Thursday 16th August 1990   Morning surgery 09.40

“So you’re telling me the food sticks about here.” Dr Lewis pointed to the bottom of her chest.
“Yes.”
“What happens then?”
“It feels quite uncomfortable, as if there is a lump there. Slowly the pain eases off.”
“Does the food ever come back up?”
“No.” Mr Gwilym shook his head.
“Are you ever sick?”
“No. I feels as if I want to be sick but I’m not.”
“Do you get heartburn or acid reflux?”
“No.”
“Are there any particular foods that are worse than others?”
“Not, really. Well, I used to have a steak sandwich every Friday night. The last time I had one, it was bad. I suppose I ate it too quickly. It felt as if a huge lump of steak was lodged there. It really hurt and it lasted for over an hour. I tried all sorts: milk, fizzy drinks, a few sips of beer. Nothing would shift it. That was three weeks ago. I have not had another sandwich since. I’m having mostly soft foods now.”
“How is your appetite?” Dr Lewis was looking increasingly concerned.
“I am not eating much. I am afraid it will get stuck. To be honest, I don’t really fancy anything.”
“Have you lost weight?”
“Yes, I’ve lost nearly a stone since this started.”

“Look, Mr Gwilym, it sounds as if you have got a blockage in the gullet. There is something that is stopping the food from going down.”
“Yes, I thought that.”
“It could be scar tissue. Patients that get a lot of heartburn can sometimes get a ring of scar tissue inside the gullet.”
“I don’t get heartburn at all really.”
“I know . . . that makes me think it might be a growth.”
“A growth? Do you mean cancer?”
“Yes, cancer is a possibility, especially with you losing all that weight. I am very worried. We will need to get a barium meal examination as soon as possible.”

“Dysphagia is another red flag, Dennis,” said Dr Lewis after Mr Gwilym had gone.

Dysphagia.
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