Ask Dr. H: Swallowing pills after radiation
Question: I never had a problem swallowing pills until I was treated with radiation for esophageal cancer. Now, any pills I take seem to get trapped in the upper part of my throat. When it happens, water hardly helps, but swallowing a piece of bread seems to dislodge the pills. Is this from a Schatzki's ring? Would stretching my esophagus help?
Question:
I never had a problem swallowing pills until I was treated with radiation for esophageal cancer. Now, any pills I take seem to get trapped in the upper part of my throat. When it happens, water hardly helps, but swallowing a piece of bread seems to dislodge the pills. Is this from a Schatzki's ring? Would stretching my esophagus help?
Answer: Radiation to the esophagus and neck can cause irritation and scarring to the tissues, as well as damage to salivary glands, which causes dry mouth. An upper endoscopy procedure done by a gastroenterologist would be helpful to visualize the esophagus lining, and a barium swallow study would enable examination of the swallowing reflex and identification of any areas of thickening/narrowing.
Schatzki's rings of esophageal tissue cause focal points of narrowing in the esophagus, and are usually seen in the setting of acid reflux, rather than esophageal radiation. An upper endoscopy could determine if you have one.
Beyond usual suggestions like crushing pills or using pudding or applesauce to help get pills down, there's an over-the-counter lubricating spray you may find helpful. Available online, Spray'n Swallow is made from coconut and palm oils, and comes in natural flavorings like wintergreen and cherry to eliminate bitter taste. You spray both sides of the pill to make it slippery and then give it a swallow. Check out the website, www.spraynswallow.com.
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Drugs and skin mottling called livedo reticularis
Q: Would you please comment on "livedo reticularis" (mottled skin on legs), which I believe is a side effect of some medications. I've been taking Lipitor, Norvasc, and Ziac for several years, and I feel one of those drugs is causing it. If the offending medication is stopped or I change to another medication, will the mottled skin disappear?
A: "Livedo reticularis" is when the skin of the arms or legs develops a finely mottled, lacelike purplish discoloration due to abnormal swelling of veins. It is different from varicose or spider veins, which are dilations of the veins due to defective valves.
Livedo reticularis can sometimes be triggered by exposure to low temperatures, but it can also be caused by an autoimmune condition like lupus, polyarteritis nodosa, or rheumatoid arthritis, in which, for reasons not understood, the body attacks the blood vessel lining as though it were a foreign invader.
The discoloration can also be caused by abnormal antibodies (proteins) in the blood, which can make the blood flow through veins sluggishly. In many cases, the exact cause of livedo reticularis is never found. The diagnosis can be made either by its appearance or through biopsy.
You're correct that certain medications have been associated with livedo reticularis - drugs like amantadine, adrenaline, quinidine, and hydroxyurea. But I'm not aware of an association between livedo reticularis and any of the medications you're taking. In fact, folks who develop this condition as a result of exposure to cold may actually be helped by the vessel-dilating properties of the blood pressure drug Norvasc.
To see a picture of livedo reticularis, check out this link:
http://www.medicinenet.com/script/main/art.asp?articlekey106681.