Re: GI and surgeon are leaving treatment up to me

[Guest guest]

Pat

 

My husband and I weighed the opions.  We are going with the HM.  As long as I

have been suffering one more month of bed rest, no work and family weighting on

me. Let's just day do the math.  LoL Look at the positive side.  I do.  I

feel the dilation option has to many problems that can go wrong.  Instead of

chicken, how about tuna  pata.  My surgery is on the 18th of April.

From: DCBlogs dcblogs@...

Subject: GI and surgeon are leaving treatment up to me

achalasia

Date: Monday, April 2, 2012, 10:52 AM

 

Hello all,

The GI and surgeon I've met with have treated hundreds of achalasia patients, so

I'm not concerned with their expertise. But they're leaving the choice up to me

as to what to do: HM or the dilation.

The surgeon argues that the HM is durable or longer lasting. The GI agrees, but

also says the dilation option has been long lasting as well.

The GI puts the success rate of the HM at 85% and the dilation at 80%.

I honestly don't know what to do.

The dilation, I have to admit, is appealing.

Not having to stay in the hospital overnight and

get-it-over-with-as-soon-as-possible. I've had three endoscopies so far, so I

know what that's all about.

But, after reading the numerous posts here, it seems, and correct me if I'm

wrong, that there's a consensus for the HM.

Any thoughts appreciated. I'm going to make a decision soon because I really

need to get off my chocolate-soup-frozen yogurt diet. I'm a single guy living by

myself and the whole idea of putting chicken in a blender and making meal just

doesn't work for me.

Thanks (this is a great a great group and I'm so happy I found it)

Pat

[Guest guest]

I have had two dilatations done. The last worked maybe 4 days... I am at a point

in life where I really need results so I am having the HM next week. I also

didn't want to end up with too much scar tissue before the HM.

Jenn in canada

Sent from my iPhone

On Apr 2, 2012, at 11:52, " DCBlogs " <dcblogs@...> wrote:

> Hello all,

>

> The GI and surgeon I've met with have treated hundreds of achalasia patients,

so I'm not concerned with their expertise. But they're leaving the choice up to

me as to what to do: HM or the dilation.

>

> The surgeon argues that the HM is durable or longer lasting. The GI agrees,

but also says the dilation option has been long lasting as well.

>

> The GI puts the success rate of the HM at 85% and the dilation at 80%.

>

> I honestly don't know what to do.

>

> The dilation, I have to admit, is appealing.

>

> Not having to stay in the hospital overnight and

get-it-over-with-as-soon-as-possible. I've had three endoscopies so far, so I

know what that's all about.

>

> But, after reading the numerous posts here, it seems, and correct me if I'm

wrong, that there's a consensus for the HM.

>

> Any thoughts appreciated. I'm going to make a decision soon because I really

need to get off my chocolate-soup-frozen yogurt diet. I'm a single guy living by

myself and the whole idea of putting chicken in a blender and making meal just

doesn't work for me.

>

> Thanks (this is a great a great group and I'm so happy I found it)

>

> Pat

>

>

[Guest guest]

I was 33 when I had the surgery and for me, I didn't want to have to do a

dilation every couple/few years for the next 50 or so. That was a huge factor

for me in choosing HM.

Also, my GI said that there was a decent/reasonable chance of something tearing

during the dilation.

>

> Hello all,

>

> The GI and surgeon I've met with have treated hundreds of achalasia patients,

so I'm not concerned with their expertise. But they're leaving the choice up to

me as to what to do: HM or the dilation.

>

> The surgeon argues that the HM is durable or longer lasting. The GI agrees,

but also says the dilation option has been long lasting as well.

>

> The GI puts the success rate of the HM at 85% and the dilation at 80%.

>

> I honestly don't know what to do.

>

> The dilation, I have to admit, is appealing.

>

> Not having to stay in the hospital overnight and

get-it-over-with-as-soon-as-possible. I've had three endoscopies so far, so I

know what that's all about.

