November 19, 2010
Whenever I get asked by patients who are my best teachers, my answer usually surprises them. I tell them my best teachers are my patients. Over the years, I’ve learned more from listening to patients than from anything I’ll ever learn in medical journals or textbooks.
Here’s one great example: One of the most common problems that I see in my practice is when patients complain of a lump in the throat or difficulty swallowing. In most cases, after seeing inflammation in the voice box, I diagnose silent reflux. I usually go one step further and treat the actual cause of the reflux (obstructed breathing), rather than just cover it up with medications. Oftentimes, however, the voice box looks completely normal, but they still have the symptoms. Usually, I’ll blame it on microscopic amounts of stomach juices that you can’t see.
Just this week I saw a young woman who complained of a lump sensation and a tightness in her throat, with difficulty swallowing. She had classic laryngopharyngeal reflux disease. I recommended the usual conservative measures, such as not eating late, avoiding alcohol close to bedtime, proper nasal breathing, and sleep position..
However, in passing, she commented that whenever she swims, the lump sensation goes away temporarily. I didn’t even think about the significance of this statement until a few hours later when I was seeing another patient with similar complaints. Of course! Not only is swimming a good form of exercise, it’s also a type of rhythmic, controlled breathing exercises. By taking regular, deep breaths, she’s doing the same thing that you’d normally do in yoga as you perform the relaxing breath.
Deep breathing has a calming effect on your involuntary nervous system, especially activities that promote prolonged exhalation. This also includes singing, whistling, humming, wind instruments, and even talking. The longer time you spend breathing out, the longer time you stimulate the parasympathetic nervous system. Since the vagus nerve is your main parasympathetic nerve that innervates the voice box as well as your digestive system, this makes absolute sense. Maybe this is why good conversation with friends or family during a slow-paced meal helps you to digest better.
One possible explanation for a lump in your throat is excessive tension and stress in your cricipharyngeal muscle, which is a sphincter-type muscle that closes off the top of your esophagus just behind your voice box. If you’re not sleeping well, then your body will have more physiologic stress, causing tension and spasms in various parts of your body, including the cricopharyngeus muscle. Plus, if there’s direct irritation by stomach juices in the immediate area, then it’s even more likely to go into spasm. (If this tension happens to occur in your muscles of mastication, then you’re likely to have TMJ.)
As a result of the above patient’s passing comment, I reaffirmed that complementary ways of stress reduction and relaxation are just as important as any medical recommendation that I recommend for better sleep. I experience numerous other similar “eureka” moments almost every day, mainly by listening for my patients’ pearls of wisdom.
What’s your opinion on this subject?