Choking Feeling, Ear Pressure and Blood on Toilet Paper

[Elros]

Dr. Pho,
  I'm a 30yr old asian male and since 2/1/09 I've been having this choking feeling in my throat area around the adam's apple and just below, and sometimes my jaw lymph nodes seem to enlarge. When I have that choking feeling I always have ear pressure. In the beginning I had fatigue, dizziness and headaches that subsided within 10 days, and I also occasionally have slight burning in the upper chest area (right below clavicle) and orbital, nose or face pressure in addition to mucous in the throat, but no coughing, runny nose or breathing problems. The main persistent symptoms though are the choking feeling and ear pressure but no chest or stomach pains. My doctor thinks it's just a reflux problem so he prescribed me 40mg famotidine which I've been taking for a month now but hasn't resolved my problem.
  Also, I've had blood (red and bright red) on the toilet paper when wiping for awhile now, and starting from mid-Feb., I had BMs 3 times in the span of several hours for a couple of days and the feeling that I had to go, weak pulsating rectal area, and some weird pain/ache around the tailbone which made it difficult to sit. An anoscopy confirmed that I have hemorrhoids, but my doc also scheduled a flexible sigmoidoscopy even though he thinks I don't need it. I started taking metamucil and citrucel and that has reduced/eliminated the weird rectal aches and pains, and I've been having normal bowel movements now, but if I don't take fiber for a day or two those weird pains seem to come back.
1. What is this choking feeling/ear pressure due to? Do you think it's reflux? If so what kind? If not then what? Why doesn't famotidine really help? Should I try different medication besides famotidine?
2. As for my rectal/BM problems, was it all due to hemorrhoids or could it be something else? Should I go through with the sigmoidoscopy or is it unnecessary? How did fiber eliminate a lot of my symptoms? And how can I stop getting blood on the toilet paper when wiping?

[feanorius]

Dr. Pho,
     Does the reflux also explain the plugged ears and sometimes plugged sinuses? Sometimes the plugged feeling is greater than the choking feeling, it eventually goes away,, and also sometimes I can go hours feeling completely fine. So it's hard to pinpoint what's the cause. I'm assuming eating might cause it but sometimes eating seems to make my symptoms better. It's all very confusing and I don't understand how it could just start all of a sudden when I've never had this problem before.
Do you think that the reflux problem and the bowel movement/hemorrhoids problem are related or is it just coincidence it happened at the same time?
My doctor said it could take up to 6 months for my reflux to be completely resolved taking famotidine. Do you think I should take famotidine for that long before moving on to omeprazole?
And finally, is it urgent to undergo a sigmoidoscopy or do you feel it's fine if I wait a month since I'll be busy for a while.

Thanks

[Kevin Pho, MD]

To answer your questions:

1) The feeling of choking can be caused by reflux, and if it continues, I would consider an upper GI series or upper endoscopy.  If H2 blockers like famotidine doesn't help, you can consider medications like omeprazole which work by a different mechanism.

2) Hemorrhoids are the most likely, and I would undergo a sigmoidoscopy to be sure.  Eating fiber can soften the stool, and irritate the hemorrhoids less.

Treating the hemorrhoids can help reduce the amount of blood on the toilet paper.

These questions can be discussed with your personal physician.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd