If you’ve felt physical discomfort or ripping chest pain after swallowing, or if you feel like food gets stuck, you’re not alone. More than 250,000 Americans struggle with the condition that causes this. Nevertheless, it’s not well understood and patients often feel embarrassed, ashamed, overwhelmed, and afraid.
In his new book, Esophagus Attack!, Dr. Doug Lake walks you through every facet of esophagus attacks and has created a comprehensive guide to causes and solutions to these attacks. You’ll hear from successful patients and discover how to get the medical and emotional support you need.
Drew Appelbaum: Hey listeners, my name is Drew Applebaum, and I’m excited to be here today with Doug Lake, author of Esophagus Attack! The 3-step method to enjoy eating again. Doug, thank you for joining, welcome to The Author Hour Podcast.
Dr. Doug Lake: It’s such a pleasure to be here Drew, thank you. This is a great opportunity, I look forward to this.
Drew Appelbaum: Doug, kick us off, can you give us a rundown of your professional background?
Dr. Doug Lake: Sure. When I meet patients, it’s usually in a fluoroscopy room. So, a dark room where I introduce myself as, “Doug Lake, I’m a radiologist. My job is to interpret medical images and perform image-guided procedures.”
In this realm though, I’m an author. So, I’ve written a book designed to help the people that I interact with on a daily basis.
Drew Appelbaum: Now, why was now the time to write this book?
Dr. Doug Lake: It’s a journey, and a long answer if I’m not careful. So, I’ll try to cut to the chase on this one. For me, it’s been a process to write the book. It took me about three years to write an initial rough draft that was just truly awful.
At the end of it, I didn’t know what to do with it. And then, a chance encounter led me to Scribe, which has helped me rewrite the book, flesh it out into a much more beneficial type of book. But what originally got me to this point was a challenge in my life where I had lost a son to a rare disease, and then my youngest daughter, our rainbow baby, ended up having the same disease.
Call it a mid-life crisis, call it whatever you will, but I was at Boston Children’s Hospital, seeing professionals who literally help families from all over the world, not just Boston, not just Massachusetts, not just the United States, but people from all over the world come to these people and ask for their help.
My mid-life crisis in a sense was, “Doug, what are you really doing to help the world? What are you doing to benefit people?” And I answered that with, “Well, yeah, I help people one at a time.”
I realized, when I came back from that, that in interacting with my next months’ worth of patients, and explaining why food gets stuck in their esophagus, why they have esophagus attacks. And then explaining, “This is my three-step process.” It has been only two or three patients who have said, “Hey,” and turned to the technologist or me, and said, “Can you write that down?”
I went on Amazon, and I started looking, thinking, “Okay, somebody has to have written this book, somebody has to have explained to people because it’s such a common problem.”
I couldn’t find anything, and I got more frustrated and decided, “All right, this is the thing that I’m going to try to help people with–by explaining my experience with this and how it relates to what they’ve gone through.”
Drew Appelbaum: Now, did you have any learnings or major breakthroughs during the writing of the book? Maybe some of the research you were doing?
Dr. Doug Lake: I did, but for the average listener, it’s pretty much in the weeds. I don’t know that I want to explain too much about it, but the biggest one is really the foundational element of how GERD happens, and what is gastroesophageal reflux disease?
For decades, we’ve assumed it’s simply acid refluxing up the esophagus and damaging the esophagus. There’s emerging research in the last five years, saying that it’s more than that and that it may be part of the body’s immune system attacking the esophagus and causing some of these problems, or a haywire immune response causing it.
But it doesn’t change what people do, it doesn’t change how you treat the disease, and it doesn’t change the idea that you do need to try to reduce the amount of reflux that happens to help improve the disease for people.
Understanding the Problem
Drew Appelbaum: Now, is this a diet book? Who is this book for?
Dr. Doug Lake: Yeah, it’s not a diet book, there’s a great book about a reflux diet and then there’s at least 20 more. It’s not a diet book at all. It’s more, number one, understanding the problem in a deeper manner and then a three-step process to eat.
How do you go about eating? The foundational element of it is your esophagus is mostly muscle, it has an inner lining of schema cells, but it’s mostly muscle and, what most people do when they sit down to eat is–I used to do it and it’s so common.
You sit down for your typical Thanksgiving meal, and the first thing you want to eat is the turkey that somebody worked and worked and worked to create. Or, the prime rib at another meal or it’s the big meat.
