Swallowing issues and health insurance.

September 9, 2012 4:01 PM

Throat/swallowing annoyances, and navigating the health insurance industry. What should I say, and how nervous should I be?

For the last month and a half, I've had some discomfort in my throat, basically a pain while swallowing, which is anything from very dull and minor to pretty stabby-feeling.

Last month, I went to my health insurance, an HMO, and had a throat culture done to test for strep. No strep was found, and the nurse said my lymph nodes also weren't swollen, and blood pressure normal. Just scheduled an appointment online which will be with my 'real doctor'. What would the course of action be here? From friends who've had, for instance, broken bones, they've said that they need to go through their real doctor to go to a specialist of any kind.

Could this mystery ailment be allergy-related? How justified is deathly fear of serious illness?

Are there any key words to say to make sure that there's some answer reached or test given (blood.. tests?) that will give me some peace of mind? For reference, 25, male, otherwise healthy - running, working, etc.

posted by tmcw to health & fitness (12 answers total)

At about the same age I had very similar symptoms. I later on came to suspect that it'd had something to do with extreme stress at work and that I had been tensing a muscle in my jaw or throat or somewhere that produced soreness that resulted in the pain while swallowing.

(Your issue could very well be more serious but in my case my GP couldn't tell me anything, I never got around to seeing a specialist, and the problem just went away on its own; ten years later it hasn't recurred and nothing else has come of it.)
posted by XMLicious at 4:11 PM on September 9, 2012

(And I should say, my sympathies because it was pretty terrifying as it incrementally got worse over a month or two, since I was wondering if I'd eventually become unable to swallow at all.)
posted by XMLicious at 4:13 PM on September 9, 2012

In an HMO, everything usually runs through your GP. So if he/she can't figure it out it will be up to the GP to refer you on. I would go straight to an ENT, but you'll have to play the game and work through the GP. There is no way for anybody here to diagnose the throat pain. Allergy induced post-nasal drip irritating your throat could definitely cause throat pain, although in my experience with exactly that, it was accompanied by a cough.
posted by COD at 4:23 PM on September 9, 2012

Gastroesophageal reflux can also cause throat pain/soreness, so be prepared to answer questions about your digestive system.
posted by SweetTeaAndABiscuit at 4:31 PM on September 9, 2012 [1 favorite]

My allergies sometimes cause a sore throat/pain when swallowing, so yes, it could be allergy-related. A good ENT can help with that, so I'd ask for a referral to one over a regular allergist, since the ENT will be able to cover all bases.
posted by carolinecrane at 4:52 PM on September 9, 2012

There is no magic word to get medical problems diagnosed - there is only finding a good doctor. Find someone you like and trust who explains to you why they're doing what they're doing in a way that you can understand.

Whether or not you need a referral from your PCP depends on your insurance, so if you have your insurance brochure or have a website you can check, you'll probably fairly easily be able to find this information there.

Non-deadly illnesses (like the ideas listed above) are, by and large, much more common than deadly ones, so worrying about the unlikely possibility of something deadly is not justified without more evidence. If it helps, mouth and throat cancers are pretty uncommon in people who don't abuse tobacco, and certainly it's a long jump from throat pain to omg cancer!
posted by treehorn+bunny at 5:48 PM on September 9, 2012

Is your voice (both speaking and singing) normal? Or have you developed a quaver, hoarseness, trouble projecting, reduced ability to stay in tune, new and different overtones, etc.? My vocal chord issues first presented as trouble swallowing often accompanied by varying pain. Again, an ENT is the right specialist.
posted by carmicha at 8:34 PM on September 9, 2012

@treehorn: luckily not a smoker, which I guess is good.

@carmicha: my voice is normal as far as I can tell.

Thanks everyone!
posted by tmcw at 8:32 AM on September 10, 2012

Do you have any history of heartburn or allergies? You should get checked out by a gastroenterologist. If you have any allergies/asthma, I recommend getting checked for Esosinophilic Esophagitis which has dysphagia as one of the main symptoms.
posted by Aliera at 8:48 AM on September 10, 2012

Also do any particular foods worsen or trigger your swallowing issues? You might want to keep track of throat issues and what you ate (a food diary) to show your doctor.
posted by Aliera at 8:50 AM on September 10, 2012

The best thing you can do to assure that you get the appropriate referrals and tests is to give your doctor complete, accurate information. Come prepared with answers to questions like these (make notes so you don't forget anything):

When did it start? suddenly or gradually? was there anything unusual going on then that might have triggered it (stress, allergies. flu, etc)?

Has it gotten worse over time?

How often do you feel it -- every day? how many times/day? How long does it last?

What makes it worse?

What makes it better? What things have you tried?

How intrusive is it? Have you changed, say, what or how you eat because of it?

That's a start. Good luck getting it sorted.
posted by Corvid at 2:56 PM on September 10, 2012

I was surprised to read XMLicious comment because when I was 25, I too experienced what you're describing. If I remember right, it followed after a bad cold but persisted to one degree or another for a decade and it was definitely aggravated by stress.
posted by bonobothegreat at 6:19 PM on September 10, 2012