Saturday, June 29, 2013

Esophageal What???

My mother recently subjected herself to a sleep study.  She did the proper scientific research before embarking on this experience...she read the blog account of mine.  She told me that it totally cracked her up. I couldn't remember what I had written that was so funny, so I had to go back and re-read the post.  My kids wanted it read aloud to them and they cracked up.  Whether my posts of my experiences are funny or informative, I'll let you decide, but I decided to keep posting about these things.  Surely someone else is going through the same thing and either needs a good laugh or to be informed about what will happen.

So, today's topic will be my esophageal manometry.  Mouthful, huh?  No, pretty much a noseful.  But we'll get to that.

No one can pronounce or spell the test.  Ee-sof-a-gee-uhl man-om-eh-tree--that was my attempt to show you the pronunciation.  Did it help?  Are you saying it out loud to yourself now?  Don't try to deny it, you know you are.  Now, say it five times fast.  Just kidding.

This test is to measure the pressure in your esophagus.  My surgeon wanted it done to decide if I am a good candidate for a Nissen fundoplication surgery.  Another mouthful, but you're on your own for pronunciation, mostly just because I am not 100% sure how to!  Maybe before I get into the esophageal manometry, I should explain how I arrived here.

I have had acid reflux and GERD (Gastroesophageal Reflux Disease) symptoms for a couple of years now. I have tried every medication available to treat it and none of them works for me.  My reflux is bad enough that I wake up coughing, choking, and vomiting some nights.  More recently, I started aspirating.  The first time scared me half to death.  I woke up one morning, choking and coughing with a horrific pain my my chest.  I was clawing at my neck and chest, gasping for air, and choking.  I thought I was having a heart attack.  Luckily, my paramedic husband was home and I stumbled out to him.  He asked me if the pain was sharp or crushing.  In between coughs, I gasped, "sharp."  He said it wasn't a heart attack then, and judging by the way I was coughing and choking, decided I must have breathed in some of the acid/stomach contents that came up.  I can tell you that it burned and hurt like nobody's business!  I was coughing for hours afterward and my lungs felt raw the rest of the day.  This happened several more times and I finally went to see a gastroenterologist.

He wanted me to have an EGD, or an endoscopy.  I wasn't thrilled with this testing, but it pales in comparison to the manometry.  Hold your horses, I'll get to that one in a minute!  I had to check in to the hospital and luckily was given anesthesia.  Not sure I could have handled that one without it.  Though, I think a manometry should definitely be done under sedation.  I can understand why it isn't because you have to follow commands, but I'm thinking Versed would be amazing so you can just forget the whole thing ever happened!

During the EGD, they also inserted something called a Bravo monitor in my esophagus that was supposed to record the number of reflux events in a 48 hour period and transmit the data to a pager-type device you wear on your belt or keep close to you.  You also have to keep a log of what you eat and drink and when you lie down, etc.  Then you turn in the pager part and after a few days, the monitor detaches from your esophagus and...well...makes its "exit", shall we say.  It felt funny.  I could definitely feel the monitor there, sort of like having a tickle in your throat that you can't get rid of.

I am told that my GI doc doesn't impress easily and he was a little miffed that no one had told me to discontinue my reflux meds, but he was impressed by my results.  Apparently, I had 233 reflux incidents in less than 48 hours.  And I thought it was actually a mild sampling.  I have a small hiatal hernia and some mild esophagitis.  If left untreated, severe acid reflux can cause lots of problems like Barrett's Esophagus and esophageal cancer.  Even without that, aspirating can cause pneumonia and I am just plain tired of being awakened in the night choking and vomiting and having to sleep in the recliner most nights.  So, the doc referred me to a surgeon.  He said that this guy was the best in the KC area at this type of surgery.  I went to see the guy and right off he tells me that I am too overweight for the surgery.  He said that being overweight causes too much abdominal pressure and that since I have a good amount around my mid-section, it is likely that the surgery would undo itself.  He recommended that I have a gastric bypass and gave me a referral.  I was dumbfounded.  I went in there expecting to be scheduling the Nissen fundoplication and instead he's telling me to have a surgery that I do not want nor does my insurance pay for.  I decided to get a second opinion.

