Candice -

I can answer your questions based on my own 10-year personal experience with achalasia and esophageal spasms. This story ends well, so bear with me.

Achalasia means that when you swallow you have either no or weak peristalsis (the involuntary wave-like motion that propels the food down your esophagus.) Then when the food reaches the sphincter muscle that should automatically open and let the food into your stomach, that muscle doesn't open or opens only if there is a lot of pressure on it. For some reason, spasms seem to go with the achalasia. The nerves to your esophagus are misfiring and when they do fire they can cause the muscle to go into EXTREMELY (and believe me I know) painful spasms.

When I first went to the doctor, he tried to convince me that I was insane. I was living in Uruguay at the time. I lost 25 pounds in less than three months. His response: "Well you look good." This doctor finally prescribe procardia (adalat; generic name: nephedipine) for me but not in a sufficient dose. It did help somewhat however.

(Niphedipine is a blood pressure medicine that relaxes smooth muscles, like those inside the arteries -- it also relaxes the smooth muscles that line your esophagus. I would ask your doctor if she could try you out on some of this medicine -- for a medicine it is quite inexpensive. You can get it in either in capsules that you can break under your tongue 15-20 minutes before you eat or in time-release tablets that you can take once or twice a day. I had no luck with nitroglycerine myself.)

Anyway, the situation got so desperate that I returned to the U.S. I think to properly diagnose the problem you need to have an endoscopy (doctor looks at your esophagus using a laser light - you are out thank god) and through a manometry test which measures the muscle contractions in your esophagus and the pressures required to open the sphincter (manometry is quite unpleasant but I think you need it to see if any kind of surgical intervention is required).

This was 1992 and I had to go back to the country where I lived. After my diagnosis, the doctors recommended surgery and I had an esophagocardiomyotemy. They cut the sphincter muscle so it can't close. At the time, they had to open me up. If they can do it with a laser now, that is really, really great.

I would say that the surgery solved about 80% of my swallowing problem. I continued to be plagued by spasms for several years afterwards. I got them somewhat under control by working with my doctor in the U.S. and taking a number of medicines. They greatly reduced in frequency over the years and now I can go for months without having an attack.

If you actually do have achalasia, I would bet money that the problem with your coughing is that the food is not going down into your stomach in the first place. When you lay down, the food goes back up into your mouth where it then can get into your windpipe. Your body reacts and clears the windpipe by coughing. I've had a lot of experience with this too.

YOUR FIRST COURSE OF ACTION IS TO RAISE THE HEAD OF YOUR BED! You need the help of gravity to keep that food from coming back up. Put a couple of bricks (or more) under the legs at the head of your bed. Extra pillows can work too but the pillows tend to slip while you are sleeping. Please do this right away. It has never happened to me, but if the food finds its way down your windpipe you will end up with pneumonia.

Sorry for writing a book but I know a lot of things now I wish I had known when I was first starting out with this.

P.S. NOBODY knows what causes achalasia but it almost certainly is NOT diet!