Achalasia & Vomiting

[Guest guest]

Hi,

I am new to this group, found it after doing a search on achalasia.

Before I ask my question I will tell alittle about my history with

achalasia.

I started having symptoms around the end of 2000, which involved

slight difficulty in swallowing food. At first I thought I had

something caught in my esophagus, so I went to see my doctor. He

could determine nothing, so he sent me to see a gastrologist, one of

the best in town. After he examined me, he diagnosed me with

esophagitus. After 3 failed attempts to open up my esophagus by

means of dilation, I gave up for awhile and lived with it some. But

it got worst to where I was vomiting at every meal, could not get

more than a few small bites down before I was off to the bathroom

and on my knees in pain. After 6 months of this I gave in and went

back. I explained to him that dilation wasnt working at all so he

finally came to the conclusion that he assumed I had achalasia.

After more test to confirm his theory, he sent me to a larpascopic

surgen in N.O. who was suppose to be the best in my area. I was

scheduled to see him on a Tuesday, but the Saturday before that I

ran into sever complications, nothing would go down at all except

small amounts of water at a time. Soup, soft foods, nothing else

would pass. So I went without eating (I lost 50 lbs in a matter of

weeks prior), Tuesday came along and I saw my doctor, Dr.

. After talking with him about it, he advised me that

surgery would be the best procedure concidering my age (Nov. 2001, I

was 27). The closest time he could schedule me was that Friday....so

I starved some more. After a few days tho, the hunger pains go away,

but I noticed my strength was failing.

Finally sugery day, hadnt eaten anything in almost a week, and drank

very little. During surgery they noticed I was severly dehydrated so

they had to give me 2 bags to get me back up to normal before they

could operate. I got a partial myotomy, and after surgery was hell

with a bout of acid reflux. Man did that hurt....

Recovery wasnt bad at all, was out of work for a few weeks, couldnt

pick up on anything heavy for a long while. And now I am happy to

say that I can eat just about anything I want, I just got to watch

the amount of acid I eat. I still get bouts of acid reflux that

hurts like I am having a heart attack or something. Water helps to

sooth the pain, and after taking some Zantac's, it goes

way....sometimes.

Now, my question is this....my little girl has a stomach virus with

vomiting. I am concerned that if I get this virus, will I be able to

vomit if needed? I have not been sick with a stomach virus yet since

I have had achalasia. How will this affect me and will I be able to

vomit?

Any help or replies of your own experience with this would be

greatly appreciated.

Thanks

Mike

[Guest guest]

Welcome to the group, Mike!

As for vomiting, I would think it would be EASIER since you've had the surgery than if you hadn't had it. In my case, in order for me to be able to truly vomit (meaning stomach contents coming up, not just regurgitating esophageal contents that never even made it past the LES to the stomach) I have to retch with extreme force to be able to get the stomach contents past the too-tight LES muscle. This means I end up bursting all the blood vessels in my eyes from the straining (all the white parts turn red... and over the next few weeks they fade and change every color of the rainbow (basically, it's bruising) until the white returns to normal), as well as blood vessels in my face -- cheeks, forehead, and all around the eyes (looks like splotchy freckles, which also do the funky color change on the way back to normal.)

Like suggested, I wonder if the pains you're attributing to heartburn are really acid reflux, or if they are what we refer to around here as "spasm pains" (I use quotes b/c often there aren't any actual muscle spasms going on, but the nerves FEEL like a muscle spasm -- sometimes, however, they really are "spasming" -- every person is different.)

Has your doctor given you a PPI medication (proton pump inhibitor) to take daily to reduce stomach acid? Does it help?

Does the pain go away if you take an antacid like Tums??

Do you actually have acid taste in your mouth every time you have these "heartburn" attacks?

Many of us have the spasm pains and they do feel like heart attacks many times. Some people get them in their back, or ribs, or breastbone/chest, or up the neck, or down one shoulder/arm like a heart attack, or even up into the tongue and roof of the mouth. These are NOT acid (how do you get acid in your arm or shoulder?) but are some sort of whacky nerve-related thing.

Drinking something hot or cold (try both, hot works for some, cold works for others) sometimes relieves them, and many of us have had luck with drugs such as Nifedipine, Nitroglycerine, and Nortryptaline. If what you're experiencing is really "spasm pains" rather than heartburn, there are several treatments you can try to alleviate them.

Welcome again to the group -- there is an incredible amount of information on the site. Be sure to check out the links, files, databases, and polls, as well as past posts. The search function on the message pages is very helpful, too.

Debbi in Michigan

PS -- I have to say "Go Yankees" too, even though I'm from Michigan, b/c Jeter is from my town and used to be shortstop for the local high school before he made it to the Big League. :oP

[Guest guest]

Hello, Mike.