>

> But, after reading the numerous posts here, it seems, and correct me if I'm

wrong, that there's a consensus for the HM.

>

> Any thoughts appreciated. I'm going to make a decision soon because I really

need to get off my chocolate-soup-frozen yogurt diet. I'm a single guy living by

myself and the whole idea of putting chicken in a blender and making meal just

doesn't work for me.

>

> Thanks (this is a great a great group and I'm so happy I found it)

>

> Pat

>

[Guest guest]

I had a dilation in late 1996 and then another in mid 1998.

No surgery.

I'm still going strong, and I'm currently a nursing student with a healthy 12yo

son.

One thing that has struck me is how many folks here who had a HM ended up having

a dilation afterward... why bother with the HM if you're going to get a dilation

anyway?

(I realize, too, that everyone's experience is different. Just relating what

has worked for my situation.)

Debbi in Michigan

aka " Pepto Deb "

[Guest guest]

 i had three dilatations before i had the lapro myotomy. wish i had had it done

before the dilatations.. it was a breeze.. and i was starving. literally. I am

not perfect now, but you know what?? i can eat. yes-- i am careful what i eat...

and i can drink.. drink till i slosh... that is such a blessing.... i hope i

dont have to have anything else done.. one never knows with this strange

affliction.i would do the myotomy.. it was not bad for me perhaps because i was

so bad before it. was such a relief.

[Guest guest]

My esophagologist at Mayo said he favored the HM for me because it lasts longer,

and apparently multiple failed dilations damage the esophagus, making a HM in

the future more complicated than it would have been originally. He left it up to

me, but he said his recommendation was the HM. I'm so glad I got that surgery!!

>

> Hello all,

>

> The GI and surgeon I've met with have treated hundreds of achalasia patients,

so I'm not concerned with their expertise. But they're leaving the choice up to

me as to what to do: HM or the dilation.

>

> The surgeon argues that the HM is durable or longer lasting. The GI agrees,

but also says the dilation option has been long lasting as well.

>

> The GI puts the success rate of the HM at 85% and the dilation at 80%.

>

> I honestly don't know what to do.

>

> The dilation, I have to admit, is appealing.

>

> Not having to stay in the hospital overnight and

get-it-over-with-as-soon-as-possible. I've had three endoscopies so far, so I

know what that's all about.

>

> But, after reading the numerous posts here, it seems, and correct me if I'm

wrong, that there's a consensus for the HM.

>

> Any thoughts appreciated. I'm going to make a decision soon because I really

need to get off my chocolate-soup-frozen yogurt diet. I'm a single guy living by

myself and the whole idea of putting chicken in a blender and making meal just

doesn't work for me.

>

> Thanks (this is a great a great group and I'm so happy I found it)

>

> Pat

>

[Guest guest]

Deb,

 

Since you have been on this site forever, you know that your dilatation results

for a person in your age range is the exception to the rule. We don't know why

that is, but keep on hanging in there and I hope you never need to go the

surgical route.

 

Generally speaking, you take a young male adult, Pat in this case, who is

considering having a dilatation and it often ends up being the same story: 

the muscle which is ruptured by the dilatation heals and the patient is back to

where they were again....having to make a choice between a dilatation and

surgery, one more dilatation later.

 

Your comment, what's the difference between having a dilatation after a HM,

versus having just a dilatation, and then more if needed.  Clearly, with a

dilatation, you have it done, and you go right back to your business, with no

recovery time. Maybe you'll need more, rarely not. Surgeons and GI docs don't

seem to ever know ahead of time how long lasting either the dilatation or

surgery will be be. It appears, through the stories on this Board, that most

dilatations end up being repeated until they are no longer effective, while most

HM's last much longer and often a " corrective " dilatation when it has to be done

is far more long lasting.  I had half a dozen dilatations in the 1980's before

I had to have the HM since the last dilatation did nothing. From 1991 to 2006 I

had nothing done (I should have since I struggled for many years), and then in

2006 I had a dilatation and nothing since, with no decrease in functioning that

I am aware of.  So, I am

coming from the " school " that says " have the HM and if need be an (adjustment)

dilatation if needed. "

 

For Pat, going in and having to choose which direction to go, I repeat Notan's

sage advice that " there are no right answers, just good guesses. "

 

________________________________

From: bigbrillohead <imahockeymom@...>

achalasia

Sent: Monday, April 2, 2012 11:41 AM

Subject: Re: GI and surgeon are leaving treatment up to me

 

I had a dilation in late 1996 and then another in mid 1998.

