Friday, February 3, 2012

Endoscopy Results: Tight But Not Too Tight

I must say I have mixed feelings about the results of my endoscopy on Wednesday. It was a little rough getting started, I was somewhat dehydrated (again - we seem to have a theme going on here), which made getting my IV started difficult. I now have a beautiful 4 inch long bruise down the underside of my left arm where one of my veins blew out while they were trying to thread the IV. The nurse anesthetist was the 3rd person to try, and she finally got it in the back of my right hand. Owie.

The anesthesiology team recommended, and I agreed, that general anesthesia would be a better option for me than the standard sedation; my issues of excessive burping and vomiting could have signaled that food was spending an inordinate amount of time in my "pouch". Should that have been the case, once all my muscles were relaxed with the sedation, it's possible that any trapped food could readily move up into my esophagus and be in danger of aspiration - something that would likely result in infection and a good week in the ICU. With a general anesthetic, the breathing tube would protect the airway. Sound reasoning to me.

Wake Forest Baptist Medical Center (WFBMC) is not only a world-class medical center, but a teaching hospital as well. One of the benefits of this is access to doctors doing cutting edge research on a huge gamut of diseases, conditions, and new techniques. Several of the GI doctors are working on a study of a new screening technique for upper GI issues - using a trans-nasal scope that can be done under light sedation in an office setting vs. the standard endoscopic procedure which needs to be done in a hospital/day surgery setting with much stronger sedation. I was asked if I would be willing to participate in their research study - the study doctor would use the trans-nasal scope to take a look and see if they could identify a stricture, ulcer, or other complications. The study doctor would record his findings for the study, but not relay them to the doctor performing the endoscopy - he would proceed as if the trans-nasal procedure had not been done. Afterward, they would compare notes to determine the efficacy of the new technique.

At first I was a bit hesitant to undergo a second procedure - but after discussing it with the study physician who indicated they had only had one complication, and it was slight abrasion just inside the nose, I agreed to participate. I have volunteered for a couple other studies at WFBMC in the past, but none that involved a procedure like this one. I think it's important that people do allow doctors to conduct this kind of research, as it can eventually benefit other patients and lead to lower health care costs - both Very Good Things! So off we went to the endoscopy suite - the anesthesiology team was awesome; I'd relayed my previous bad experience to them, and rather than using a mask over my mouth and nose he let me put my lips around the tube and breathe as if I was using a snorkel - it really helped ease my anxiety as they put me under.

Both procedures went well, they found that I did have a slight gastroenteric anastomotic stricture - a tightening of the gastrojejunostomy - the new connection between my stomach pouch and my intestines. It measured 9mm in size, where the ideal diameter is 11-15mm. So slightly constricted, but not hugely. The doctor chose not to attempt a dilation of it at this point (they would have used a balloon to stretch it), as I'm only 9 weeks post-op. They did also find a few staples that were working their way out and removed those, which could have been causing some occasional blockage as food passed by (which may have explained the inconsistent reaction I had to different foods). I'll admit to feeling a little ambivalent about them not doing a dilation - they don't want to make the opening too large, as you lose some of the benefit of the bypass procedure, but at the same time - even just an extra millimeter or two could make a difference in how I process food. But I'll trust in my team for now - they've been fantastic.

I did end up with an odd muscular reaction to the general anesthesia. I felt pretty good when we got home, but as bed time approached I started feeling very sore and stiff particularly in the smaller chest and side muscles that you don't use much unless you're coughing or stretching. I woke up Thursday morning feeling like I couldn't even move my neck - I spent about 5 minutes rolling my head from side to side, flexing my calves, and trying to roll to my side to sit up and get out of bed. Stiff and sore is an understatement, practically rigor!

I decided to take a second day off work. Although I do work from home, and didn't have to get dressed and go be sociable at an office, even the mildest twist of my torso was quite painful. The Man brought home some liquid tylenol for me, which eventually brought some relief. The good news, though, was that I successfully had a normal dinner last night: 2 ounces of beef tenderloin, a few bites of broccoli and a few bites of yukon gold potatoes and sauteed onions. Barely any burping and no vomiting! Hurray! Time will be the true test of whether I'll need additional follow up for the stricture, but I'm crossing my fingers I would need to go in for another procedure.

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