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I have been having trouble swallowing for 6 weeks. I am

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I have been having...

I have been having trouble swallowing for 6 weeks. I am unable to swallow solids, i can take water, and have been forcing down pureed baby food however it often feels like it's getting stuck and gives a choking feeling. I have had an endoscopy and seen 3 ENT's who could not find any problem I was reffered to an SLP and had 4 therapy sessions with him however have seen no difference. Today I had a Barium Swallow Test which showed 'Swallowing machanism to the right of the midline abnormal. Paralysis or paresis at the level of the hypopharynx and abnormality of the Vallecular." The radiologist mentioned it could be something to do with nerve damage, and so I would like the opinion of a neurologist. I would like to ask if it is nerve damage, does it need urgent attention and treatment or will it get better on its own? I am currently abroad and access to healthcare is not easy.

Doctor's Assistant: Do you keep personal medical records to help track this?

Yes, i have medical records from the different practitioners I have seen

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

I had a cold and a cough before the swallowing issue came about, I think had an incident where I felt i was choking on a dough ball, and since then I have had this problem.

Submitted: 4 months ago.Category: Neurology
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Answered in 4 minutes by:
3/14/2018
Neurologist: Dr. Bob, Neurologist (MD) replied 4 months ago
Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5,762
Experience: Neurology & Int Medicine (US Trained): 20 yrs experience
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Hello. Have you noticed any changes in your voice or have you had any trouble speaking? Have you had any surgery to your mouth, neck or chest? What is your age?

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Customer reply replied 4 months ago
Hi, no, no other symptoms at all apart from the swallow problem (and then symptoms related to hunger such as dizzyness, lightheadedness, fatigue). No surgery. I am 32 years old. Female. Perfectly healthy before this.
Neurologist: Dr. Bob, Neurologist (MD) replied 4 months ago

I would suggest you see a neurologist within the next couple weeks. I would start with a careful neurological exam to make sure there are no other occult or mild signs or symptoms. If there is no apparent explanation, I would consider a CT scan of the neck to look for a mechanical reason for the dysphagia. If normal, I would get an MRI of the brain to rule out a central nervous system cause. It would not be an emergency unless you were aspirating your food (going into the lungs) or having trouble breathing. Otherwise you can continue to puree your food or stick to a liquid diet. Some causes are temporary, but 6 weeks of symptoms definitely warrants further work up.

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Neurologist: Dr. Bob, Neurologist (MD) replied 4 months ago

Does this make sense?

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Customer reply replied 4 months ago
I understand I wont be able to be diagnosed without further testing and it makes sense that I need to be seen and have tests to see what the problem is exactly, but I am scheduled to be abroad for the next 4 weeks, and so I was wondering, that if it is some form of nerve damage (the radiologist brought up that it could be possible from a virus), if it is safe to wait the 4 weeks before getting it seen too or if leaving something like nerve damage untreated would cause it to get worse or become untreatable? Thanks
Neurologist: Dr. Bob, Neurologist (MD) replied 4 months ago

I see. Well, the answer to that question depends on the underlying cause. For example, nerve damage done by a virus is typically temporary and not progressive, though it can take many weeks or months to recover. If the nerve is being compressed by something, you would need to know what it is (e.g. hematoma, cyst, mass) and whether it is growing or stable in size. Most sources of compression either stop enlarging after a certain point, or grow very slowly. Similarly, a central nervous system cause (e.g. demyelination, stroke, mass) would be expected to stabilize or progress very slowly. So, ideally, you would want to get to the bottom of this before your trip, so you have a better idea of the treatment plan and prognosis. If this is not possible, you could follow up at your destination if things progressed and good medical care was available.

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Customer reply replied 4 months ago
Thank you. I am unable to do anything about it abroad, which is why i wondered if I could leave it 4 weeks before getting it seen to or if it was urgent and required urgent attention. I don't want to do irreversible damage just because i waited to long. But from what I can understand from your answer, it's not that more damage can be done by leaving it? It's just finding the cause that is the main concern?
Neurologist: Dr. Bob, Neurologist (MD) replied 4 months ago

Yes, exactly, because getting the right diagnosis will dictate prognosis. In the meantime, if you cannot access reliable medical care where you are, you will need to rely on your symptoms to guide you. It sounds like they may have stablized at this point, which would be reassuring. Were they to progress to the point of aspiration, difficulty speaking, or difficulty breathing, for example, you would need to be evaluated urgently.

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