Eventually, I devised the following regimen with the intent of providing the LES [lower esophageal sphincter] with some resistance training. The resistance was provided by positioning my head below my stomach in a kneeling posture. This required food being swallowed to be pushed up an incline. I began eating part of each breakfast (oatmeal) and sometimes lunch (a sandwich) in the exercise position. I would kneel on a platform (which happened to be 6 ½” high), take a normal mouthful, chew it as needed, and prepare to swallow. I would then lay my forearms and the backs of my hands on the floor, rest my head on my hands, and complete the swallowing process. With a little practice, I was soon able to initiate and complete the swallowing process with my head resting on my hands on the floor. I did not attempt to determine what the optimal height of the platform might be or if, indeed, any was necessary.

André Smout, a gastroenterologist at the University of Amsterdam in the Netherlands, said he read those reports when they came out.

"But we never saw the condition, so we didn't believe that it existed in real life," he said.

Smout's doubts persisted until he and colleagues studied a small group of patients a few years ago. The researchers gave eight patients with a reported inability to burp a "belch provocation" in the form of carbonated water, and used pressure sensors to observe how their throats moved. Indeed, the air stayed trapped. A Botox injection resolved their problems by giving them the ability to burp, or, to use an academic term, eructate.

"We had to admit that it really existed," Smout said.

On the morning of the event, he returned to Urology clinic, where his wound appeared well-healed and the overlying staples were removed. He and his wife went to breakfast to celebrate.
During breakfast, the man sneezed forcefully, followed by coughing. He immediately noticed a “wet” sensation and pain in his lower abdomen. Looking down, he observed several loops of pink bowel protruding from his recent surgical site. He later related that he was unsure of how to proceed, so he covered the exposed intestines with his shirt. He initially decided to drive himself to the hospital, but concerned that changing his position might injure his bowel, his wife requested an ambulance.

The most obvious explanation of these findings is that type A personalities are prone both to gesticulation and to coronary heart disease. It is possible that people with coronary heart disease move their arms more because they are otherwise physically inactive or their disease causes them to become agitated. However, my own suspicion is that arm movements over a lifetime may be a factor–combined with other known factors–in the development of coronary heart disease.