Difficulty swallowing

SO sorry to hear this about your friend… but really, he needs to bring this up with a medical professional, because the extreme weight loss is very, very unhealthy. Maybe start with a good GP, then progress to a good GI specialist (not easy to find) or maybe even an Otolaryngologist.

For short-term trips, maybe you could make him super-high-calorie smoothies (not chunky!), using powdered Ensure and other high-cal ingredients (malto, coconut cream/oil, etc.)…

But definitely, modern medicine should be able to help him…

The thing is, I have had similar trouble swallowing on long hikes. Not to the extent he did. Just certain foods I could not swallow. He couldn't swallow anything non-liquid. He only got down to 130 because he did 500 miles like that. This time he only did 80 miles and decided to quit. As soon as we hiked in to Bucks Lake he pounded down a plate of fish tacos so I kinda wonder if it isn't partially psychological. I do hope he figures it out.

I take a stimulant medication that sometimes has this side effect for me. I can feel that my stomach is hungry, and I will begin eating, and after a few bites just cannot bring myself to swallow. It sounds really kind of crazy, but it is real.

I do notice a similar effect during high intensity or long duration physical work. It would be interesting to know why that happens, but I do know that it does happen, and you aren't alone.

My solution is two-fold. First, I snack. A lot. Two bites here and there can really add up by the end of the day. I make sure that I have a couple of sweet things and a couple of salty things to choose from, because usually one thing will sound okay when the others seem downright repulsive.

I also am a big fan of smoothies as a meal replacement when this is an issue. Sometimes it's still hard to get down, but not having to chew can make a big difference in how much I can consume at once.

I would definitely look into meal replacement smoothies. My favorite is Packit Gourmet Jump Start Fruit Smoothies. They are 560 Calories! which makes them an excellent meal replacement and well balanced with Whey Protein, Fat and Carbs. It is powdered so you just add water. Also excellent for those that are looking into cold food for shorter trips.

http://www.packitgourmet.com/JumpStartFruitSmoothies.html

NON-medical opinion – NON medical!

> He chews and chews but can't make himself swallow it. He's okay with liquids.
He may be a bit dehydrated and not generating enough saliva to get the food to a swallowable state. I have experienced that myself in the past. Some medication will do that to you, or to your mouth as well.

Options:
SOUP, lots of thick soup! Very sloshy meals. Both food and liquid, so all is good.
Drink while chewing: saliva substitute as it were.
More drinking while walking and right before meals.

Cheers

The Packit Gourmet smoothies are pretty tasty alright, with the fruit chunks and all. The caloric balance is good, with 28% fat, 39% carbs, and 33% protein (quite a bit, actually). However, the carbs are 93% sugars (not many complex carbs at all). These numbers are for the Berry Berry flavor, which delivers just 425 cal at a net weight of 3.77 oz. (just 113 cal/oz.). These are fairly expensive compared to other options.

On the other hand, Ensure provides 32% fat, 53% carbs (just 39% of these are sugars), and 15% protein. 3.00 net oz. provides 382 cal., which comes out to 127 cal/oz. With vanilla Ensure, you can add most any freeze dried or dehydrated fruits, and you can also package as much as you want for the desired calories. With Packit Gourmet's Jump Start Smoothies you are locked into a fixed portion, unless you want to repackage them.

Another high protein option, and also somewhat less expensive than Packit Gourmet, is a product called Nutribiotic ProZone (I buy it at Vitamin Cottage). It is 29% fat, 41% carbs (with 63% of those being sugars), and 30% protein. 3 net oz. of that yields 372 cal., or 124 cal/oz.

Walgreen's store brand is the cheapest I've found, especially if you can get in on sale. 3 oz. net of this yields 22% fat, 64% carbs (59% of these are sugars), and 14% protein. It provides 352 cal, or 117 cal/oz. It's fairly low-fat/high-carb, so its caloric content is a bit lower.

Of all these, I prefer Ensure for its caloric balance, relative price, and cal/oz. yield. I can package up as many calories per serving as I want. However, if you want more protein, then the ProZone is the way to go. It is half-way between PG smoothies and Ensure for price, and its caloric balance is nearly identical to the PG smoothies.

What the world needs is one of these powders that has almost NO simple sugars (like Perpetuem), wherein you can add some stevia to sweeten it the way you like it.

But if convenience outweighs the cost, then probably the PG Jump Start smoothies are the way to go.

"What the world needs is one of these powders that has almost NO simple sugars (like Perpetuem), wherein you can add some stevia to sweeten it the way you like it."

the world has it. It's called Maltodextrin or Malto for short. tasteless but it already has some sweetness.

He should see a doctor. This can be a neurological problem with some older folks.
A primary care doc may refer him to an ENT doc or to a Neurologist.

Would be good to note any meds that he was taking at the time.

Also note other chemicals that were being used. DEET and other insecticides are known neuro toxins… Not saying that is what is doing it, but it does come to mind.

good luck,

Billy

Thanks for all those drink options. I also found something in the vegan section of the health food store today. Not that I think vegan options are all that great, but it's different and it was a chai tea flavor which might be nice for variety.

" Maybe start with a good GP, then progress to a good GI specialist"

+1 He should eliminate the possibility of GERD, which can lead to esophageal cancer if left untreated. I'm not saying that is his problem, but it is endemic in the US, especially in older folks, so the possibility is there. Easy to diagnose and treat.

