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

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.

We’ll start this week by letting you know what the patient and her daughter told the doctor and how the doctor proceeded with the examination. Next week, a specialist will continue to look for clues to the medical riddle. The third week, we’ll let you know what some people have suggested as possible diagnoses. The fourth week, the specialist will reveal the actual diagnosis. Then we’ll move on to a new riddle for the following month!

The Patient’s Daughter and the Patient Report the Symptoms

Mildred, age 75, recently noticed that she’s having some trouble swallowing. Her 50-year-old daughter, Lucy, is concerned and made an appointment for Mildred with her PCP. Lucy went with her mother for the doctor visit.

As always in ThirdAge Medical Riddles, the doctor uses the classic S-O-A-P notes as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

This week, we’ll learn what Lucy and Mildred told the doctor:

Lucy: “My 75-year old mother recently moved in with my husband and me and our two teenage sons. She had been living alone after my father died two years ago, but she got tired of taking care of a big house and yard so we all thought she’d be better off at our place. She sold the house, which was a huge relief to her. We love having her around! Until now, she hasn’t had any health problems. Then a week or so ago, she told me that she had noticed she was having some trouble swallowing. That sounds scary to me, like she might have a blockage or maybe could choke!”

Mildred: “I think my daughter is overreacting, but I don’t want her to worry. That’s why I agreed to come in today. All that happens is that when I eat certain foods, especially the high-fiber bran cereal I have every morning, I get the sensation that some of it is kind of stuck in the back of my throat and upper chest. If I drink water, I can eventually wash everything down just fine. It also helps when I chew gum! That seems to make extra saliva, although I could be imagining things. Anyway, I don’t think this is a big deal. I feel great overall. I just want you to put my daughter’s mind at ease!”

Mildred’s doctor was aware that older people often try to ignore symptoms because they’re afraid they’ll be hospitalized or lose their independence if a condition is discovered, so he began by assuring her that it was good she came. He said she should never consider that she is overreacting. Better safe than sorry! Although Mildred’s symptoms may not be cause for concern, they can be a sign of something more serious such as a blockage from cancer or could progress to a life-threatening problem such as aspiration at some point.