Saturday, October 07, 2006

And it starts again...

About two years ago, I started having serious problems swallowing. Fast forward six months, and I'm having surgery for a condition called achalasia. Basically, achalasia is a lack of peristalsis in the esophagus, paired with a lower esophageal sphincter (LES) that is too tight and doesn't open correctly.

The surgery (a Heller myotomy with a partial fundoplication) was an amazing success. It was done laproscopically, so the recovery time was short. I could eat again without worrying about it!

However, they symptoms are coming back. I called my previous surgeon in Kansas City for advice. He suggested another barium swallow to see what was happening, followed by a dilation. Essentially, a deflated balloon is placed in that same LES and then quickly inflated, tearing the muscle fibers and allowing food to pass through again.

I met with a surgeon this week here, since I'm not in Kansas any more, Toto (*chuckle*). He wants to do a couple more tests to see exactly what the issue is. The problem? Two of the tests he wants to do are the most painful annoying tests there are for this condition. *sigh* I already had the barium swallow - totally not a big deal, and pretty cool in that I get to see what my insides look like. However, he wants me to re-do a manometry. This IS a big deal. What it entails is sticking a "skinny" tube of sensors up my nose and down my esophagus. I am to swallow when I'm told, and to NOT swallow the rest of the time. That is HARD! And let me tell you, I don't care what 'skinny' means when a tube is stuck up my nose! Blech. This test takes about a half-hour or so if all goes well. The intent is to find how much peristalsis is left, and/or what the muscles are doing when I swallow (sometimes they push the food the wrong way, or push up then down then up etc... until the food finally ends up where it belongs), and how much stricture there is in my LES. The other test he wants me to do is a 24-hour pH study. Again, a tube up the nose and down the esophagus (although from what I understand, this is a much smaller diameter tube than the manometry *whew*) for 24 hours to see what sort of reflux is or is not going on.

If there is no reflux, one of the options is undoing the fundoplication previously done. This may be causing the extra tightness in the LES. A fundoplication is when the stomach is wrapped around the base of the esophagus to cut down on reflux. GERD patients have this done all the time. If there is too much acid on the esophagus, eventually something called Barrett's Esophagus can form - a precursor to cancer. Not good. So it's a trade-off: lower the fundoplication so I can swallow without pain but am more suceptible to reflux with the chance of Barrett's/cancer, or leave it up and have more problems swallowing. OR, do neither and try some other options.

The problem with the "other options" is that they are normally shorter lived solutions. There are a couple - the aforementioned dilation, or an injection of botox (yep, same one, different place). The botox does what botox does. It relaxes the muscles. The dilation tears them. Either way, they both reduce the effectiveness of any future surgery. That's why I had the surgery FIRST last time. Both botox and the dilation rarely last long. Further treatment is necessary sooner, rather than later. Since I hope to live a long long life, I'm more willing to undergo another surgery with a potentially longer improvement, than nickle-and-dime treatment over and over for years and years.

Then again, I expected the surgery to 'fix' things a lot longer than only a year and a half.

Ok, enough talking in circles around this mess. I am waiting to schedule the manometry and pH study (they're done at the same time, manometry first, then place the pH study, wear it for a day, then have the tube removed). I'll let y'all know when I hear about the results from that.

Originally posted: Friday September 1, 2006 - 08:30am

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