While I have been on Weight Watchers and have lost some weight, it's slow going.  Am I expected to continue to suffer until I reach the "ideal weight"?  So, I went to see the doctor that took my gallbladder out.  He said he had never heard of such a thing, being too overweight for this type of surgery and agreed to do it.  He just needed me to have the esophageal manometry first to be sure that after the surgery I can swallow well enough to get my food and drink past the surgery site.  A Nissen fundoplication is where they wrap part of the stomach around the lower part of the esophagus.  The point of this is so the squeezing of the stomach muscles clamps down on the esophagus to prevent the stomach contents from coming back up the esophagus.

Now, back to the topic at hand...the esophageal manometry.  I knew ahead of time that this involved them sticking a tube down my nose and into my esophagus and having me swallow to measure the pressure and be sure that the esophageal muscles work in sequence from top to bottom, moving food or drink down the esophagus.  I was not looking forward to this.  I don't want anything stuck through my nose.  And I gag very easily.  Which is why I have cavity problems--brushing my teeth makes me gag.  I have a two gag maximum or I end up emptying my stomach contents.  I can already tell you that my advanced directives will say "no feeding tube."

I got a packet in the mail with a pamphlet about the test.  I had been encouraged by hearing that they numb the back of your nose and throat, but then they had to go and say that sometimes people have a gagging sensation.  Sheesh.  If normal people gag, what will that mean for me?  I went back to the same hospital where I had my EGD and checked in.  When the nurse came to get me, she said that the tube was being cleaned, but we could go ahead and get everything put into the computer.  This was alarming.  I mean, I guess I knew that this is equipment that isn't disposable, but the idea of this tube being shoved down someone else's nose before me was disturbing.  I don't know why, but I was picturing an elderly man with long white nose hairs.  I was also a little worried about this because after my EGD at this hospital, I ended up with a viral infection.  Was it just an odd coincidence that I woke up from anesthetic with a horrible sore throat that I attributed to the EGD, but didn't get better so I called the hospital and was told it was abnormal and to go get a strep test?  I was worried that I would catch something from this equipment!

When they brought the tube in, they had it wrapped in a towel.  I thought it should have been in a bio-hazard sealed bag or something.  The nurse started squirting this gel-like stuff into my left nostril and asking me to "snort it".  For years, I have told my kids not to sniff when they have a cold so they don't get an ear infection, but here I was, sucking that stuff back until it went down my throat.  I'm thinking now it won't just be a viral infection, but an ear infection as well.  She kept putting more in and I kept sucking it back.  Then she picked up the tube.  Oh. My. Goodness.  That was much bigger than I had been expecting.  If you Google esophageal manometry, all the articles say "small tube"--NOT!  I was thinking spaghetti-like.  Maybe half a dozen pieces of spaghetti!  I began to wonder if I was going to be able to do this.  But, the nurse didn't wait or ask, she just started shoving.  I was told to breathe in through my nose to avoid the gagging.  It was thoroughly uncomfortable, but I managed to not gag.  Once she got it in place, she taped it to my nose and had me lie back on my side.  She had a syringe that she filled with water and squirted into my mouth and instructed me to swallow it down and then went to tell my GI doc that she had started the test.  She continued the test, periodically giving me swallows of water and then telling me to just breathe.  I was fine as long as I was just breathing.  But, she started talking to me while she was waiting on the doc.  She was such a nice nurse, but I didn't like talking with the tube in.  Talking created saliva and then I needed to swallow or I felt like I was choking.  Finally, we heard the clip-clop of the doctor's shoes and he came in and watched me swallow.  He said it looked good, but that he would review the results and pass them on to the surgeon.

The nurse did one more swallow and some breathing and then removed the tube.  When she removed the tube, she didn't do it slowly, she just pulled it right on out.  Very weird sensation, but I think if she had gone slower, I would have gagged or vomited.  She handed me some tissue, walked me out, and gave me a hug.  The hug was nice, but I felt used and abused.  There are things like this that you feel like you should get some sort of reward or trophy or SOMEthing because it was such a big deal to you and such an accomplishment that you can't believe you are walking out to the car like nothing happened and driving yourself home when you feel like you should be doped and in a wheelchair for something like that.  For the rest of the day, I felt like I had a cold or sinus infection.  The one nostril felt stuffy since it was all numb and I was blowing out the numbing gel half of the day.  Once the numbness wore off, my throat was sore.  I was volunteering at Vacation Bible School at our church all that week and while the other adult in my group did all of the teaching, thankfully, it's next to impossible not to talk to a group of children.  By the next morning, though, I felt back to normal, so no viruses or infections, despite my misgivings about the use and reuse of the equipment.

The test came out fine, so the next step is to have the surgery, which is scheduled in less than two weeks.  I'll let you know how that comes out!

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