No surgery.

I'm still going strong, and I'm currently a nursing student with a healthy 12yo

son.

One thing that has struck me is how many folks here who had a HM ended up having

a dilation afterward... why bother with the HM if you're going to get a dilation

anyway?

(I realize, too, that everyone's experience is different. Just relating what has

worked for my situation.)

Debbi in Michigan

aka " Pepto Deb "

[Guest guest]

We saw four big shot specialists, each at different major Boston teaching

hospitals—two gastroenterologists and two surgeons, the most experienced

achalasia docs we could find here. All four strongly recommended surgery over

dilatation.

We were very surprised to hear the GI docs say this. Each had done many

dilatations for achalasia over the years. They don't do them anymore, expect in

unusual cases such as people who are not good surgical risks.

These docs said that in the old days dilation and surgery were something of a

tossup, based on patient preference. But with the advent of minimally invasive

surgery, and perfection of HM technique, the balance shifted since there was no

comparable improvement in dilatation methods.

They all said the HM is more likely to be long-lasting, but the primary

consideration is the risk of perforating the esophagus during dilatation, which

is a blind and fairly violent procedure. The risk is small, but about half the

time emergency surgery is needed—open chest surgery with a big incision and

extended recovery. They considered this an unwarranted risk, small though it may

be, with laparoscopic HM available as an alternative with 90+% success rate in

experienced hands.

At least here in Boston, it seems that dilatation is considered obsolete for

primary achalasia treatment except in special cases. I know other docs have a

different point of view. But the risk of emergency chest surgery, open and quite

possibly without the chance to pick one's surgeon, decided it for us.

My SO is one month out from her HM, able to eat, and continuing to progress

slowly. She was able to start eating solid food one week out. We ate dinner out

last night. It felt surreal after all this time.

I will also say these are personal decisions and for someone else a different

choice might be right. If we did not think these four big shot docs made sense,

we would have gone the other way.

>

> Hello all,

>

> The GI and surgeon I've met with have treated hundreds of achalasia patients,

so I'm not concerned with their expertise. But they're leaving the choice up to

me as to what to do: HM or the dilation.

>

> The surgeon argues that the HM is durable or longer lasting. The GI agrees,

but also says the dilation option has been long lasting as well.

>

> The GI puts the success rate of the HM at 85% and the dilation at 80%.

>

> I honestly don't know what to do.

>

> The dilation, I have to admit, is appealing.

>

> Not having to stay in the hospital overnight and

get-it-over-with-as-soon-as-possible. I've had three endoscopies so far, so I

know what that's all about.

>

> But, after reading the numerous posts here, it seems, and correct me if I'm

wrong, that there's a consensus for the HM.

>

> Any thoughts appreciated. I'm going to make a decision soon because I really

need to get off my chocolate-soup-frozen yogurt diet. I'm a single guy living by

myself and the whole idea of putting chicken in a blender and making meal just

doesn't work for me.

>

> Thanks (this is a great a great group and I'm so happy I found it)

>

> Pat

>

[Guest guest]

Thanks everyone for the feedback. Obviously, some hard won wisdom here.

Here's an article I read that seems to give equal weight to both

approaches.

http://www.medpagetoday.com/Pulmonology/GeneralPulmonary/26467

Surgery, Balloon Dilation Yield Similar Achalasia Outcomes

By Bankhead, Staff Writer, MedPage Today

Published: May 13, 2011

Reviewed by Zalman S. Agus, MD; Emeritus Professor

University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN,

BC-ADM, CDE, Nurse Planner

Action Points

Point out that this study found that achalasia outcomes with laparoscopic

myotomy were not superior to those with pneumatic dilation and suggest that

graded dilation is a reasonable protocol for pneumatic dilation.