Doing that is sort of like, Steph Curry walking up to begin his warmup for a basketball game and shooting half-court shots. He doesn’t do that, he just doesn’t and you shouldn’t try to wolf down the biggest chunk of meat that you can, that will get you in trouble.
You need to warm up your esophagus first, and you do that with liquid first, and then easy solids, and then more difficult solids, and you flush every solid bite with liquid, that’s a good chunk of the book right there summarized in just a sentence. That’s the approach.
Drew Appelbaum: Let’s start from the beginning though, what exactly is an esophagus attack? What does it feel like?
Dr. Doug Lake: Every patient is different–I’ve had over a thousand patients describe to me what this is for them. For some people, it’s just a mild achiness or sense that, “Something feels like it’s stuck after I ate, what do I need to do? Well, I need to try to sip more liquid and try to get it to pass.” For others, especially if it’s the first time, it can be exquisite pain. For me, it was exquisite pain.
I remember a Thanksgiving meal where I downed the turkey first thing, I was so hungry, so hungry, I had run a 5K in the morning and I hadn’t eaten anything until that point, and I was just famished. I took the first bite and I thought I was having a heart attack. I didn’t know what it was.
As a physician in training, I went through all sorts of things that it could be. And I couldn’t figure it out honestly, I didn’t realize it until I eventually got the food to go down and I said “Woah, what was that?” A number of patients describe it to me as it’s nearly a heart attack-like process and it ends up with a lot of patients going to the ER.
65,000 people a year present to the emergency rooms around the United States with esophagus attacks–food stuck in the esophagus and they need to get it out.
Drew Appelbaum: 65,000 people a year will go to the emergency room but how much of this is an issue in the US, how many people do you think are dealing with this on a regular basis that maybe don’t make it to the emergency room?
Dr. Doug Lake: I’ve got two answers for that Drew. One is, what the statistics say, which is about 250,000 people in the United States struggle with food getting stuck, and can usually get it unstuck themselves or have figured out ways in their diet to get around it.
And then there is my seat of the pants viewpoint as a radiologist and seeing people with this problem, it’s a steady stream of people. Two to three people a day who come in and complain of this problem, with different words, and everybody describes it a little bit differently but, in essence, “I experience pain within 30 seconds of eating food,” for some reason, and usually, they point to their upper chest or the base of their neck to say, “It hurts here when I eat food,” and that number of people, I don’t have a good number for it, Drew. I have a sense it’s more than 250,000 though.
Drew Appelbaum: I feel like it’s pretty prevalent out there. But, is this prevalent in kids or young adults as well, or is this only middle age and above?
Dr. Doug Lake: Good question. My two answers for that, one is that my book is designed for the adult, it is not designed for the pediatric age group. Kids are different, I don’t see as many kids, the esophagus is smaller and so my approach is not designed for kids under the age of 16.
Does it happen in kids? Absolutely. There is a disease that was considered rare, it just was named about 30 years ago called eosinophilic esophagitis is the problem that kids have and it can cause this exact scenario and a problem where kids eat slowly and have a hard time swallowing their food and complain of pain after eating.
My book is not designed for that age group, it’s really designed for folks who are 16 and older, usually, 20, 30s, and 40s are the folks who have this problem and probably have eosinophilic esophagitis or they have GERD. Then over the age of 40 or 50, it’s usually years of having gastroesophageal reflux disease or acid going up into the esophagus and it slowly damages the esophagus, narrows the esophagus, it makes it harder to eat and get food to go down.
Drew Appelbaum: So, how much of a problem is food getting stuck in your esophagus?
Dr. Doug Lake: Yeah, I have stories in the book, and I can go into some of them but it’s a tremendous problem. There’s first the pain, the literal pain of food getting stuck and it feels like a heart attack.
Then there’s the emotional pain which is even deeper and more powerful where people don’t feel like they can eat with others. We’re in the middle of a pandemic and people aren’t eating with others as much as they were but that’s going to change.
In a few years, with more vaccines and changes in the world, we’ll come back together as a society, we’ll come back together as families and we’ll have that opportunity to join up around a table and eat together. I can’t tell you how many people struggle with those moments, they have anxiety, they’re concerned, is this going to happen again in the middle of the meal They don’t have any control over it, they fret about it, it happened to my mom, it’s happened to me, it’s a real problem.
You Can Help Yourself
Drew Appelbaum: Now, you mentioned earlier that you looked around for some writings about it, some research that might have been done on the issue and you found that there is little to no documentation on it. Why do you think this is?
Dr. Doug Lake: There’s a lot in the medical literature but there isn’t very much that I could find at all that relates to what the average person can do to either understand this, prevent it, or make it go away? Most in the medical literature is devoted to our pill-based treatments, which have value, don’t get me wrong, it’s important to take the right medicines to help with this problem and a CRGI doctor to help fix the esophagus problems.
But, like anything in medicine, there is much more that the individual can do to help prevent it and the book is really designed around the ideas of things that you can change either in your diet or lifestyle changes that can help stop this problem and help you to move on from it.
Drew Appelbaum: Let’s dig into your personal story a little bit, you mentioned you had this issue. Can you tell us what you felt, what your fears were, and what made you eventually seek medical attention?
Dr. Doug Lake: Yeah, for me Drew, it was, I remember going through the laundry list of things in my mind that this could be, and the final one that I arrived at was the C word, it’s a trigger word for a lot of people with cancer.
I’m aware that I’ll try not to say that anymore during this podcast but because it does trigger a lot of people into anxiety and fear, but that was my fear. That really caused me to go down into an emotional basement of, “I’m going to just wall this off, I’m going to try to ignore it, it’s probably not a real problem and I’m going to ignore it.” I did successfully ignore it for way too long.
Fortunately for me and for many others, one of the primary messages of this book is, the vast majority of the time, 99 plus percent of the time, it’s not cancer. But there is a segment of the population, a small percentage that this problem will be cancer, it will be something that develops, that we have to treat it.
One of the biggest take-home messages is, do see your doctor if you have this problem because there is that 1% chance that this is something bad, but don’t let it hold you back because 99% of the time, it’s not the C word.
Drew Appelbaum: What are other issues of the esophagus that folks might get diagnosed with if they’re having issues with swallowing and digestion?
Dr. Doug Lake: Yeah, there’s a whole medical terminology list of things that will be things that patients will hear that relate to this. There’s gastroesophageal reflux disease or GERD, there’s eosinophilic esophagitis as a diagnosis. They’ll hear about Hiatal hernias, they’ll hear about GERD related chest pain, there are a number of different things that I get into in chapter 10 that are more of a dictionary of sorts or a resource manual.
These are all the different things that you might hear about from your doctor and whether or not this book has a basis or applicability to that problem and then, there are the common ways that we manage this if it’s with PPI’s which is proton pump inhibitors or H2 blockers, is there a role for surgery or not for this problem? But there’s a whole laundry list of things that can cause it.
But it really comes down to GERD and eosinophilic esophagitis as being the most common causes.
Drew Appelbaum: Now, a lot of people will stay away from their doctor or not fully know how to explain the issues that they’re facing. How would you explain what’s happening in an esophagus attack to a medical team or doctor?
Dr. Doug Lake: Sure, I’ll explain it as I explained it to my doctor. Within 30 seconds of me eating, usually a larger bite than normal, I experience chest pain or fullness that begins at the top of my chest where my sternum is, where my neck meets my chest.
It lasts for 20 to 30 seconds and it goes away. With each subsequent bite, if I’m not careful to chew my food carefully or if I don’t cut it up into small enough pieces, I can have the same problem again.
My doctor asked me, “Well, does it happen with exertion?” I would say, “No, it happens when I’m at the dinner table, I’m not exerting myself, I don’t think it’s a heart attack.” Then the doctor might say, “Does it come on right away or does it take five minutes or 10 minutes? Is it something more with the stomach or is it something further down the GI tract? Like a gallbladder issue?”
For me, it’s right away. There’s a whole bunch of questions that typically are asked but those are the primary ones that we start out with.
Drew Appelbaum: Now, you mentioned you might end up going to the emergency room often once you recognize what’s happening and you want to go get food unstuck. What are some of the best ways to make a plan to avoid the emergency department and some of the medical bills that might come along with this?
Dr. Doug Lake: Yeah, great question Drew. The emergency room is going to be necessary for some folks. Part of the book is also setting up some guardrails for people to try some things, hear the things that I do when food is stuck, and one of the chapters describes how to try to non invasively get things unstuck.
One of the primary goals of the book is to explain, “Here’s how you eat to try to avoid this problem.” But, if you do have to go to the emergency room when food is stuck, you do want to have either somebody who can take you or if you have to call the ambulance, you have to call the ambulance.
Like anything, it’s so much better to take care of a problem before you have to get emergency help than it is to actually go to the emergency room.
