The first time it happened
It was an average day for me. I woke up feeling completely normal and went about my day as I typically would. Suddenly, while out driving around doing errands, I felt as if I couldn’t swallow. The saliva built up in my mouth—like the sensation you get right before you vomit—and I had to force it back, throwing my head back to force the excessive build up down my throat. It felt as if my throat was closing up. I pulled over and tried drinking water, hoping to clear the blockage, but I couldn’t swallow—I coughed the water up, with some of it coming out of my nose. Soon tightness in my chest accompanied the restricted swallowing.
I managed to drive myself to a store, and my boyfriend came and took me to urgent care. As I described my symptoms to the nurse, she immediately asked, “Are you allergic to anything?” I said that I hadn’t been diagnosed with anything, but I do break out in hives anytime I drink orange juice or eat anything with orange flavoring. I then realized that the chicken I’d eaten earlier had been marinated in orange and lemon juice. The doctor theorized that my sensitivity to orange had progressed into a full-blown allergy. I was injected with an Epi Pen and Benadryl. Through the grogginess, I could feel some relief. I was sent home with a 7-day steroid prescription. (If you’re allergic to one of these foods, you’re at risk for overlapping food allergies.)
An allergy or reflux?
A week later—the first day without taking the steroid—I had the same type of episode. I hadn’t eaten anything with orange that day, but I did drink lemonade. Was I now allergic to all citrus? This episode was far worse. Not only were my symptoms more severe, but I was also panicking. I was brought to a nearby emergency room where I was given another Benadryl injection, as well as Pepcid. I was told by the doctor to cut out all citrus from my diet as that could induce acid reflux—a digestive disease in which stomach acids come back up and irritate the esophagus, which can also bring on the same symptoms as an allergic reaction: chest tightness and difficulty swallowing. The doctor said it’s common for people with severe acid reflux to think they’re having a heart attack.
He also suggested I follow up with my primary care physician. I did, and she sent me to get allergy testing for all citrus fruit: orange, tangerine, lemon, lime, tomato, and grapefruit. Every test came back negative. Still my doctor recommended I stay away from all acidic foods—as well as cut out coffee, alcohol, and spicy foods—saying that it must have been acid reflux, since it wasn’t an allergy. She also put me on Nexium, a proton-pump inhibitor, used to treat a variety of gastrointestinal issues.
But I wasn’t convinced. The most common symptoms of acid reflux are heartburn and the taste of sour regurgitated liquid. I had experienced neither. What’s more, the Nexium made me feel worse, not better. It felt as if my throat was being inflated with an abundance of air, and the only thing to give me a bit of relief was an occasional burp. (Acid reflux has a handful of symptoms—some of which may surprise you.)
The acid reflux diet may not sound like much of a diet, until you realize how many of our everyday foods are considered acidic. No more tomatoes meant no more pasta with marinara sauce and no more pizza. No more lime meant no more guacamole and tuna fish, and no more spicy foods meant no more Thai and Indian takeout. I lost 20 pounds in 3 months.
Without rhyme or reason, the episodes continued every few days—and the symptoms would last for a few hours each time—despite the restricted diet and medication. It felt like something was obstructing my passageway, as if my esophagus was a pipe, and all I wanted was the medicinal equivalent of Draino to clear it. I continued visiting doctors, searching for answers and relief. One doctor I saw was convinced that I was inducing these symptoms myself and that I was suffering from panic attacks, which can also have physical symptoms like an allergic reaction and acid reflux: tightness in the chest and difficulty swallowing. I had to fill out a psych questionnaire and was sent home with a prescription for Xanax. I didn’t even fill the prescription, because I knew that wasn’t what was wrong with me.
And then a GI doctor changed everything.
My next stop was a gastrointestinal specialist. He said it could be acid reflux, but that it could also be something more, and that there were tests that could determine for sure what had been going on with me for the last few months. Finally, a doctor determined to get to the bottom of this with me!
First, he recommended a less invasive test called a barium swallow study, or esophagram—a radiographic exam in which a series of x-rays are taken of the upper gastrointestinal tract while you consume both liquid and pill form of barium sulfate, which highlights the pipe. While the liquid went down without any obstruction during the test, the x-ray technicians did see the barium pill get stuck about halfway down. They had me take three big gulps of water before it finally passed through.
Finally, an answer.
My doctor explained that I could be experiencing esophageal narrowing—a condition that causes damage to the esophagus lining which then causes narrowing and inflammation. The next step was the more invasive approach, an endoscopy; a procedure used to examine the digestive system via a tiny camera on the end of a long, flexible wand. If I was in fact dealing with esophageal narrowing, the doctor said he would inflate a balloon in my esophagus to “pop it back out” to its normal size.
He was right. After thousands of dollars, blood work, multiple doctors, hospital visits, and medications, it turns out I had been living for four months with an esophageal stricture. (This is just one of many tricky health conditions that are frequently misdiagnosed.) A ring had formed within my esophagus causing me to feel the same symptoms one does during an allergic reaction, acid reflux, and panic attacks. The chest tightness and difficulty swallowing was produced by food impaction within the ring. It wasn’t the acidity of citrus that I should have been avoiding that whole time, but rather solid foods, meats in particular. Another name for this condition is “steakhouse syndrome,” as steak, chicken, and any other type of meat is chewy and therefore harder to break down, making it more likely to get stuck.
Rather than use the balloon technique, I woke from the procedure to find that my doctor had actually cut the ring by making four incisions and removing the pieces for biopsy. The results were benign. My recovery time was longer than expected, as my esophagus was raw from the surgery for about a month. My doctor opted to remove the stricture rather than his original plan of “popping it out,” because there is a chance that the stricture would have narrowed again over time.
In retrospect, it makes sense that the Benadryl and steroids gave me temporary relief, because they both have anti-inflammatory properties and an esophageal stricture is in fact inflammation.
As to what caused my esophageal stricture? That remains a mystery. None of my testing indicated acid reflux, the most common cause. My doctor said my case was some freak thing—he compared it to being struck by lightening.
Today, I still find myself very aware of the foods I eat, the bite sizes I take, and I over-chew my food—to the point where I am always the very last one to finish a meal, and my food is always cold halfway through. Nevertheless, I am infinitely grateful to the doctor who finally diagnosed me correctly, and for the fact that his procedure has led me back to my normal self.