Saturday, December 17, 2011

Achalasia talk...

I have achalasia.

I was lucky; the radiologist who performed my first barium swallow knew exactly what it was. Time between that test and my myotomy surgery was only four or five months. Many people with achalasia spend years trying to get their symptoms properly diagnosed. I was also lucky to have found an extremely knowledgeable support group online - the people in that group taught me a great deal about treatments, other symptoms, and so much more. The people in this group helped me immensely, and gave me the information I needed to educate a few of the professionals I came across. Who knows about a rare condition more than the very people that have it? I'd dare to say no one.

I. am. very. lucky.

My symptoms appeared in a textbook fashion. At first, I only had problems with dry food (bagels, rice, etc). Then over time, all food. Not long after, I got to the point that I couldn't even drink water without it 'sticking'. Only soda, with its carbonation, created enough pressure to push food and liquid through my LES. Then the truly horrible symptoms. I couldn't sleep laying flat; I had to raise my head. However, even still I would often wake up choking (aspirating - can easily lead to nasty pneumonia) on the food and liquid in my esophagus. I would get horrible chest pains that, according to others who've experienced both, were similar to a heart attack. And more gross and painful stuff, but you get the idea.

I had the barium swallow (that showed the barium was just sitting in my esophagus), an upper-GI endoscopy (to rule out cancer), and menometry (which proved that peristalsis wasn't happening, nor was my LES opening). The first two tests were no big deal. The third was .... not fun. All three of these are explained in the link above.

I had the laproscopic heller's myotomy surgery, with fundoplication, in December 2004. The surgeon cut my LES and wrapped part of my stomach around my esophagus to keep stomach acids from going back up through the, now cut, LES. Again, I've been lucky. I haven't had problems with acid reflux.

However, the surgery didn't relieve my symptoms for as long as I'd hoped. From the link above: "Surgery relieves symptoms in 70 to 90 percent of people. Symptom relief is sustained in about 85 percent of people 10 years after surgery and in about 65 percent of people 20 years after the surgery." But, only a few years later, food started 'sticking' again. Not as badly as before, and I haven't had the choking or chest pains, but eating is often uncomfortable. (Now I'm not feeling so lucky - only 15% don't get relief lasting at least 10 years. Mine didn't even last for five.)

I had a balloon dilation performed in 2009. The GI doc was conservative; he used a fairly small diameter balloon. I understand - perforation is most likely to occur during the first dilation procedure and perforation scares the crap out of me. His intent was to see how well it worked, and we could always do another if necessary. Well, something more will be necessary. I had only a couple of months of total relief after that procedure. I've been acting like an ostrich with my head in the sand about it, but it's getting worse and I really should have something done.

My worry is that I'm stretching out my esophagus by not getting the 'sticking' taken care of. A person can't regain lost elasticity, and I will probably live many more decades. Some people have had to have their esophagus removed (which requires the stomach to be pulled up to be reattached higher in the chest). I'd really rather avoid that, thanks.

But I'm also worried about acid reflux. Barrett's Esophagus can result from too much acid, and it can more easily lead to esophageal cancer. That's not easily treated, and in fact has a pretty horrible survival rate. Any treatment I get will increase my chances of acid reflux.

So, what to do... Something does need to be done, and I certainly shouldn't try to make the decision without professional advice.

Honestly, there's a test I'm sure I'll be asked to have redone and I'm hoping to avoid it. It was horrible the first time (manometry). Sure, it doesn't sound that bad, but it was painful. I don't know if it always is, or if the lady that was doing it did it wrong. All I know for sure is that I do NOT want to do it again. I need to get over the fear of it and get seen; maybe it won't need to be done again, and I'm procrastinating for no reason. Ugh.

In any case, the reason I'm writing this post... I have a Google Alert set up to email me whenever "achalasia" is in the news. I received an email today with not one but two articles in the same journal volume.

The first. Plain words summary: the myotomy surgery and balloon dilations have similar outcomes. Previously, it was generally thought that the surgery resulted in a longer term improvement.

The second. Plain words summary: there's a new method for the myotomy surgery that's done through the esophagus itself. The 'old old' way was to get to the esophagus from the back, deflating a lung, which obviously required a great deal of recovery. The 'new' way was laproscopic, from the front of the abdomen (and the method I had). A day or two in the hospital, but only five small inch-long scars. This 'new new' method results in no external scars at all, and from this (and other) recent journal articles, I've learned it's pretty successful in treating the problem. This particular study addresses this surgery even after a previous myotomy.

I'm now living very close to one of the best centers in the country for achalasia, the Cleveland Clinic. I really need to deal with the process of getting referred there for some sort of treatment for the symptoms I'm having now. I'll kick myself later if I don't take advantage of the geography before Darrell gets PCS orders. My problems aren't a huge problem currently; I'm only having to slow down while eating, take a type of breath I can't describe if I feel food not going down quite right, and food only gets badly stuck if I'm not drinking a lot during a meal.  (Strangely, soda not only doesn't help like it did before my surgery, it makes it worse.)  But, I'd be an idiot to not take advantage of the situation. Progress is being made, and perhaps I'm a good candidate for this new procedure. Or at the very least, I can get another dilation done by someone with a great deal of experience.

I just really hope I don't have to do that manometry test again. *shudder*

Wednesday, December 14, 2011


The deal: if Kaden can get three days in a row of "green behavior" at school, we'd go to Wendy's so he could use his free frosty coupon.  Today was (finally) a day three!  Off to Wendy's we went.