Dysphagia has many causes.

See a doc.

He should see a doctor. I had a friend with a similar issue when he mt. biked. His Dr. diagnosed blocked arteries in the heart. I'm not trying to say anything about what your friend has, but it could be bad but fixable.

He did see a doctor. His doctor was not impressed with his complaint. My boyfriend is sort of a hypochondriac so I don't blame the doctor.

This sign in Chinese medicine is known as "plum-pit" feeling. This can be due to esophageal spasm. It can be triggered by food allergies, or chronic esophageal inflammation. Get it checked. If his doctor is not listening, get a new doctor.

Piper: "His last trip he lost so much weight he weighed only 130lbs at the end."

"If his doctor is not listening, get a new doctor."

+1

A good doc will at least explain the possibilities, what to anticipate, and how to rule out causes. Go with him if You need to, just to help sort through things.

Your friend needs to see a gastroenterologist. Don't stop trying until you get in to see that specialist. Dysphagia (difficulty swallowing) is common and GI docs are the best choice to try to find the cause. Read up on the issue at

http://emedicine.medscape.com/article/2212409-overview

p.s. if that link does not work for you, pm me with your email and I will send a pdf file.

I really think he needs a psychiatrist. I mean here he is not able to eat, we walk a couple miles down a road, didn't even lose altitude, and next thing that happens is he's polishing off a plate of fish tacos and a couple beers like nothing happened. It's only because I experienced something similar, although not nearly so extreme, that I wonder if it's a reaction to strenuous exercise or a psychosomatic thing.

It could be psychogenic, one of the causes. But that is a diagnosis made after a minimum workup to exclude structural causes. Some persons may have psychogenic issues on top of structural causes if they fear any choking associated with their problem. Swallowing is a complex process. You don't realize it until you have a problem with it. Good luck!

I made the mistake of not having enough diversity in my diet on the Wonderland. I had difficulty gagging down the food I brought by day 4ish and started throwing it up. I swapped some food with my hiking companion and was able to eat no problem. I ended up carrying several thousand calories of dead weight back to the truck with me. After this experience, I'm less worried about calories per ounce and more concerned about calories I can actually consume. If this means I go from 1.5 to 2.5 lbs food per day, so be it.

I really could not force my food down which is why I'm wondering if he might have the same issue. Even if I did not feel nauseous looking at it, I could not force myself to swallow it. Different food, no problem. Perhaps mix it up and bring food he eats in the front country.

Just playing "what if" here, Piper,…if & when better/proper medical attention does diagnose a psychosomatic component for your young friend's malady. Am thinking the altitude and exertion you suspect will have physical effects, and the top one I'd suspect is dehydration. I tend to lose my appetite at altitude while exercising and will almost gag if I put something in my mouth that demands saliva my body is unwilling to give. Over time, my meals have become porridges, become stews, become soups, become broths. I still love salty chips, but try extra hard to drink water so I stay in love. Further speculating wildly, I wonder if digestive-juice production decreases with age? I'm a touch older than he and experience something similar when I snack on a handful of almonds during the day. I yearn when reaching for them, but immediately regret once chewing. Seems like I will chew them for five minutes before I feel capable of swallowing them.

[ex-post edit seeing Ian B above: Plus one]

Charley your description sounds like my boyfriend's. He kept complaining that things were too dry. But he also complained that some pretty tasty things that weren't dry at all were impossible to eat very much of. I'm sure he's at the doctor today, if not sometime this week. He has no qualms about visiting doctors. I just don't think doctors have any clue about things that happen to physically active people, especially when they do somewhat super-human physical things like take an 80 mile walk in 3.5 days.

After my Dad had a "mini" stroke during surgery he choked on something he was eating. After that he couldn't swallow anything. It almost killed him (he was in his 70s with other medical problems).

I once thought I my stomach upset was just hunger and exhaustion (3 hours sleep). I tried to each a cracker and it "balled up" when I tried to swallow it. Turned out to be the flu, but I couldn't force myself to eat anything. I was in my 40s then.

So, it really can be just physiological. The act of swallowing is complex. It doesn't always take much to "throw it outta wack".

If the doctors can't find anything physically wrong then I would switch to liquid meals when the problem occurs and slowly try to introduce thicker foods. Then start chewing the thick liquid and finally introducing solid food in the liquid. But, I would push the doctors as much as possible to insure nothing was physically wrong. Good luck.

It always mystifies me that most people just "accept" everything their doctor says.

Unfortunately, if you want to get really good medical care, you have to treat the process like a "consumer-driven" thing. If you were shopping for a car, would you just "accept" everything the car salesman told you? [Ummm, I'm gonna think "no"…]

Yes, there are great doctors out there, but there are also a bunch of mediocre doctors out there, and sometimes, you have to question them, or push them (do it in a respectful and polite way, though). YOU know your body best, and YOU have the time/energy to make sure that your treatment is working (or not)… and YOU have the right to either see another doctor, or go back to the previous one and ask for alternatives because the treatment isn't working.

If you're known as a "hypochondriac" by your doctor, your care will go downhill fast — "boy who cried wolf" syndrome…

I hope OP's friend gets this sorted out satisfactorily.

it helps if you research it

find out what to say to get then to do a particular procedure

for example, say that you have difficulty swallowing all the time, or you have acid reflux to get referred to a gastroenterologist to look down your throat