Can't equalize post cervical fusion

[anthropisces]

I had a cervical fusion procedure on November 29th. I had a fusion procedure done 18 years ago and now I have multiple levels fused.

This time, post surgery, my inability to swallow was very disconcerting. It has improved dramatically yet I still have problems. The last bite of food remains in my throat until I drink something.

Last weekend, one week out of the collar, I tried a little freediving.

Upon inversion my first attempt at ear clearing sent air into my stomach. I was able to make one descent, but it was not easy. After my several unsuccessful attempts I had a lot of air in my stomach and got pretty nauseaus.

One of the guys in our club is a doctor and says that I may need very specific rehabilitation for this.

The swallowing difficulty is called dysphagia. I'm not up on throat anatomy, but there is something going on with whatever mechanism is supposed to close my esophagus or motivate food.

I have no problem with reflux or lung problems. I only have the problem that there is sort of a burping sound when I try to equalize, and then a reverse burping phenomenon, in which air seems to end up in my stomach.

Does anyone have any idea what type of rehab could help with this? I'm going to see the doc that fused me next week, and will get all the info I can from him.

I probably need to tweak my equalization technique. On land I clear with my mouth open. I'm not sure what technique I'm using under water.

In general, equalizing is a cinch for me. My max depth is currently 80'.

 

[trux]

Hello Anthropisces,

I am afraid you have scared most of the DB members with the thread name, because it is very well probable that almost nobody of them (if anybody at all) ever hear about the kind of surgery you had. Neither I had. But frankly told, 80 feet is a decent depth - and is is about the limit for most recreational divers where diverse problems begin. That's because at around 20-30m at an untrained person you reach so-called negative depth, where the ambient pressure compresses the lungs below the residual volume.

So burping, inability to equalize, inability to get air into the mouth/sinus cavity is pretty common due to the reverse pressure. I am not even sure if it has anything to do with the cervical fusion. It is possible it contributes to aggravating the effects, but is is also possible there is no problem here. I simply do not know. However, I think that you can get much deeper nevertheless, by working on the chest flexibility and on the relaxation, instead of focusing on the swallowing reflex, or other troubles you experience. Since you are apparently able to get to the 80 feet, you can go much deeper with the same equalization technique if you relax better, and if you work more on the chest and diaphragm elasticity.

 

[anthropisces]

I was hitting 80. Now I can't even do six feet
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[trux]

Ah, ok, sorry, I did not read carefully and misunderstood. In that case perhaps you indeed have problems with the control of the esophagus. It looks like you naturally learned to use Frenzel equalization technique previously (it is in fact rather common). Try equalizing with Valsalva instead - no closing of esophagus involved, you just simply push the air to the sinus with the diaphragm.

Or drill equalizing exercises dry - if you manage to do it dry easily, there is no reason it shoud not work in water.

 

[Simos]

I don't know much either but sounds to me that if you have trouble with frenzel valsava could work or for sure BTV should work if you can get it. It might take a bit of time but certainly possible...
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[Chrillepille]

Hi anthropisces!

If you can add some more information, it would be very interesting. Here are some specific questions:

Did you have an anterior or posterior fusion?

Was the previous surgery anterior or posterior?

Do you remember if you had the same problems with equalization and swallowing after the previous surgery?

Do you have any clue of what happens in your body when you equalize in water?

Along with being a freediver I'm also a physical therapist working with cervical fusion patients and if you feel like sharing your experience and what your surgeon tells you, it would be very interesting reading for me.

Take care!
Christian

 

[anthropisces]

I hit 30 today. Some air would spontaeously dump into my stomach at depth. I think it will get better though. It was good just to get out and make a few drops.
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[anthropisces]

Christian,

In 1993 I was fused anteriorly c4-c5, c5-c6. I don't remember any difficulty swallowing, and certainly nothing approaching what I experienced when I woke up from surgery this time.

In 1993 a bone graft was taken from my hip, I was put in a collar for about 12 weeks I think.


This time alograft was used for two more anterior fusions. These were at c3-4 and c6-7. Also different this time is that titanium plates were used. It may be that the titanium plate is pushing on my esophagus.

I am still trying to figure out what is happening when I equalize. One rather disturbing phenomenon is that air will reverse burp out of my respiratory tract into my stomach, spontaneously. For instance I was at jsut under 30 feet and while swimming around down there there was suddently this portion of air that burped backwards into my stomach. There is no mistaking it.

As far as ear clearing is concerned, something is making that more difficult too. It may be something I have to relearn.

Certain head positions will give me the equivalent of a sore throat, which I can remedy by changing head position.

I went and saw the PA who assists my surgeon. He was of course not too concerned and said that he doesn't think it will get much better and that I will simply have to live with it. He was pretty ambivalent. He asked me if I wanted a prescription to see an ENT specialist, which he gave me.

My reading tells me that my swallowing will improve. Perhaps equalization along with it. I would like to know if there is specific rehabilitation that can be done for this or if it is simply a matter of time, or if it will never improve.

 

[sgnips]

My reading tells me that my swallowing will improve. Perhaps equalization along with it. I would like to know if there is specific rehabilitation that can be done for this or if it is simply a matter of time, or if it will never improve.

Hi Anthropisces,
i just had a look at "spinal fusion" on wikipedia so you can imagin i have absolutely no idea on what problems this kind of surgery can cause to equalizing

i sincerely hope you can improve your swallowing faster than you hope

i can guess your eq problems might be due to your swallowing difficulties, as long as those are due to lack of glottis mobility or control loss on it

performing frenzel needs a closed glottis, so as you improve on this side, your eq should get better (i suppose and hope)

don't trust on valsalva: it's a hard hard eq technique which is almost impossible to perform after few feet of descent :head

good luck

 

[neurodoc]

It sounds like the muscles that control your throat (epiglottis etc) have become weakened. This is possibly due to the pressure exerted on the posterior portions of your throat from the swelling on the front of the spine, either as an effect of the surgery or if bone spurs were part of the reason for the fusion procedure. Swallowing difficulties are quite common with these problems-I've had many patients who have been through it. These muscles can be retrained if there is some remaining function, which it sounds like there has to be or you wouldn't be able to drink or eat without choking. Learning to play the didgeridoo has been shown to strengthen the throat musculature-research even showed it to help with sleep apnea. Gargling can too, if you're up to it without choking. Use saline solution (mildly salted water) at first, so if some of it gets inhaled (I'm talking a drop or two) it isn't as rough as if it were mouthwash or something equally irritating. If you go to Eric Fattah's website, he has an excellent tutorial on equalizing, which includes exercises to strengthen and learn control of the throat muscles. You may need to go back to these and re-train some of it to regain enough control to get back to 80 feet (or more, who knows?).