Mike wrote:

>... will I be able to vomit if needed?

As had been point out already, you probably are more able to vomit now than

you were before surgery. Even if you can't that would probably not be the

end of the world. Most of the times I have had the heaves they have been

dry. It would be better to vomit and get it over quickly. A long spell of

dry heaves leaves me feeling sore, exhausted and with out relief. I have

found that I can sometimes drink water and force things through the other

end. I have never felt in danger, but if I thought I had some kind of

poison or something else that had to get out quickly I would call my doctor

or go to the ER.

I have not had the surgery, so I can't tell you how much better it is after

surgery. I wonder how many of those here that have had the surgery have

noticed a difference in the ability to vomit.

notan

[Guest guest]

Thanks for the warm welcome....

Well, from what you just described for your vomiting experience, I

hope I never have to go through that....sounds awful. But then

again, it might not be that bad for me...my doctor told me after my

surgery that I would not be able to vomit or even belch. Well I have

been able to belch just fine actually.

As for the acid reflux pains, the more I read about these spasms,

the more I think that's what is going on with me. I have no taste in

my mouth from it, and the pain seems to generate from my middle

section and goes to my right side of my ribs and through to my back.

Sometimes it shoots pain into my teeth and my bottom jaw. Usually

last for quite some time, water is a temporary relief for a few

seconds (maybe a minute) before it comes back again. Tap water (not

ice water) seems to work the best for me.

Last bout I had lasted for a few hours, I took 150mg of Zantac, 4

tums extra strength and drank 2 tbl spoons of Pepto, along with a

ton of water. The antacids didnt seem to help, went away on its own

after awhile.

Now sometimes I can take an antacid and it goes away almost

imediately, so I might have acid reflux and spasms....

I did talk to my doctor about this after surgery and he said it was

probably acid reflux, and told me to take zantac, that was over a

year ago.

Next time it comes about, I will pay closer attention and try some

new things, like maybe drink milk or eat a cracker, etc.

Thanks for your reply and help on this, well appreciated.

Mike

> Welcome to the group, Mike!

>

> As for vomiting, I would think it would be EASIER since you've had

the surgery than if you hadn't had it. In my case, in order for me

to be able to truly vomit (meaning stomach contents coming up, not

just regurgitating esophageal contents that never even made it past

the LES to the stomach) I have to retch with extreme force to be

able to get the stomach contents past the too-tight LES muscle.

This means I end up bursting all the blood vessels in my eyes from

the straining (all the white parts turn red... and over the next few

weeks they fade and change every color of the rainbow (basically,

it's bruising) until the white returns to normal), as well as blood

vessels in my face -- cheeks, forehead, and all around the eyes

(looks like splotchy freckles, which also do the funky color change

on the way back to normal.)

>

> Like suggested, I wonder if the pains you're attributing to

heartburn are really acid reflux, or if they are what we refer to

around here as " spasm pains " (I use quotes b/c often there aren't

any actual muscle spasms going on, but the nerves FEEL like a muscle

spasm -- sometimes, however, they really are " spasming " -- every

person is different.)

>

> Has your doctor given you a PPI medication (proton pump inhibitor)

to take daily to reduce stomach acid? Does it help?

>

> Does the pain go away if you take an antacid like Tums??

>

> Do you actually have acid taste in your mouth every time you have

these " heartburn " attacks?

>

> Many of us have the spasm pains and they do feel like heart

attacks many times. Some people get them in their back, or ribs, or

breastbone/chest, or up the neck, or down one shoulder/arm like a

heart attack, or even up into the tongue and roof of the mouth.

These are NOT acid (how do you get acid in your arm or shoulder?)

but are some sort of whacky nerve-related thing.

>

> Drinking something hot or cold (try both, hot works for some, cold

works for others) sometimes relieves them, and many of us have had

luck with drugs such as Nifedipine, Nitroglycerine, and

Nortryptaline. If what you're experiencing is really " spasm pains "

rather than heartburn, there are several treatments you can try to

alleviate them.

>

> Welcome again to the group -- there is an incredible amount of

information on the site. Be sure to check out the links, files,

databases, and polls, as well as past posts. The search function on

the message pages is very helpful, too.