A Three-Step Process
Drew Appelbaum: Let’s dig into that three-step process a little bit that you mentioned earlier. You created this process to help folks eat safely and confidently. Can you talk to us about it?
Dr. Doug Lake: Yeah, absolutely. Step one is that I explain it to people as liquid before solid and I explain the why. The real why is that, your brain knows you’re sitting down to eat. You’re sitting in front of whatever it is that you’re going to have for lunch or dinner.
Your brain is excited about eating, your mouth is salivating, but your esophagus is kind of a dumb muscle. Think of it like your bicep, it doesn’t know that you’re going to eat until you send something down the pipe.
Instead of taking that big bite of chicken or beef, you start out with liquid. So, liquid does two things, one, it lubricates the esophagus, it combines with your native saliva to lubricate the esophagus and literally, make it slicker.
I describe it to home improvement folks like WD-40 for the esophagus, it’s not quite like that but you can think of it that way. But the second part is that the liquid also alerts your esophagus, and is the only good method that we have to tell the esophagus, “Hey, stuff’s coming down. As the muscle, you need to contract and relax.” The esophagus does have a contraction and relaxing pattern that helps food to go through and also forces solid food to go through.
Like anything that you do, you want to warm yourself up. Liquid is the first thing to warm yourself up. So, step one is liquid before solid. Step two is easy solids before difficult solids. Back to my steak analogy, if I’m sitting down for a steak dinner, I usually have corn, peas, mashed potatoes, maybe a side salad.
I’m going to have corn and peas first before I dig into the steak and that’s also to warm up the esophagus and make sure that things are going down well, easily, with no issues. Only after taking probably 20 or 30 bites of small things that I know are going to get through without a problem, do I tackle the more difficult solids, the things like chicken, steak, pork, things like that.
Step three is probably the most important and it’s flush with liquid. So, every solid bite that you take, you do want to flush liquid down, and it does two things, it re-slickens the esophagus so to speak. So, it resets the esophagus, and then two, it’s also kind of a test, you’re saying, “Okay, did everything pass through, is everything through, can I go on to my next solid bite?”
If you take a sip or a gulp of liquid and you get that fullness or you get that pain again, that’s an alert to you to say, “Nope, I’m not ready for my next solid bite, I need to take more liquid or I need to figure out what’s going on and why something feels like it’s stuck.”
Drew Appelbaum: Now, you can go through the three-step process but it’s not going to work 100% of the time. What is the approach to getting food unstuck when the inevitable happens?
Dr. Doug Lake: I’ve got a number of things that I describe. The first is to take small sips of liquid. Just little sips of liquid if the food is stuck, it’s there and it’s somewhere still in the esophagus typically. The pain occurs when the esophagus contracts and relaxes.
It’s a muscle and it is squeezing hard to try to get that thing through. That’s what’s causing some of the pain and you can think of it, kind of like pebbles in a river so to speak, or something that’s blocking a dam. You’re getting little bits through and by sipping more liquid and then the esophagus contracting, things are reorienting slightly, and things are maybe advancing just a millimeter or two with each bit of liquid.
So, little sips of liquid first. The next thing I do is stand up or lean back from the table. My wife always knows that food’s stuck, she sees the look on my face, she sees me lean back or stand up and she always asks, “Hey, something’s stuck?”
I always tell her, something’s stuck and part of it is to alert her that no, I’m not choking, this isn’t something going into my trachea and causing me to have difficulty with breathing, that’s a whole other problem that we should probably talk about in a minute.
I lean back or stand up. That also reorients the esophagus, there’s a slight change in orientation with the diaphragm when you stand up. Then, I usually take my glass of liquid, I walk away from the table, so I’m not even tempted to take any more solid food, it’s not even in front of me.
Because a lot of people will think, “I’m just going to have another bite of peas or another bite of corn or something. Maybe steak will make this go down.” That just doesn’t work. That never works, you don’t want to pile more solid things on top of the blockage.
Then I take more sips of liquid, try to walk around, try to relax. I think it’s misunderstood and not fully understood how much our emotions impact our health overall, but specific to esophagus attacks, the more relaxing you can do–relaxation breathing, trying to think of things that get you in a relaxed state will help your esophagus relax more. You want to do that because our medical treatments for esophagus attacks all revolve around, as best we can, making the esophagus muscle relax.
