Solve the Medical Riddle: Her 75-year-old Mother Has Trouble Swallowing, Second Week

By Marie Savard MD

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

Last week, the patient reported her symptoms with her daughter present. The doctor proceeded with the examination using the components of the classic S-O-A-P notes, which are as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

The doctor then scheduled Mildred for an appointment at the radiology department of a nearby hospital. Mildred’s daughter, Lucy, came along for support. The radiologist used the modified barium swallow (MBS), the gold standard test for the assessment and diagnosis of dysphagia. That is the medical term for difficulty swallowing. He gave Mildred small amounts of applesauce with barium, and a small piece of a cookie with barium. Barium is a metallic element that shows up on x-ray which allows the doctor to view the outline of the back of her throat and esophagus.

The radiologist let Mildred have the test while seated in a chair rather than strapping her onto an x-ray table that could tilt vertically. She felt confident she could remain still during the test, and she did. The assessment, which took under an hour, included x-ray and video of the swallowing process to determine which stage of swallowing was involved.

Mildred was allowed to leave right after the test and resume her normal diet and activities, but she was advised to drink plenty of water to help eliminate the barium. She was also told that her stool would look chalky for a day or two and that this is of no concern.

The results of the MBS would be sent to Mildred’s doctor to help him make a diagnosis and possibly refer her to specialists.

To be continued . . .

Come back to ThirdAge.com next Thursday to find out what some people have guessed the diagnosis might be.

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.