Note that there was a greater need for redilation in patients younger than

40 in the pneumatic-dilation group which may suggest that younger patients

should be treated preferentially with laporoscopic myotomy.

Laparoscopic surgery for achalasia achieved results similar to those of

pneumatic dilation after two years of follow-up, investigators in a

multinational European trial reported.

Both techniques achieved therapeutic success (Eckardt score ≤3) in about

90% of patients. Two years after intervention, patients treated with either

technique had similar esophageal sphincter pressure, esophageal emptying,

and quality of life, according to Guy E. Boeckxstaens, MD, PhD, of

University Hospital of Leuven in Belgium, and colleagues.

.....

http://www.medpagetoday.com/Pulmonology/GeneralPulmonary/26467

[Guest guest]

Hello Pat and Welcome to our group!

 

I also struggled with which route to take, the easy way seemed at first the

choice, but after strong consideration and finding a very great surgeon, I

decided to go with the HM and not just a bandaid approach.  The most important

thing is make sure your surgeon has excellant results with this surgery.  The

surgery is not a difficult thing in the hands of a good surgeon. 

 

My surgery was in 2010, before that, I suffered for 22yrs and never thought I

would see the day that I could swallow a meal with ease again.  The surgery was

an instant success, many are and some are not....it is a risk and I think the

surgeon has alot to do with it and the type of cut they make.  I eat very well

now, many days I completely forget that I even have achalasia...which for me is

like a miracle after suffering for so long.

 

You must think that you have a long life ahead,  several dilitations could

compromise a successful HM in the future.  Best of luck with your decision,

please keep us posted on your journey.

 

Julee in Oregon

________________________________

From: dcblogs administrator <dcblogs@...>

achalasia

Sent: Monday, April 2, 2012 12:48 PM

Subject: Re: GI and surgeon are leaving treatment up to me

 

Thanks everyone for the feedback. Obviously, some hard won wisdom here.

Here's an article I read that seems to give equal weight to both

approaches.

http://www.medpagetoday.com/Pulmonology/GeneralPulmonary/26467

Surgery, Balloon Dilation Yield Similar Achalasia Outcomes

By Bankhead, Staff Writer, MedPage Today

Published: May 13, 2011

Reviewed by Zalman S. Agus, MD; Emeritus Professor

University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN,

BC-ADM, CDE, Nurse Planner

Action Points

Point out that this study found that achalasia outcomes with laparoscopic

myotomy were not superior to those with pneumatic dilation and suggest that

graded dilation is a reasonable protocol for pneumatic dilation.

Note that there was a greater need for redilation in patients younger than

40 in the pneumatic-dilation group which may suggest that younger patients

should be treated preferentially with laporoscopic myotomy.

Laparoscopic surgery for achalasia achieved results similar to those of

pneumatic dilation after two years of follow-up, investigators in a

multinational European trial reported.

Both techniques achieved therapeutic success (Eckardt score ≤3) in about

90% of patients. Two years after intervention, patients treated with either

technique had similar esophageal sphincter pressure, esophageal emptying,

and quality of life, according to Guy E. Boeckxstaens, MD, PhD, of

University Hospital of Leuven in Belgium, and colleagues.

.....

http://www.medpagetoday.com/Pulmonology/GeneralPulmonary/26467

[Guest guest]

> The surgeon argues that the HM is durable or longer lasting. The GI

agrees, but also says the dilation option has been long lasting as well.

>

> The GI puts the success rate of the HM at 85% and the dilation at 80%.

Hi, Pat,

I had a pneumatic dilatation four years ago and continue to eat well.

The GI at University of Southern California used a 30 mm " balloon. "

Warm regards,

Love in San Diego

[Guest guest]

I bothered having the HM because I thought it was going to work!!

How was I supposed to know that I was going to be in the 10% where it didn't

work. That's why I had my dilation after...which by the way didn't work either!

>

> One thing that has struck me is how many folks here who had a HM ended up

having a dilation afterward... why bother with the HM if you're going to get a

dilation anyway?

>

>

> Debbi in Michigan

> aka " Pepto Deb "

>

[Guest guest]

Welcome Pat,

I am with you on chocolate-soup-yogurt diet. I can't bring myself to blend

chicken either.

Good luck with your choice.

I chose the HM because I believed it would work. I had it done in Nov last year

and had a dilation in late Feb. Neither has worked so for 7 months now I have

been on the choc-soup-yogurt (and Sustagen) diet!!

I know I am in the minority because most people get good results with either the

HM or dilation or both. I am just one of the unlucky ones where neither has

worked. Still not sure where that leaves me (and others) when the regular

treatments don't work.

(Australia)

> Any thoughts appreciated. I'm going to make a decision soon because I really

need to get off my chocolate-soup-frozen yogurt diet. I'm a single guy living by

myself and the whole idea of putting chicken in a blender and making meal just

doesn't work for me.

>

> Thanks (this is a great a great group and I'm so happy I found it)

>

> Pat

>

[Guest guest]

Hi, Pat ~~ No easy discussions here, lol! Initially, I was leaning the

direction you are. This is what changed my mind:

http://www.sages.org/publication/id/ACHALASIA/

" Varying definitions of success in the literature make analysis of the efficacy

of dilatation difficult. Post-dilatation, dysphagia-free rates (either single or

repeated) have been reported to range from 40?78% at 5 years to 12-58% at 15

years [29-31]. A single treatment with dilatation is adequate in only 13% of

patients followed over this time interval [31]. While some authors have reported

remission rates of up to 97% at 5 years and 93% at 10 years with on-demand

repeat dilations [32], it is generally accepted that long lasting treatment

effects cannot be expected from such therapy [33]. Younger patients (<40 years)

are less likely to achieve long-term clinical resolution than older patients [7,

33]. Other predictors of treatment failure with balloon dilation include the

presence of pulmonary symptoms and failed response to the first or second

initial dilations [29] [34, 35]. Some authors have recommended the routine use

of manometry before and after intervention, as high initial LES pressures (e.g.,

>15-30 mm Hg) or a reduction of LES pressure <50% after the first dilation have

been found to be predictors of poor outcomes [29, 35].

Complications of pneumatic esophageal dilatation include esophageal perforation,

intramural hematoma, and gastroesophageal reflux. The most feared complication,

esophageal perforation, occurred in 1.6% (range 0.67% ? 5.6%) of patients in a

meta-analysis of 1,065 patients treated by experienced physicians [3, 27]. After

balloon dilation, the damaged LES allows gastric contents to more easily reflux

into the esophagus, and up to 40% of patients develop chronic active or

ulcerating esophagitis after dilatation [32, 33, 36], though only 4% are

symptomatic [37].

Recommendation: Among nonoperative treatment techniques endoscopic dilation is

the most effective for dysphagia relief in patients with achalasia but is also

associated with the highest risk of complications. It should be considered in

selected patients who refuse surgery or are poor operative candidates (++++,

strong). "

Plus, though I'm in the actual cohort that Dilation should work for -- over 70,

and female, there was a question in my mind if I would *remain* eligible for

surgery if the dilation failed. AND, I have a friend whose boss used to get

dilations every couple of years, for decades. And then, as if by magic, they

stopped working: I truly didn't want to be 80, ineligible for surgery, and

unable to swallow.

Good luck with whatever you decide; keep us posted.

in the Wonderful Wilds of West Virginia

>

> Thanks everyone for the feedback. Obviously, some hard won wisdom here.

>

> Here's an article I read that seems to give equal weight to both

> approaches.

>

> http://www.medpagetoday.com/Pulmonology/GeneralPulmonary/26467

>

> Surgery, Balloon Dilation Yield Similar Achalasia Outcomes

> By Bankhead, Staff Writer, MedPage Today

> Published: May 13, 2011

>

> Reviewed by Zalman S. Agus, MD; Emeritus Professor

> University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN,

> BC-ADM, CDE, Nurse Planner

>

> Action Points

> Point out that this study found that achalasia outcomes with laparoscopic

> myotomy were not superior to those with pneumatic dilation and suggest that

> graded dilation is a reasonable protocol for pneumatic dilation.

> Note that there was a greater need for redilation in patients younger than

> 40 in the pneumatic-dilation group which may suggest that younger patients

> should be treated preferentially with laporoscopic myotomy.

> Laparoscopic surgery for achalasia achieved results similar to those of

> pneumatic dilation after two years of follow-up, investigators in a

> multinational European trial reported.

>

> Both techniques achieved therapeutic success (Eckardt score ≤3) in about

> 90% of patients. Two years after intervention, patients treated with either

> technique had similar esophageal sphincter pressure, esophageal emptying,

> and quality of life, according to Guy E. Boeckxstaens, MD, PhD, of

> University Hospital of Leuven in Belgium, and colleagues.

> ....

> http://www.medpagetoday.com/Pulmonology/GeneralPulmonary/26467

>

>

>

[Guest guest]

Hello and Pat,

I drink Ensure and naked juice - protein varieties - after the failed HM and

dilations. Those pureed chicken and choc-soup-yogurt concoctions sound horrible.

- when you say you're unsure what treatment is left, I'm certain the

surgeons will push for an esophagectomy, because that's the " final option " and

what surgeons do and like to do. I remember after my failed HM, an emergency

room physician and my GI basically said, " This is what you HAVE to do. "

I'm glad I didn't.

You have to ascertain what symptoms are most troubling. There are non-surgical

approaches that work.

for me - eating without discomfort and maintaining an appetite were of

paramount importance. When I started pain management, I could eat foods I had

trouble with prior - and starting gaining weight - to the point where I could

work, exercise, and -- well, live a life.no. Obviously, forcing food and fluids

down is always going to be present.

But I actually started to enjoy eating again, and even making a social event out

of eating out with others.

now- without pain management (thanks to the DEA's INTERVENTION IN MEDICINE and

WAR ON DOCTORS <sorry, but that's the sad truth chronic pain advocates have been

battling against for years>), I'm a walking corpse, and have the same problem

getting enough protein. Meat was especially difficult to get through, as I

always felt asphyxiated and pain getting those " boluses " down. Salads or other

voluminous foods were also very problematic. Worse I have NO appetite, and just

" force " myself to eat when it may be necessary. no enjoyment eating out. Not

enough nutrition. It's like just waiting to wither away.

Once you pinpoint what symptoms bother you, find a treatment that suits you, not

your surgeon.

Steve

- In achalasia , " lindsayaus " <lindsay_kite@...> wrote:

>

>

> Welcome Pat,

>

> I am with you on chocolate-soup-yogurt diet. I can't bring myself to blend

chicken either.

> Good luck with your choice.

> I chose the HM because I believed it would work. I had it done in Nov last

year and had a dilation in late Feb. Neither has worked so for 7 months now I

have been on the choc-soup-yogurt (and Sustagen) diet!!

> I know I am in the minority because most people get good results with either

the HM or dilation or both. I am just one of the unlucky ones where neither has

worked. Still not sure where that leaves me (and others) when the regular

treatments don't work.

>

>

> (Australia)

>

>

> > Any thoughts appreciated. I'm going to make a decision soon because I really

need to get off my chocolate-soup-frozen yogurt diet. I'm a single guy living by

myself and the whole idea of putting chicken in a blender and making meal just

doesn't work for me.

> >

> > Thanks (this is a great a great group and I'm so happy I found it)

> >

> > Pat

> >

>

[Guest guest]

Steve,

the choc/soup/yogurt is all eaten separately (not together as it sounds).

Like you, I also never have an appetite.

