Jill Sherrill stepped on the scale at her gym and blanched. Her weight had slipped, again. In the previous 10 months, Sherrill, who is 5-foot-5, had lost about 10 kilos without trying. Her friends had urged her to consult her doctor about worsening digestive problems, but for a variety of reasons Sherrill had opted to treat herself.
But on that day in August 2015, the reading — 50 kilos — “scared me to death. I thought, ‘Oh, my God, I’m dying’,” she recalled.
Sherrill’s fear jolted her into action, prompting her to reach out to a close relative with whom she had been in sporadic contact. His guidance proved to be instrumental in helping her receive effective treatment for a debilitating problem.
People who have been diagnosed with acid reflux but continue to have symptoms despite treatment should request a referral to a specialist. Difficulty swallowing and regurgitating food should be investigated.
“I got really sidetracked,” said Sherrill, who lives in Sacramento. “The familial connection was what it took.”
* * * *
Sherrill, now 72, had a varied career. A former teacher and paralegal, she rents rooms in her home through Airbnb. In early 2014, one of her guests was a French wine merchant on a business trip.
“We got along really well,” Sherrill recalled — so well that the man brought his two young daughters to the United States for a vacation soon afterward. They stayed with Sherrill, who had studied French in high school.
During that visit, the man asked whether Sherrill would be interested in spending three months in France caring for his daughters while he and his wife were in Australia preparing to relocate the family.
To Sherrill, who has no children and was fond of the girls, then 7 and 11, it sounded like an adventure. In October 2014, she decamped to a farmhouse outside Bordeaux.
* * * *
It wasn’t the lark she had imagined.
“I found living in France to be a real challenge,” Sherrill recalled. “The water was different, the food was different.” She began suffering bouts of acid indigestion, which she chalked up to the contrast between the rich French food she was eating and the tamer vegetarian diet to which she was accustomed.
Before flying home in January 2015, she spent a few days sightseeing in Paris.
One night after dinner, she recalled, “I came back to my dumpy hotel room near the Moulin Rouge and thought, ‘Oh, my God, my oesophagus is so sore.’ It felt like it was going to explode. I knew I had to see my doctor when I got home.”
A year earlier, she had complained to her dentist of a swallowing problem and occasional episodes in which she coughed up food. He told her he’d never heard of such a problem. In February 2015, nearly 5 kilos lighter than when she’d arrived in France, Sherrill saw her longtime family physician at Kaiser Permanente. The doctor told Sherrill she suspected that her problem was a severe form of acid reflux known as gastroesophageal reflux disease, or GERD. It occurs when a muscle in the oesophagus doesn’t close properly, allowing the backflow of stomach contents. Symptoms include frequent heartburn and coughing.
The doctor prescribed a common acid-blocking drug and gave Sherrill a list of things to avoid including wine, coffee and citrus fruit. Sherrill began taking the drug, which initially seemed to relieve her sore throat, and followed the diet. But she was plagued by a new problem: Choking episodes.
Once while cooking dinner, she was munching on raw carrots and suddenly began coughing. “It felt like bits of carrot were stuck in my neck,” she said. Another time, she lay down after drinking water, dozed off briefly and awoke sputtering as water shot out of her nose.
After four months, Sherrill said, she began to doubt the GERD diagnosis. Her acid problem remained, and she didn’t think the drug was working. She emailed her doctor and said she wanted to discontinue the medication. Sherrill noted her weight loss and asked to be referred to a reflux specialist. The doctor replied that she had consulted a gastroenterologist and suggested Sherrill try a different medication.
Sherrill decided to take matters into her own hands.
She researched health food remedies and began drinking apple cider vinegar and taking capsules containing orange peel extract, which is advertised as a cure for heartburn. She hoped they would reduce her now copious production of excess saliva, which caused her to choke when she lay flat or while eating, a reliable pleasure that had become an ordeal.
“I was becoming thin, wiry and hyperactive,” Sherrill said. She took long walks after dinner, hoping more exercise would aid digestion and help her sleep, which was increasingly difficult.
She bought a 12-inch foam wedge pillow to elevate her head and torso, a remedy recommended to ease reflux. But Sherrill quickly discovered that if she rolled off the pillow during the night, she awoke coughing convulsively.
Stepping on the scale at the gym made her realise she needed to take more effective action. A few days earlier, she had suffered a mortifying choking fit in a restaurant after downing an orange peel capsule. The pill, she said, seemed to detonate in her oesophagus, causing her to cough so violently that nearby patrons wanted to call 911.
* * * *
Sherrill said she flashed on an incident that occurred 15 years earlier when she asked her older brother, whom she saw infrequently, about a scar on his neck. He told her he had undergone surgery to treat choking. Sherrill immediately sent him a text. Thirty minutes later, to her surprise, he called.
Sherrill said her brother, also a longtime Kaiser member, urged her to be more assertive than the occasional email. (Sherrill said she had relied on email rather than visits to her doctor partly because she feared she would be prescribed drugs she did not want to take.)
He advised her to call a Kaiser patient hotline and insist on seeing a specialist. The condition he had been treated for was rare, he told her, so it was likely that she had a different problem. And, he quipped, as a lawyer and former Marine, he had “to be pretty miserable to give anyone permission to cut” his throat.
Sherrill called the hotline and emailed her doctor about her worsening condition and her brother’s diagnosis. Within hours, she received a referral to a gastroenterologist. He ordered a variety of tests, among them a barium swallow, an imaging test that uses X-rays to inspect the upper gastrointestinal tract.
The reason for Sherrill’s problem was immediately apparent. She, too, had Zenker’s diverticulum, the same rare disorder as her brother.
Caused by a malfunction in a muscle in the upper oesophagus, Zenker’s diverticulum is a pouch that forms where the pharynx, or voicebox, meets the oesophagus.
Food, liquid and other substances (such as an orange peel capsule) become trapped in the pouch, resulting in choking and aspiration, which can cause pneumonia. Regurgitation can occur minutes or even hours after eating. The disorder is more common in people over 60 and in those of northern European ancestry. The problem is rare — estimated at 2 in 100,000 people annually in Britain, according to Paula Borges, a head and neck surgeon at Kaiser Permanente Sacramento who treated Sherrill. It is unusual, Borges said, to see cases in siblings.
In Sherrill’s case, the pouch was fairly large, and the severity of her symptoms meant surgery was required. Sometimes patients have both GERD and Zenker’s.
“In those circumstances, patients will often be treated with diet changes and medication,” and seem to improve, “so that can be a little confounding,” Borges said.
Borges had hoped to treat Sherrill using an endoscopic procedure to eliminate the pouch, a less invasive operation that permits a faster recovery. It didn’t work, an outcome that Sherrill had been warned was a possibility. Borges was unable to reach the pouch, which was wedged between two muscles in Sherrill’s throat.
A second operation, which involved opening Sherrill’s neck, was performed in December 2015. Sherrill spent three days in the hospital and six days on a feeding tube. The operation was a success. Her pain and swallowing difficulty disappeared, and she was able to eat and drink normally, regaining most of the weight she had lost. So far, the problem has not recurred.
Borges recommends that people who have been diagnosed with acid reflux but continue to have symptoms despite treatment request a referral to a specialist. Difficulty swallowing and regurgitating food should be investigated, she advised.
Sherrill says she believes she successfully navigated the Kaiser system with her brother’s help and is pleased with the care she received. She wishes she had been more proactive and had gone to see her primary-care physician, who remains her doctor, rather than relying on email.
“My error was in trying to adjust to a deteriorating situation,” she said. “A face-to-face contact is more real than another email in a computer inbox.”
–Washington Post
