### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi,I am 44yr, male, copywriter, winston-salem, North Carolina, single, overweight...Im 6 foot and 275 lbs. Back several years ago when I weighed this much, I had some back problems and got shortwinded easily. Now Im experiencing the same but with added symptoms I want to tell you about. The last couple of weeks Ive had a lot of acid reflux....feeling like somethings always stuck in my throat...Sometimes if I take deep breaths, I feel a pain in my back...Sometimes if I swallow just right I feel this shooting pain like right at the collar area, but feels like its in my throat....but sometimes its almost like I feel it all the way through to my back. And every now and then, for no reason right at that area...like at the throat slightly to the left, at collar level I feel a shooting pain for half a second....Also My back hurts a lot now and sometimes my lower arms and hands do too....especially noticeable when I type (I type for a living and have at times wodered if Im experiencing c

### output:

Thanks for the elaborate history that you have given us, will need one more information if you use Tobacco in any form, Cigarettes or Chewing. Your BMI (body mass index) calculate it with this link http://www.ChatDoctor .com/Chat Doctor/web/JSP/calculator/healthcare/bmi.jsp. It says that you are at Morbid Obesity. It is for sure that the Extra pounds that you are carrying will certainly lead on to the amalgam of Symptoms that you have mentioned. 1) Acid Reflux disease leading to Barrels Esophagus and further damage 2) Spine related injuries 3) If you're a Smoker then the Chances of having a Laryngeal Carcinoma. Acid reflux disease will need you to reduce weight, quit smoking, regularize your diet regimen, (avoid fat rich foods, Take more of vegetables, reduce your junk food intake or completely avoid it, avoid Coffee and Tea, more so Caffeine in any form chocolates and Beverages). Spine needs examination be the orthopedic to know the cause, and then we might need to treat accordingly. Laryngeal Carcinoma will need clearance, surgery to remove and based on the spread radiotherapy. Hernia that you have mentioned is fine if the intestinal coils do not get wound up causing the gangrene of the loops, and then it might be become an emergency. The complications of this Obesity leads to any untoward complications. Please take care of it. In all you need to make a trip to the Hospital at the earliest. You can opt for the Bariatric Surgery if required to reduce the fat. However, the opinion should be taken by a Bariatric surgeon first.