I have had no social life for 7 months now. The only socializing has been with

family for birthday gatherings and Christmas. I sat and drunk water while I

watched them drink and eat anything they wanted. That wears thin after a while.

I am also getting sick of having the same liquids and slop every day for months.

There has to be something better than this.

I have read lots about the esophagectomy and wondered if that might be an

option....but I thought it might have been many many years down the track. I am

hoping the second opinion I get on Thursday doesn't suggest this.

I have to say I am a little envious of others here who have the HM or one

dilation and it works for years!

I am also envious of all the newbies who still have the HM or dilation to pin

all their hopes on for a better life. I remember before my HM I was excited by

the prospect of being able to eat almost normally by the new year. Now it's

April and all my hopes are gone.

> >

> >

> > Welcome Pat,

> >

> > I am with you on chocolate-soup-yogurt diet. I can't bring myself to blend

chicken either.

> > Good luck with your choice.

> > I chose the HM because I believed it would work. I had it done in Nov last

year and had a dilation in late Feb. Neither has worked so for 7 months now I

have been on the choc-soup-yogurt (and Sustagen) diet!!

> > I know I am in the minority because most people get good results with either

the HM or dilation or both. I am just one of the unlucky ones where neither has

worked. Still not sure where that leaves me (and others) when the regular

treatments don't work.

> >

> >

> > (Australia)

> >

> >

> > > Any thoughts appreciated. I'm going to make a decision soon because I

really need to get off my chocolate-soup-frozen yogurt diet. I'm a single guy

living by myself and the whole idea of putting chicken in a blender and making

meal just doesn't work for me.

> > >

> > > Thanks (this is a great a great group and I'm so happy I found it)

> > >

> > > Pat

> > >

> >

>

[Guest guest]

Hi,

Seems like HM has recently been the number one method to treat Achalasia

specially in USA ... however i have a different point of view. I would probably

opt for the Dilatation first and see how it goes. I had a discussion with

medical specialist regarding this and he said better to try couple of

dilatations first to see the response and then decide if or when you need the

surgery. My brother has an Achalasia and his first dilatation worked for at

least 12-13 months and he had another dilatation 4 months ago and so far it has

been good. I am sure other members would be able to share their success rates of

dilatation/HM that would help you in this decision making. One has to decide

keeping all the factors, advantages, and disadvantages in his/her mind.

Personally speaking, i would like to avoid surgery if possible

Best of luck.

Regards

Hassaan

achalasia

From: dcblogs@...

Date: Mon, 2 Apr 2012 14:52:22 +0000

Subject: GI and surgeon are leaving treatment up to me

Hello all,

The GI and surgeon I've met with have treated hundreds of achalasia patients, so

I'm not concerned with their expertise. But they're leaving the choice up to me

as to what to do: HM or the dilation.

The surgeon argues that the HM is durable or longer lasting. The GI agrees, but

also says the dilation option has been long lasting as well.

The GI puts the success rate of the HM at 85% and the dilation at 80%.

I honestly don't know what to do.

The dilation, I have to admit, is appealing.

Not having to stay in the hospital overnight and

get-it-over-with-as-soon-as-possible. I've had three endoscopies so far, so I

know what that's all about.

But, after reading the numerous posts here, it seems, and correct me if I'm

wrong, that there's a consensus for the HM.

Any thoughts appreciated. I'm going to make a decision soon because I really

need to get off my chocolate-soup-frozen yogurt diet. I'm a single guy living by

myself and the whole idea of putting chicken in a blender and making meal just

doesn't work for me.

Thanks (this is a great a great group and I'm so happy I found it)

Pat

[Guest guest]

<Pat wrote:

<Both techniques achieved therapeutic success (Eckardt score ≤3) in about

<90% of patients. Two years after intervention, patients treated with either

<technique had similar esophageal sphincter pressure, esophageal emptying,

<and quality of life, according to Guy E. Boeckxstaens, MD, PhD, of

<University Hospital of Leuven in Belgium, and colleagues.

 

This is all fine, but there is a failure in it: THE OBSERVATION TIME IS ONLY 2

YEARS !!!!