If you come to the ER, you’re going to get three or four medicines that are designed to relax your body and relax your esophagus muscles. So, if you can go to relaxation in your mind and help your muscle to relax, that’s going to help you a lot.
All the while, taking little sips of liquid and seeing if things will pass down with each liquid. If you get crescendo-ing or increasing pain during all of this, that’s a big red flag that says, “Things aren’t passing through, you’re completely blocked.” That’s when you need to find your way to an emergency room.
Drew Appelbaum: What would you say is the biggest red flag when someone should make that decision to go to the emergency room?
Dr. Doug Lake: Yeah, number one, it’s if you can’t get it unstuck on your own. Each person is going to have a different time interval. I’ve heard of patients who in five minutes or 10 minutes of working at this, it’s time to go. I’ve heard patients tell me that they work at it for two or three hours.
Drew, that’s too long. After a while, your saliva is no longer able to go down the esophagus like it’s supposed to. So, it can end up going in other places like aspirating into your lungs, things like that. So, it’s a great question but I don’t have a fantastic answer to it because it’s different for each person and each person’s anatomy.
But a good rule would be 30 minutes. If you’ve been struggling at this for more than 30 minutes, that’s a hard stop to think about taking it to the next level which is heading to the emergency room.
Drew Appelbaum: Now, I know we talked about various other esophagus problems earlier and we just went through the three-step process to help an esophagus attack. Will the three-step process help with the other esophagus problems that we spoke of earlier?
Dr. Doug Lake: It generally does. So, for patients who have other problems with their esophagus, it does help. If they’re having problems with food getting stuck. If you’re not having problems with food getting stuck or you don’t have that issue, I consider the three-steps just informational.
It’s good to know about it. It is also important to know that if your GERD goes untreated for say, decades, 20, 30, 40 years, those are the patients who I end up seeing in their 50s, 60s, and 70s who have what are called esophageal strictures, a narrowing of the esophagus. We don’t have a great explanation for why it happens but my sort of kindergarten understanding is that I think that reflux that happens over years and years, the esophagus distillate, where the esophagus meets the stomach if the esophagus isn’t closing down–we have a sphincter, a muscle, that’s designed to keep the esophagus closed so that things don’t come up from the stomach. If that’s sitting wide open and we have reflux over decades, over time, your body does heal itself.
In this sense, it creates a ring of tissue that narrows the esophagus. That helps with the reflux, your body will stop the reflux but then, because you’ve got this ring of tissue–medically we call Schatzki’s ring, if that ring of tissue develops, you can’t get food to pass through it. It develops a stricture or a narrowing and that’s where people get in trouble. So, medically, we can fix strictures, we can help prescribe pills for the GERD but it’s the lifestyle changes that allow people to make enduring changes to prevent this problem from happening.
Then, the three-step process helps all of those folks so that they can eat with the esophagus that they now have. Because the 20-year-old esophagus may not be the same as the 65-year-old esophagus.
Drew Appelbaum: Well, writing a book, especially like this one which is going to help so many people, including some of my family members, is no small feat. I know we just scratched the surface, there’s for everyone ailing out there, there’s so much more in the book and I just want to say congratulations on publishing.
Dr. Doug Lake: Thank you, Drew, I appreciate it and the team at Scribe has done so much to help this book come to the world and I can’t thank them enough. There are so many folks who have impacted this, Tucker, Emily, Howe, Ellie, I can’t begin to name everybody, but I appreciate all of the help from the bottom of my heart.
Drew Appelbaum: Now, I have one last question for you. If readers could take away only one thing from the book, what would you want it to be?
Dr. Doug Lake: You’re not alone with this problem and you may be scared, you may be fearful. Know that 99% of the time, this is not the “C” word, this is something else, and don’t hold yourself back from getting answers, getting help, this is a treatable problem, and you can move on to living your life normally again.
Drew Appelbaum: Doug, this has been a pleasure, I’m really excited for people to check out this book. Everyone, the book is called Esophagus Attack! You can find it on Amazon. Doug, besides checking out the book, where can people connect with you?
Dr. Doug Lake: I am on Twitter, @douglakemd. I have a website that’s just getting up and started, that’s douglakemd.com. I work at McFarland Clinic and I’m part-time faculty at Stanford. So, I’m out at Stanford for one week a year. So, those are the best ones I’d say.
Drew Appelbaum: Doug, thank you so much for coming on the show today, and best of luck with your new book.
Dr. Doug Lake: Drew, it’s been a pleasure. Thank you for having me.