Ordered the frosty.

He ate his dinner and promptly gave his frosty to Justin.

*shrug*  Oooookay.  *laugh*

I'm a professor again!

Passed my online training courses and just heard from my program chair - I'll be starting a Physical Geology (and lab) class in late January! I've missed teaching.

Studies the materials of the earth, its structure, surface features and the geologic processes involved in its development. This course includes laboratory experience.
1. Recognize and appreciate the vastness of geological time and illustrate this by example and/or metaphor.
2. Recognize and classify the common minerals and rocks by their observable characteristics.
3. Locate and identify geologic features using topographic and/or geologic maps.
4. Discuss the origin of intrusive and extrusive igneous rocks and recognize landforms associated with each.
5. Understand the weathering processes involved in the transition from bedrock to soil and sediment.
6. Discuss the processes involved in the formation of sedimentary rocks and relate them to modern and ancient depositional environments.
7. Understand the agents and processes of metamorphism and relate these to the various metamorphic rocks.
8. Analyze the causes and effects of earthquakes and relate seismology to the structure of the earth.
9. Describe the hydrological cycle and relate this concept to both the surface and subsurface waters.
10. Discuss the mechanics of Earth`s waters (e.g., running water, waves, tides and currents, groundwater), mass wasting, wind and glacial ice and relate these agents and processes to the origin of landforms.
11. Classify folds, faults, and mountains and discuss their origin.
12. Discuss the basic lines of evidence for continental drift, sea floor spreading, and plate tectonics.
13. Discuss the characteristics of plate boundaries and heat plumes and their relationships to earthquakes, volcanic and mountain building activities.
14. Read, analyze and apply written material to new situations.
15. Write and speak clearly and logically in presentations and essays.
16. Demonstrate the ability to select and apply contemporary forms of technology to solve problems or compile information.

Saturday, December 10, 2011

Woo hooo!

Darrell's name is on the list!  And in the top 25%, so he should be promoted before summer.  No idea what that means yet regarding his next assignment.  Branch says they won't talk to him until his sequence number is called and he actually pins on the new rank.  (Velcros on the new rank?)  AND, my best friend's husband made the list too!  (Hi Dave!)

In other news, now that I'm working at the VA, I have more of a reason to pay attention to the Army-Navy game.  Sure, I'm an Army vet, but I didn't attend West Point.  I care more about my own alma mater (Kansas State) than West Point.  There's quite a bit of friendly service rivalry at the VA, as you can imagine...  It's 14-14 at the half, not bad!

ETA: Ah, so "we" lost.  Bummer, but at least this year it was a close game.

Friday, December 02, 2011

Board results out Thursday?!!??

In other news, the promotion board results for Darrell's possible promotion to master sergeant will be released on Thursday!! It usually doesn't happen until mid/late January. He, of course, is sure he won't get it. I understand that. It's a lot easier to deal with if you convince yourself you won't get it. I'm hopeful, but then this is his fourth time and I thought he'd get it each and every time.

If he's selected, he'll get a sequence number. It should be pretty low, since he's been qualified for promotion for years. If he's selected and gets a sequence number of, say, 7, then each month as the Army decides how many more E8s they need, they'll promote that many from the list. For example, say they need four in January. Sequence numbers 1-4 will get promoted that month. February they need three. Sequence numbers 5-7 get promoted that month, including Darrell. Get it? But it doesn't much matter what the sequence number is - if he's selected and gets a number, it's just a matter of time before his number is called (although obviously the bank account prefers sooner...)

If he's selected, we're almost surely moving this coming summer. There's only one E8 slot at the ROTC battalion here, and even though the guy there now is leaving this summer, there's already a guy on orders to replace him. Besides, they usually pick E8s that have held the rank awhile (and have already done a 1SG gig or two) to have that spot. We're okay with this - I'd rather move next summer and stay at the next duty station for a few years than to stay here and have Justin get even tighter with his friends here before having to leave (again).

Almost certainly, he'd get a first sergeant (1SG) spot in a unit getting ready to deploy to Afghanistan. That's where the need is. We're not expecting to have any say in where we go for this one.  I'd love a short list to choose from, but not expecting that to happen.

If he's not selected, it's another year before the next promotion board is held. Last year, they selected only five out of hundreds with his MOS. He would have to walk on water or be BFFs with a board member to have made it last year. The Army just didn't need a lot of his MOS promoted last year - it was nothing personal. Although he knows that's the case, it's still really hard to take. His evaluations are pristine. His experience is as good as he can possibly have - he's done everything he can do that's within his control. However, he doesn't compete as well against guys who have gone to all the super cool schools (airborne, air assault, ranger, pathfinder, etc). He's never had the opportunity to attend any of them, even though he's begged to his whole career. Not fair, but it is what it is.

So, we wait. We expected the wait. But yesterday we found out that the wait is only one more week instead of almost two months. Eeeeek!!  Also hoping for MY BFF's husband to make it.  Cross your fingers for us...

Thursday, December 01, 2011

A little better...

The prednisone appears to be working.  Riley is breathing a lot easier tonight compared to last night.

I've asked the boys to sit on the floor whenever they're around him.  We're just going to love the heck out of this dog for as long as he is with us.

Wiggle seat update!

Kaden has had the wiggle seat in class for two days now.  He got green for behavior both days!  He's only gotten green twice since the school year started (well, once she started using the green-yellow-red thing).  Great job Kaden!  If he can do it again tomorrow, it's Wendy's for dinner!