Giselle

[Guest guest]

Dear Giselle,

I want to simply thank you for the email you sent me this morning. If only I could remember to compose my responses offline, it would save me from having to write it so many times online, and you would have had this email 12 hours ago.

Usually a person has to "be careful what they wish for" for if they get their wish, its usually not what they had expected. In your case you were blessed with a good turn. Having your endoscopy tomorrow not only gets it over with and quickly relieves you of apprehensions, but enables the physician giving you a second opinion to have those test results available.

I will share my opinion of what you are planning, hopefully to give you some perspective and support.

A bougie stretching, balloon dilitation, and a botox treatment carries with it not just risks of perforation in one case, but of creating scar tissue. We have read where scar tissue has compromised the ability of surgeons to perform certain Heller Myotomies. It has been shown ad nauseum to provide only temporary relief. So, why beat around the bush? I firmly believe, with what the current technology has to offer that you are making the right choice to go straight to the surgery. In many cases the Heller Myotomy has "frozen in time" the deterioration of the esophagus and so it remains in the same condition for many years to come (and that's a great thing).

As you know, achalasia is a progressive disease. It has been a losing battle for virtually everyone who has tried to fight it on their terms. It just makes no sense at all. I have yet to read one testimonial stating that holistic medicine provided anything more than temporary relief, and certainly nothing approaching a cure.

Regarding manometry, you know my feelings about that. But, its your doctor who decides, and for you to agree or find another doctor. I am including a link to the s Hopkins website having to do with diagnostic tests for people with "swallowing problems." They include:

"The following objective tests are commonly used in the evaluation of patients with symptoms of swallowing disorders: Barium Radiography, Modified Barium Swallow, Radionuclide Clearance Studies, Pharyngoscopy, Esophagoscopy, Manometric Studies, and Continuous (24 Hour) pH Monitor."

Digestive Disease Library

s Hopkins Hospital is the perennial #1 rated hospital in the US, and their Department of Gastroenterology is rated third in the country. In the 1980's and 1990's they did not require a manometry study to be done to either confirm achalasia or for the surgery. Their most common tests were the barium swallow, the endoscopy (of course) and the Radionuclide Clearance Studies (what I have referred to as the "Corn Flake" Study," which is the easiest test going.

Not being a medical person I cannot recommend that you have the surgery. That is for your doctors to decide who know you best. Based upon what I have read, it seems to be the best choice.

I would not be ashamed to quiz the doctor on the manometry studies and push them into telling you exactly why that test must be done. A patient has the right to those answers. You've already been diagnosed with achalasia. Let him tell you how it now makes a difference as far as where they must do their cutting.

You want to know if the catheter can be introduced thru your mouth instead of thru the nose. You want to know if you can be asleep when it is first inserted, then woken up in order to drink the water so the measurements can be taken. Measurements of what? You have achalasia, you don't have peristalsis. What else is there to know (asks the dumb patient to the all knowing doctor)?

Unfortunately, if this superb surgeon wants the test, you're going to have to have it. But try on your terms.

Now comes the newest wrinkle, and as an attorney you are eminently qualified to do your own research.

You've made up your mind to have the surgery. Which surgery are you going to have? (You mean I have choices of surgeries now?) We can cross off my operation, the open Heller Myotomy. Now we have the "usual" laparascopic Heller Myotomy, but now I've read there is also the VATS Heller Myotomy (Video-Assisted Thoracic Surgery) referred to as the thorascoscopic technique. And let's not forget the "Leonardo DaVinci" robot technique, the newest and maybe the best. You must discuss this with your surgeon. Right now, it might be safe to say that what he does best is best for you, regardless of what the future may hold. In 1991 I was very much aware of laparascopic surgery, but there was not one thoracic surgeon alive who could give me assurances that they knew what they were doing with this brand new technique. The results speak for themselves.

These surgeries, while basically the same, have some interesting differences. Board members have posted that the VATS and the daVinci may not involve the wrapping of part of the stomach around the base of the esophagus to prevent reflux. I am not well versed in this, and I ask the others here, who are more knowledgeable, to share what they know about these newer surgical techniques.

Giselle, I am very glad that you are so focused on getting all this done ASAP. Have a great weekend in Las Vegas!

Thank you again for your email this morning; your kind and complimentary words made my day.