fabiola.MD

    Pediatrician

    Satisfied Customers:

    118
    Pediatric Immunology. General Pediatrics