Sunday, November 11, 2018

Pipe Cleaner

Seeing as I'm writing this entry and Jamie isn't, it probably goes without saying that I did not die on the table (though I also wouldn't put it past me to haunt this blog from The Great Beyond). As much as you'd probably expect brain surgery to cause me more agita than an endoscopy, I was actually pretty nervous about "the procedure," in part because it was painted as fairly minor. I heard quite a few stories from people who'd had it done, and not a one was a tale of horror. But leave it to me to complicate something mundane. While the gastroenterology nurse practitioner specifically referred me to a hospital where a more potent out-patient anesthesia (Propofol) could be administered than the sedative they provide in the office, there was always a lingering concern that I'd have a seizure or ill-timed spasm with a camera down my throat. I was comforted some by the fact that I'd undergone general anesthesia for my cranioplasty after the stroke, without incident, and that I haven't had a conscious seizure since 2012. Nevertheless, I wasn't fully certain I'd be unconscious until the anesthesiologist confirmed it the morning of. Some people had told me they'd been in "twilight sleep," and I was pretty eager not to be aware of anything happening. As it turned out, I remember quite a bit, but nothing of the procedure itself. First, I talked to the doctor, who said the nicest thing while filling in the rest of the crew about my case. He said I was a 48-year-old man who'd had a hemorrhagic stroke and was currently suffering from dysphagia but would generally be considered a, "low-risk patient." Seriously, that's the kindest description a medical professional has given of me in years.

Once I was wheeled to the endoscopy suite (fancy, I know), the anesthesia nurse, Jay, put a menthol-coated swab on my tongue, to numb my throat, I mumbled something like, "You're gonna give me more than that, right?", and he re-assured me as they placed a green plastic bite guard in my mouth (see below). I was pleased it wasn't some kind of jack designed to pry my mouth open, because I remember how sore I was after having my Wisdom Teeth removed.
Image result for endoscopy bite guard
Bite down, insert camera through hole
Then Jay said something about starting the anesthesia, and I was being wheeled back to the recovery room. While I don't remember dreaming, I know as I started to wake, I was repeatedly tapping my right index finger against the blanket, because I thought I'd been told to answer a question and was trying to click on my response. I can't tell you what the question and answer were, but it was very important at the time. For Science! 

The fog cleared quickly, I checked that everything that should work was (five fingers, five toes, two arms, two legs, one mouth). Soon the doctor came in to reassure me, Jamie, and my parents that he hadn't found any masses or cancer but had experienced some spasming and "resistance" at the GE junction (lower esophagus connecting to the stomach) and dilated it with a 60fr Maloney dilator  (kind of a balloon in a tube, see below), "raising the possibility of achalasia." That's the only hint of any of this being neurological and/or stroke related. I may be going back in for a motility test, but that depends on how well the dilation holds. So far, it's been quite miraculous, as I've been able to eat fairly normally and feel food in my belly for the first time in months. For the sake of my BMI, I just have to try to keep my portions down, exercise, and hopefully lose a little more weight. Though I don't have a lot of faith in the reasonability of the BMI, as it says I still need to lose another 20-25 pounds.

Much to my chagrin, there was no video of the procedure, but I have inserted some scanned images below to  demonstrate why I couldn't eat before and why I can now simply unhinge my jaw and slide in an eclair (not that I would ever do such a thing). 
ConMed Esophageal Balloon Dilators
Esophageal dilator

Diagram of the upper digestive tract
On the trip in

On the return trip, after dilation