DEAR DR. DONOHUE: I cannot swallow my food. Solids give me the most trouble. I find that drinking a Pepsi helps the food go down and helps relieve it when it gets stuck. What could this be, and what can be done for it? – B.R.

Difficulty swallowing has many causes, but let me choose one that fits your description – achalasia (awk-uh-LAY-shuh). It’s a Greek word that means “unable to relax.” What won’t relax is the esophagus’s sphincter, a muscle that wraps around the lowermost part of the esophagus and keeps it closed so stomach juices don’t back up into it. Normally, when a person swallows, the sphincter relaxes to let food pass into the stomach. In achalasia, it stays contracted.

In addition to the sphincter problem, the usually coordinated contractions of the esophagus – the muscular swallowing tube – have gone haywire, and that compounds the swallowing problem.

Sometimes achalasia makes swallowing liquids almost as much a problem as swallowing solids. In this respect you are lucky.

The diagnosis of this disorder is made by having a patient swallow barium, an opaque, chalky material that outlines on X-rays what happens in the esophagus when a person swallows. The pressure generated in the esophagus during swallowing can also be checked.

About the only thing you can do for it on your own is to eat slowly and chew food completely.

Nitrate medicines, the ones used for heart disease, can sometimes relax the sphincter. Injections of Botox into the sphincter can relieve its spasms. Botox is a diluted solution of the toxin of the most serious kind of food poisoning, botulism. Botox is safe. Dilating the spastic sphincter with a balloon is another treatment. If the above fail, there are surgical remedies for it.

We have put the cart before the horse. You need to have this presumed diagnosis confirmed.

DEAR DR. DONOHUE: What is the difference between asthma and emphysema? – G.M.

The only thing the two have in common is that their target organ is the lung.

Picture a tree with its leaves. It gives you a rough idea of lung anatomy. The trunk and its branches are similar to airways (bronchi). The leaves are like the lung air sacs, delicate structures through which oxygen passes into the blood and carbon dioxide leaves it.

Asthma is a sudden constriction of airways. An asthma attack makes people feel like someone is choking them. By definition, the constriction is reversible. How long it takes for the airways to dilate is unpredictable, and sometimes the constriction is so strong and so protracted that it causes death. Treatment consists of medicines that relax the narrowed airways.

Emphysema is a permanent condition. The air sacs have been dilated and battered. Oxygen cannot get through them to reach the blood. Emphysema patients, therefore, are chronically out of breath. Although the air sac destruction is permanent, emphysema can still be helped with medicines and supplemental oxygen.

Cigarette smoking is the No. 1 cause of emphysema but is not the only one.

Cigarette smoking doesn’t cause asthma, but it makes it worse and more difficult to treat.

The facts on emphysema and its twin illness, chronic bronchitis, are handled in the pamphlet on chronic obstructive pulmonary disease. Readers can obtain a copy by writing to: Dr. Donohue – No. 601, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am under investigation for multiple sclerosis. The doctor wants me to have a brain scan. Why? Aren’t these scans for brain tumors? Do you think it is necessary for me to have one? – M.M.

It is quite necessary for you to have an MRI (magnetic resonance imaging) scan of the brain. The scan can pick up minute scars in the brain. Those scars furnish valuable evidence to confirm or refute the MS diagnosis.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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