>

> Debbi in Michigan

>

> PS -- I have to say " Go Yankees " too, even though I'm from

Michigan, b/c Jeter is from my town and used to be shortstop

for the local high school before he made it to the Big League. :oP

[Guest guest]

Mike -- one thing I wanted to clarify is that I have NOT had surgery... that's why my vomiting has to be so forceful. In your case, your LES is "always open" so even if you had a "wrap" done to reduce acid reflux (technical name is fundoplication, and there are a few different names for different types of fundoplication, such as Dor, Toupet, Nissen), your LES itself is still always open, so I would tend to think that you WOULD be able to vomit. There are several here who have had successful surgeries, and I'm sure they'll chime in with their post-surgical experience with vomiting. I just wanted to make sure you understood that I had NOT had the surgery, and that's why my own vomiting experience is so extreme. )

As for the "spasm pains" there are several things to try. You've already found that water helps sometimes. Like you, I can't do cold -- that makes it worse (although it does help others) -- what works even better for me than tap water is warm tap water (but not hot like coffee). Depending on the setting of your water heater, most residential settings if you just run the hot water until it's good and hot, it's warm to drink but not scalding hot like freshly brewed coffee. For my minor spasm pains, or if I can catch them when they just start before they peak, the "warm but not hot" water will often do the trick for me.

It could very well be that you have acid reflux that triggers a spasm pain, or that you have spasm pains sometimes and acid reflux other times, or it could be that the act of swallowing the antacid (rather than the antacid itself) stops the pain. It's hard to tell, because for some reason doctors are concentrating their research and treatments JUST on our swallowing, without paying attention to the fact that for some of us, the "spasm pains" or NCCP's (non-cardiac chest pains) can be just as debilitating. Fortunately there are a few doctors out there who are looking into it, or who are willing to let us "experiment" on ourselves to try to find something that helps stop or prevent the pains.

Again, nobody knows for sure, but since our achalasia is caused by damaged nerves, I tend to think that the NCCP's are caused by damaged nerves as well. A couple weeks ago (you can find it in the old messages on the site) I did some preliminary research on Phantom Limb Pain (PLP), which is when amputees can feel pain (and other sensations, like hot/cold, touch, tingles, etc) in the limb that has been amputated. This is believed to be caused by damage to the nerves, and they've had some success in treating people with certain anti-depressant and anti-convulsant medications. I believe that treating achalasia-related NCCP with these medications is a pretty new idea -- I haven't been able to find much information on it besides anecdotal information offered by members here based on their experiences. However, the use of these meds in relation to treating PLP and other "nerve pain" conditions has been around for a while. These types of meds are taken on a daily basis as a preventive.

Others in the group, myself included, have had luck using Nifedipine (a calcium channel blocker originally used to treat high blood pressure) or Nitroglycerin. These drugs relax smooth muscle tissue -- arteries are made of smooth muscle, so when they relax the blood pressure drops. Well, the esophagus is ALSO smooth muscle. Relax the smooth muscle, relax the spasm. ) My nifedipine (one brand name is Procardia) comes as a liquid in a gel-capsule. When I get a spasm that won't resolve with my warm water, then I poke the end of the capsule with a steak knife and squirt it under my tongue. I hold it there as long as I can (doesn't taste bad... tastes kinda minty) and then I swallow it when I have too much saliva to hold back any longer. It absorbs under the tongue (this is called "sublingual" medication) and also through the stomach.

Still others in the group have had success using Levsin (generic name: Hyoscyamine sulfate), which also is available as a sublingual tablet (NuLev) for fast-absorption. Levsin is an antispasmodic medication, often used to treat things like irritable bowel syndrome and overactive bladder spasms, etc.

I suggest reading as much as you can about these (there's a LOT of info in the archived messages here!) and print out any posts that you want to discuss with your doctor. You can also research the individual drug names on the internet, although in each and every case, treatment of NCCP in achalasia patients is an "off book" (non-approved) use of the medication. That's not to say that it won't work (the members here are proof of that!) but just that the manufacturer hasn't done any clinical trials and gotten FDA approval for that particular use of the drug -- there are so few achalasians around that there's no financial payoff for them to spend the money to get FDA approval.

In my case, I don't discuss my spasm pains with my GI specialist (for starters, he's in another state! LOL) -- I've found my regular family doctor is more than willing to let me "play around" with different medications to find one that works for me, and he's most familiar with my whole medical history (beyond just my esophagus) and so would be more inclined to catch a potential drug interaction, for example.

Feel free to ask any questions -- hopefully someone here can give you some first-hand information on the vomiting after a myotomy perspective, since there are so many members here who had surgery successfully. And if you have any more questions about spasm pains/NCCP's, feel free to post them and get some other perspectives!Debbi in Michigan

[Guest guest]

Mike

I too after my surgery can't vomit..let me tell you I learned really quick not to ingest to much of anything. LOL. I can however burp...but not all that I want sometimes..So i take GasX chewables. They seem to work well for me.

In Indiana

[Guest guest]

Hi again Mike! I'm glad the info was helpful to you, and I'm glad I cleared up the fact that I hadn't had surgery -- sorry I didn't mention that in the first place! I see that some people here who have had surgery have responded since.... looks like it's just "one of those things" that works for some and doesn't for others. Hopefully your ability to belch will also mean that you'll be able to vomit should the need arise.