As well they excluded patients, which had during the dilatation esphagesl tears

and had to be operated (before they started the gradiented Dilatation).

 

a

[Guest guest]

Debbi wrote:

>

> I had a dilation in late 1996 and then another in mid 1998.

>

I wonder if you have the oldest still working dilation in the group.

aka " Pepto Deb "

I don't see any pink. The handle doesn't seem right without the font.

notan

[Guest guest]

Steve wrote:

>

> ... now- without pain management (thanks to the DEA's INTERVENTION IN

> MEDICINE and WAR ON DOCTORS <sorry, but that's the sad truth chronic

> pain advocates have been battling against for years>) ...

>

Steve, do you know the source of your pain? Is it spasms, neuropathy,

esophagitis, or some other NCCP?

notan

[Guest guest]

wrote:

>

> ... Now it's April and all my hopes are gone.

>

I will keep hoping for you.

notan

[Guest guest]

Hello ,

Great article on the major complication of dilatations - perforation.

I wish I could expound on one of my surgeon's salacious sermons on the joys of

exploratory surgery to clean out the chest cavity after perforation occurs in

the LES or esophagus, but it's buried in my records.

Steve

> >

> > Thanks everyone for the feedback. Obviously, some hard won wisdom here.

> >

> > Here's an article I read that seems to give equal weight to both

> > approaches.

> >

> > http://www.medpagetoday.com/Pulmonology/GeneralPulmonary/26467

> >

> > Surgery, Balloon Dilation Yield Similar Achalasia Outcomes

> > By Bankhead, Staff Writer, MedPage Today

> > Published: May 13, 2011

> >

> > Reviewed by Zalman S. Agus, MD; Emeritus Professor

> > University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN,

> > BC-ADM, CDE, Nurse Planner

> >

> > Action Points

> > Point out that this study found that achalasia outcomes with laparoscopic

> > myotomy were not superior to those with pneumatic dilation and suggest that

> > graded dilation is a reasonable protocol for pneumatic dilation.

> > Note that there was a greater need for redilation in patients younger than

> > 40 in the pneumatic-dilation group which may suggest that younger patients

> > should be treated preferentially with laporoscopic myotomy.

> > Laparoscopic surgery for achalasia achieved results similar to those of

> > pneumatic dilation after two years of follow-up, investigators in a

> > multinational European trial reported.

> >

> > Both techniques achieved therapeutic success (Eckardt score ≤3) in about

> > 90% of patients. Two years after intervention, patients treated with either

> > technique had similar esophageal sphincter pressure, esophageal emptying,

> > and quality of life, according to Guy E. Boeckxstaens, MD, PhD, of

> > University Hospital of Leuven in Belgium, and colleagues.

> > ....

> > http://www.medpagetoday.com/Pulmonology/GeneralPulmonary/26467

> >

> >

> >

[Guest guest]

Hello a,

I agree. The 90% clinical therapeutic rate for HMs or dilations is misleading.

As stated in other posts, most doctors and surgeons don't understand what

constitutes success to the patients and their concerns. If practitioners

complete a procedure, it's a " success " for the medical team. Communicating the

aftermath HMs and dilations isn't always translated well into the clinical

measurements of success.

So many patients have variable responses to these procedures, or are forced into

more invasive treatments that make GIs busy, but not advance patient best

interests.

Steve

> <Both techniques achieved therapeutic success (Eckardt score ≤3) in about

> <90% of patients. Two years after intervention, patients treated with either

> <technique had similar esophageal sphincter pressure, esophageal emptying,

> <and quality of life, according to Guy E. Boeckxstaens, MD, PhD, of

> <University Hospital of Leuven in Belgium, and colleagues.

>  

> This is all fine, but there is a failure in it: THE OBSERVATION TIME IS ONLY 2

YEARS !!!!

> As well they excluded patients, which had during the dilatation esphagesl

tears and had to be operated (before they started the gradiented Dilatation).

>  

> a

>

>