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Dr. Andrew Rynne

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What causes difficulty in swallowing BP medication?

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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 3130 Questions

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Posted on Mon, 26 Oct 2015 in General Health
Question: QMy husband has had some difficulty swallowing his blood pressure pills, and didn't think much about this, but has since felt like it is noticeable when swallowing on a regular bases regardless of pills and food. This has been for awhile. There is no particular pain and doesn't feel tired or weight loss. He just went to our Dr. Who looked in his mouth (throat), and said he didn't see anything different, even though My husband thinks it looks different at the back of his throught. The Dr. Didn't feel his throught or anything, but took a swab. We didn't think he was at all thorough enough. Also XXXXXXX quit smoking 7 years ago, and has smoked most of his life (he is 56 yrs). I'mm disappointed with his care, as he went to the Dr. Awhile ago, stating the diff. Swallowing his pills. He simply prescribed a diff. Pill. Can you answer me please as what to do..... XXXXXXX
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 44 minutes later
Brief Answer:
See an ENT

Detailed Answer:
Hello XXXXXXX

I am sorry that your husband's doctor was not very thorough. It's possible that the doctor assumed that if the problem continued on the new pills that your husband would return to him for further evaluation.

Difficulty with swallowing can be caused by a number of problems. These include things like acid reflux irritating the throat.

Given that XXXXXXX feels it is noticeable regardless of what he is swallowing, and he has a history of smoking, I would advise that he see an Ear Nose Throat specialist. An ENT can use a special mirror to visualize the throat down to the vocal cords. If the ENT sees nothing abnormal, he may want to get a CT or MRI of the neck. Also a swallow study may be helpful. This is where various consistency foods and liquids are swallowed during observation/imaging.

I don't know how the Canadian health care system works in terms of getting to see a specialist. I am assuming XXXXXXX cannot self-refer and needs a referral from the primary doctor. If this is the case, I would now call the primary doctor and tell him that the problem has continued and is not exclusive to swallowing pills - occurs with any swallowing, and assertively request a referral to ENT. If the primary doctor is unwilling, he may be willing to do some of this evaluation himself (i.e. order the swallow study, etc).

I hope this information helps. Please let me know if I can provide further information or clarification.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 4 hours later
I asked my husband to do that, but the doctor insisted he saw nothing, and instead did a throat swab. We will have to wait for these results, perhaps 4 to 5 days. So in his follow up we could perhaps insist on seeing an ENT. This can take time. In the mean time, we could order a swallow test. How do we do this? Thank you... XXXXXXX
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 2 hours later
Brief Answer:
The dr. would need to order the swallow study.

Detailed Answer:
Hi XXXXXXX

At least in the US, a swallow study requires a request from a doctor.

I should have been clearer when I wrote: " If the primary doctor is unwilling, he may be willing to do some of this evaluation himself (i.e. order the swallow study, etc)."

I meant if the primary doctor is unwilling to refer XXXXXXX to ENT, he might be willing to do some of the evaluation himself such as ordering a swallow study.

If the swab was done to check for infection, a culture should be ready in 3 days. So you can give the doctor that much time and then follow up, letting him know that the swallowing is not just a problem with pills and that it is not possible to see down into the lower part of the oropharynx without a mirror or scope, so you would like this evaluated further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 13 hours later
Thank you for this information. It has been very helpful. This allows us to know what to ask for and how they can be done, example swallow study and seeing the oropharynx with mirror or scope. Were you suggesting Tom's Dr., as opposed to an ENT, using the mirror or scope to see in that area?
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 4 hours later
Brief Answer:
Indirect laryngoscopy (mirror) may be done by the primary, other cannot.

Detailed Answer:
Hi XXXXXXX

The exam with the mirror, called indirect laryngoscopy, uses a little mirror like is sometimes used in a dentist's office. Some family practice doctors are trained in how to do this, others are not. So whether Tom's primary doctor can do it depends on if he has experience with this. Basically a light is shined into the throat, and the doctor holds the little mirror (it has a long handle) with the round mirror at the end facing down, at the back of the throat. Sometimes a doctor will numb the throat with a spray first, but I have had it done on myself without the numbing spray and was fine. Sometimes the doctor will have the patient take short breaths or make a high pitched "aaaaa" noise to prevent gagging if not using the numbing spray. The doctor can then see the reflection down the throat in the mirror. The bright light that's needed can either come from an otoscope, or be reflected from a mirror on a head band doctors sometimes wear for this purpose.

Here is some info on indirect laryngoscopy: https://www.nlm.nih.gov/medlineplus/ency/article/007507.htm

Any kind of actual scoping would not be done by the primary doctor. And may not be needed if enough can be seen with the mirror/indirect laryngoscopy.

The swallow study, at least in the US, is often done by the speech therapy department, and is ordered by either the primary doc or the ENT.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 2 hours later
Thank you very much, this is extremely helpful. We now know what can possibly be done by Tom's primary doctor, if there is a wait to see an ENT..... The next chance to see his Doctor is Tues. Oct. 6th, where we will inquire or tell the doctor what we want done, if he does not feel there is a need.....Thank you again.... XXXXXXX
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 11 minutes later
Brief Answer:
Good luck to you,

Detailed Answer:
But please keep in mind that the primary doctor may not have had training in indirect laryngoscopy and may not be comfortable with doing this himself. Just something to keep in mind.

I wish you and XXXXXXX well. If you have no further questions for me, please go ahead and close the discussion (and rate it if you desire).

Bonnie Berger-Durnbaugh, MD
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 17 hours later
I didn't look back to check the date, but I believe I am able to have discussion with you until Nov. 1st, say if any concerns come up. If this is correct, can I still talk to you by this email or should I close now?..... XXXXXXX
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 11 hours later
Brief Answer:
Yes, you can keep it open.

Detailed Answer:
Hi XXXXXXX

I am not sure about HCM's policies as we don't actually see what information HCM sends the patients, but I think it can stay open for 10 days from the time that we answer. If after 10 days it closes, you can ask a question and request me by name and they will flag your question for me to answer, but I think then you have to start over with paying again.

You may not want to respond to this post now, but just not close the discussion and I will respond if you ask.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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