Here is my latest article also available for comment on fightmedicine.net:
Mike Swick managed to come back in the second round of last night’s UFC on Fox to knock out DaMarques Johnson. Mike Swick is no stranger to comebacks. He has had a slew of injuries including a torn ACL and meniscus. But Mike has been battling something much more elusive and much more debilitating.
Imagine waking up every night with the feeling that you are having a heart attack; a crushing pain in your chest leaving you breathless and worried. This is what Mike Swick began to experience in 2007 while preparing to face Yushin Okami at UFC 69 in Houston (interview with Kevin Iole, July 25, 2012). Mike was suffering from a rare disorder known as Diffuse Esophageal Spasm, or DES. DES has no known cause and is difficult to diagnose.
The esophagus is the tube of muscle that connects your mouth to your stomach. The other tube, the trachea, or windpipe, is what connects your mouth to your lungs. The esophagus is lined with smooth muscle, which is the type of muscle in your body that is responsible for unconscious contraction of things such as blood vessels and the bladder. This is in contrast to skeletal, or striated muscle, which is what you can voluntarily control to move your body. Normally, the esophagus is gradually contracting in sequence from the top down to help push food down towards you stomach in a controlled and sequential manner. In DES, the entire esophagus, or certain parts of it, contract all-at-once for prolonged periods of time. This can result in indigestion, or sometimes a crushing chest pain that feels like a heart attack. Because it is so rare, doctors have to rule out more common things first and thus it may go undiagnosed for some time.
Diagnosis is made by having a patient swallow barium, which is a liquid that shows up on x-ray. Normally, if you swallow barium and take an x-ray, a nice long tube (the esophagus) will be visible. If someone has DES, the esophagus often looks like a corkscrew. In addition, a pressure sensing device known as a manometer can be placed down the esophagus and the pressures within various parts of the esophagus can be measured.
One possible cause (or possibly a consequence) of these unregulated contractions is that the smooth muscle of the esophagus hypertrophies, that is, it grows bigger and stronger. Another problem that may be the cause of this condition is the inability of the esophagus to recognize compounds that tell it to relax, such as nitric oxide (NO). The effects of NO are famous as being enhanced by Viagra-like medications in that these medications help relax the blood vessels and allow more blood-flow (which was ironically discovered as a side effect for a completely unrelated medication study). Some researchers have speculated that DES can progress to an even more debilitating disease known as achalasia, where you have trouble swallowing food – first solids and then eventually liquids.
Since the cause of DE is poorly understood, treatments become even harder to find. Treatments range from pills (NO, Viagra-type medications, and calcium channel blockers) to botox injections to surgery. For Mike Swick, this means he can never really defeat this elusive opponent. Even if he gets the symptoms under control, his treatments may have side effects that affect his ability to train and perform. NO and Viagra-type medications can relax blood vessels that go to the brain and heart and thus drop his blood pressure when he tries to exercise. Calcium-channel blockers seem to have little effect on chest pain. Botox is unpredictable. And surgery carries the risk all surgeries carry which can have long-lasting consequences. In addition, Mike will likely have to follow a very strict diet as not to exacerbate any symptoms of pain or indigestion. Since Mike will have to continue to cut weight for future fights, this may end up being very tricky for him.
What is perhaps the scariest thing for Mike is that this disease is not like tearing your ACL which can be reconstructed. This is something that Mike has to live with whether he continues to fight or not. But, if Mike has shown us anything, it is that he is a fighter and certainly no stranger to comeback victories!
Feel free to comment or start a conversation here at Bloody Elbow or at Fightmedicine.net