Rich's doctor is recommending he get a feeding tube as soon as possible. He is getting very little food down, trying to maintain his weight with Ensure, and even that is not going down easily. His esophagus is severely distended-- something like five times its normal diameter. It's so constricted at the bottom that the food is literally getting clogged and bulging out to the side.
He's very scared, needless to say. Lord have mercy.