My husband suffers from choking. Not normal choking -- he turns livid and starts jerking his extremities, and then just about passes out before breathing again. It's very scary, and he is totally exhausted afterward. It usually just starts like a cough, at no particular time, and it does not seem to be increased during activities such as eating. All of a sudden, he gasps like something just got stuck in his throat. This tends to be happening more often, too. His doctor doesn't seem to be too concerned, but we are. Can you give me any idea what could cause this?

D.P.

Well, it appalls me that your husband is nearly passing out, yet his doctor "doesn't seem to be too concerned." You need to ask this doctor two questions: "Why is my husband doing this?" and "What are you going to do about it?" If you are not satisfied with his responses, you should consider finding your husband a doctor who WILL show some concern.
I don't envy his doctor, however. This is a toughie. Doctors dearly love to be able to observe a problem, but if the patient cannot "stage" an attack, then we must base our opinion on the history alone. Here are the few possible explanations that I can think of:

• Epilepsy. Not all epileptic attacks conform to the classic "grand mal" seizure, characterized by rhythmic movements of the tongue and extremities, loss of bladder control and altered consciousness. Your observations -- he "starts jerking his extremities" and "is totally exhausted afterward" -- both suggest epilepsy to me. If your husband's doctor thinks epilepsy may be a possibility, then referral to a neurologist is appropriate. Epilepsy is testable and treatable.
  
• Paradoxical vocal-cord motion. The vocal cords are anchored together on the inner surface of the thyroid cartilage ("Adam's apple"), forming a V. When you breathe, the V is open so that air can pass into the trachea ("windpipe"). When you speak, the cords move together, closing up the V. The gap between the cords is extremely skinny when you speak. You cannot inhale and speak at the same time (at least, not with a "normal" speaking voice)! Some individuals develop "paradoxical" movement of the cords, such that they open during speech and close when they take a breath. When this occurs, speech is very breathy, and breathing may be very noisy. (This noise is known by the medical term "stridor.") The patient struggles to breathe, and may eventually pass out. The vocal-cord motion then returns to normal, and the patient recovers.
  

To diagnose this condition, one must view the vocal cords (with a flexible fiberoptic scope) during one of the "spells." This is an unusual problem, with which only some ear, nose and throat doctors (ENTs) and some pulmonary-medicine specialists are familiar. Treatment? Try to identify the factors causing the spells, and avoid them. A physician would treat the spells with sedation if they are prolonged.

Incidentally, this explanation does not account for your husband's "jerking extremities."

-- REALLY bad reflux disease. Stomach acid and digestive enzymes can ascend the esophagus, spilling over into the larynx (voice box). When this occurs, the vocal cords perform a very natural, protective function: They slam shut. This protective closure is known as "laryngospasm" and is your body's way of preventing that stuff from entering your lungs. If laryngospasm were severe enough, the individual would pass out before the vocal cords would relax and open.

Once again, this explanation does not account for the "jerking extremities." Also, if your husband's problems were due to reflux, he would probably notice a sudden case of severe heartburn and/or a bilious-sour taste in his mouth immediately before an attack.

Finally, I think your husband's doctor should at least think about all of the other potential causes for fainting spells. For example, sudden aberrations of the heart's rhythm can cause fainting spells. Heart-rhythm problems are testable and treatable!