What the heck is an esophageal tear? and how I almost died…

When I tossed up an update on my situation in the hospital last week, there were a couple of things some people wanted to know – like what the hell is an esophageal tear? How did this happen? Can this happen to me? And what can I do to make sure this doesn’t happen?! So, this is exactly what I’ll be covering in this article, to help provide some clarity, education and possibly help someone else avoid a week like I had.

I can’t stand articles that provide just topical, verbatim research on something without providing any real-life applications or problem-solving solutions. The focus here is to shine some light on a rare but potentially life-threatening condition pulling from my personal experience, input from the medical team at the hospital, supplemented with my own deep dive research into the topic.

Let’s get this clear – I am not a doctor and this article is not intended to replace any medical advice from your own physician. I wanted to share my experience and some of the things I was painfully reminded of while going through this process that could be of some value to others like myself. You’re probably not going to suffer an esophageal tear, but if you do, it’s a pretty damn scary situation that you never want to go through if you value your life and overall health. It can’t hurt to take a minute to educate yourself and be prepared.

What happened?

It was a beautiful, sunny Sunday afternoon and I was enjoying myself at a small backyard BBQ. After just a few bites of food, I started to notice a choking feeling and my chest tightening up. I went around the corner and got out whatever was in my mouth and throat at the time….(or so I thought). My throat was clear, I could talk and wasn’t turning blue or anything, but I still felt like I was having difficulty swallowing, shortness of breath and the chest tightness was persisting. This continued for about an hour, at which time I decided to leave the BBQ and get myself over to the nearest emergency department.

Because of my symptoms presented, I was immediately transferred directly to ICU department where I had an x-ray, CT scan of my chest and was booked for the first available endoscopy to see what was going on inside. The good news was my heart looked fine and I didn’t have covid. The question was – what was going on down my throat that was causing the persisting symptoms, now several hours after leaving the BBQ.

That evening, I was put under general anesthesia and had the endoscopy procedure completed to investigate the area a little closer. When I woke, the surgeon explained that they discovered a large tear in the esophagus with a chunk of food lodged in this tear. They removed the food and blood from the area and discovered that the tear was actually a complete rupture of the esophagus and required immediate sealing. In other words, I had a hole in my esophagus. The technical/medical term for the condition I had was a Mallory Weiss tear, which happens to be proportionately more common in weightlifters due to the reverse pressure that’s created during a heavy lift that can displace stomach acid upwards. They placed three tiny medical clamps on the hole and I was instructed to avoid food and water for 4-5 days to allow for the tissue to heal itself with the clamps in place.

The medical team advised that it was a great idea I made the trip into emergency that day and that I was about four hours away from a potentially life threatening situation – where the food and whatever was in the hole can enter the lungs and other areas of the body, causing infection and extreme difficulty breathing. But it was listening to the alternative options that made this next fasting phase easier to push through. If the tissues didn’t show any signs of fusing and the hole wasn’t closing by the end of the week, they would need to cut me open (through the neck) and go in to manually stitch up and repair the area using a combination of my own stomach tissues and mesh. There are also risks involved with this plan b surgery because you are working in a very delicate area and nothing is guaranteed.

So, I spent the next five days confined to my hospital room with no food or water, and 3-4 different IV tubes in my arms – feeding me fluids, glucose, antibiotics and antacid/anti-nausea solutions. This was probably the most challenging period, where the days seem to drag on forever, with nothing to do, nothing to eat or drink and a generalized feeling of weakness and lack of mental focus. I found some things to keep me busy, focused on positive thinking, daily meditations and healing visualization practices. I was going to be fine. I told myself this every hour.

On day four of five, I did another CT Scan test where I was instructed to drink three different liquids of varying viscosity and swallow while the scan traced the path of the liquid down my throat. The result? Everything looked great, the tissue was healing and things were travelling how they were suppose to, without any leaking into my lungs. I received the ‘ok’ to have some clear liquids that day….YESSSSSSSSSS! Seems like the fasting had paid off and I was on the road to recovery while avoiding a serious, invasive surgery.

They continued to monitor me for another day and I graduated to small servings of vegetable broth and jello. On day 5, I was allowed to leave the hospital and advised to continue on a diet of soups, liquids and clear foods for another week. So much for my bodybuilding gains but it didn’t even bother me or matter at that point. I was so focused on improving this issue and I was more than happy to put my training and diet on hold for a few more weeks.

Why did it happen and what causes it?

There are several cause and risk factors that can lead to an esophageal tear including:

• surgical procedures
• severe vomiting
• swallowing a large piece of food (without chewing enough)
• swallowing strong cleaning fluids
• ulcers in the esophagus
• physical trauma or injury to the area (i.e. a fight)
• ingestion of a foreign object (i.e. coins or sharp objects)
• gunshot or stab wounds
• lifting a heavy object
• straining during defecation
• tumors

There were several of these I could rule out immediately and it started to become a little more what caused it in my specific situation.

After about age 35 I started getting some heartburn and reflux after cheat meals. This persisted and I received a prescription medication to reduce acid reflux. I was told to take this medication “as needed” and for me this became rarely or never. Once in awhile I’d feel a little reflux but nothing that felt severe or required much attention. Now looking back, it seems that I probably should have been taking a regular low dose of this medication to keep acid from the stomach neutralized. It seems that over time, this stomach acid had been quietly creeping up on me (literally) and slowly worn out a spot on my esophagus to eventually cause a tear and then complete rupture. I know that what I ate at the BBQ that Sunday didn’t really have anything to do with the symptoms, it was simply to final straw that broke the camels back. The tear opened up a bit more and food got stuck in there.

There are several other lifestyle related factors that I was also able to identify as contributing factors for what I went through – which I’ll cover in the next section, but I doubt any of this would have happened if I had been taking a low dose of the reflux medication on a daily basis.

How to prevent it from happening

It’s your choice to follow any of this advice. These were just some take home lessons I learned from the whole experience. Some of these would apply only to me and some are more general in nature. I know they will all become part of my new lifestyle – T-Rex 3.0. Keeping healthy and super fit over 40.

1. If you occasionally get heartburn and acid reflux, talk to your doctor about taking a daily prescription medication. As I learned, it’s generally better to keep acid levels low, even if you may not “feel” them every day. It’s a preventative measure.
2. Review all your current prescription medications for any that may be acid forming or a trigger to reflex. In some cases, there may be an alternative option for you that is easier on your stomach and still provide the same intended benefit.
3. Limit snacks, meals or taking pills before bed. In other words, don’t lay down within an hour of eating or taking pills. If the food hasn’t had enough time to digest and travel down the stomach, it will creep back up on you, bringing stomach acid back up with it.
4. On your yearly physical, be sure to have your doctor check your stomach and liver function. Sometimes these things go missed for people that just do a simple blood panel analysis. If something doesn’t seem right or is out of the ordinary, ask to be referred to a gastroenterologist.
5. Avoid or reduce all acid forming foods and beverages that may trigger or increase heartburn and reflux. Also remember that with acid comes inflammation and if your stomach acid content is high, so will be your inflammation. If this persists, you’ll experience a generalized inflammation of the gut and a bloating feeling most of the day, but particularly after meals. Some of the most common acid forming foods are:

• spicy foods
• raw onions
• garlic, black pepper, salt
• chocolate
• alcohol and particularly red wine
• coffee
• carbonated beverages
• caffeine
• tomatoes
• citrus fruits
• fried foods
• peppermint
• fatty and processed meats
• dairy

6. Include some preventive type foods that can protect the gut and neutralize acidity. Some of the best foods to consume to help with reflux and heartburn are:

• most vegetables and leafy greens
• ginger
• oatmeal
• lean meats and seafood
• eggs and egg whites
• healthy fats esp. avocado
• melons
• fennel
• non acidic fruits: berries, apples, pears, bananas

7. Chew your food longer. Most experts say to chew your food an estimated 32 times before swallowing. I’m sure this is far more than the average of what most bodybuilders are currently doing. More “work” up top, means less work below and less acid required to break down the food. You also avoid the possibly of chunks of food getting trapped in the esophagus.
8. Consider preventative supplementation in your daily regime to protect the esophagus, prevent inflammation and recover from a tear. Things like slippery elm, aloe vera gel drink, milk thistle, turmeric and other have been reported to help relieve symptoms of reflux and inflammation.
9. Raise the head of your bed with pillows when sleeping or napping. This will prevent the contents of the stomach to travel back up and hang out where they shouldn’t be.
10. Monitor stress. While stress doesn’t directly cause heartburn and stomach acid, it can slow down digestion and make a pre-existing issue worse. Controlling your stress levels should be part of your prevention or recovery plan for dealing with any type of digestive disorder.

Take care of your hatch

Gut health is essential for not only your overall health but even reaching your own body/physique goals. If any of your systems aren’t firing like they should, you won’t get to where you could potentially be and something will always be holding you back. They say the stomach is the best way to a person’s heart, but don’t forget to show your esophagus some love too!!

Coach Sean

Inquiries email: [email protected]