Okay, you KNOW you're in a weird group of people when people are HOPING you can puke! ) Oh well, if you can't laugh at our weird situation, what can you laugh at?

I'm glad to hear your NCCP's are only every few weeks. Some members here have to deal with them on a daily basis -- as you can imagine, that makes it hard to just go on with everyday life! Even though it's only every few weeks, in my opinion that's still too often (meaning that it's a shame that ANYone has to deal with them for ANY period of time), and hopefully your doctor will be willing to help you find a way to treat them.

I'm curious (and maybe you said in your post and I've forgotten) but was it the surgeon, the gastroenterologist, or your regular "family doctor" that told you it was acid reflux? If it was the GI doc, he needs a good lashing with a wet noodle -- these NCCP's are quite common among achalasia patients! If it was the surgeon or the family doctor, I could "kind of" see where they would assume that the NCCP's were heartburn rather than "spasm pains" simply because they probably don't know much about achalasia in general (which doesn't absolve them from needing to educate themselves on the subject when they are presented with a patient who has achalasia!)

You mention hoping that we can all help future achalasia patients -- I feel like I'm helping to "do my part" by educating my own doctors along the way. Since being diagnosed, I've had three different "family doctors" (the first retired, so I switched to one of his partners [who was nice enough but is just about to retire himself], so I finally went to another partner who is in his 30's) and even though I don't see them for my achalasia per se, I've always shared my achalasia with them, and I got my Nifedipine through them. My current doc is more than willing to let me try Nortryptaline as a preventative (my spasms have been increasing in frequency the past year, and when they get to the point that I don't feel like dealing with them anymore, I'll go for the daily preventative) and I'm also thinking about trying Levsin to treat spasms as they occur. If by sharing my experiences with these doctors along the way means that someone else one day gets better treatment faster, all the better! )

As for stress, many of us have noticed a correlation between stress and symptoms. My swallowing is impaired if I'm trying to rush through a meal, or if I'm trying to eat while working (phones, computer work, bosses' demands, etc.) I'm also more likely to experience the NCCP's if I'm going through a stressful time (although I've also gotten them during times of relaxation.) There's nothing yet to show that stress CAUSES achalasia, however I think most people here would agree that it certainly exacerbates the symptoms in many cases.

Debbi in Michigan

[Guest guest]

Joyce, Phenergan is only available by prescription, but your doctor

may be willing to give you some to keep on hand, " just in case " if

you're worried about it.

I was given Phenergan when I was in the hospital with an intestinal

virus during my ninth month of pregnancy, and I've also been given it

when I had a particularly nasty case of bronchitis -- it basically

knocked me out so much I didn't even cough! )

In cases where you suspect true poisoning, etc., I would go to the ER

and have my stomach pumped, as notan mentioned earlier. But in cases

of a regular old intestinal virus, it's really not crucial that you

vomit. A call to your doctor's office if you're in doubt would be in

order, and they can direct you to either wait it out or go to the ER

for a stomach pumping.

Debbi

[Guest guest]

some places you have to special order it and its like 14.00 for an 8 oz bottle

[Guest guest]

Mike

You can get it at your local pharmacy and you drink it...I've heard its really

nasty stuff...but it is what they give you if you go to the hospital from

ingesting something bad for you...I'm allergic to a lot of drugs this is why

they though it would be a good idea..but i like going and getting something that

goes in my vein instead..

In Indiana

[Guest guest]

Mike,

Activated charcoal is only use in poisonings and only when certain toxins

are ingested. It is has a risk of aspiration and should only be administered in

certain circumstances. It absorbs toxins and allows you to pass them. I can't imagine how it would be used in other ways. It was once advised that you have it at

home if your kid was to ingest poison but now they recommend syrup of ipecac.

How it could be beneficial to a person with achalasia is beyond me. I would

definitely check out the information you have received before ever doing anything

with charcoal other then using it in a bar-becue.

Bobbie

[Guest guest]

--I had my surgery August 7th 2003 and no one said I wouldnt be able

to vomit. I asked. I have vomited and Im happy to say, its just

like it always was! I do feel more pressure in my face but nothing

else. Maybe it will take longer but it does happen for me....so far

anyway....I will let you know the next time I get the urge ...that

would be awful!!!! To not be able too. Cathey -

In achalasia , " joychasfaith " <joychasfaith@y...>

wrote:

> I haven't been reading the posts here for a couple months, but when

> I do peek in, there seems to always be some new info to pick up.

> Prior to and since my surgery not one doctor mentioned that I might

> NOT be able to vomit after surgery. So this is news to me. Here I

> was all excited that I haven't regergitated...I only hick-up and

> belch now, to releave that stuck feeling. That may very well be

> because they slice the lower " E " (which is separate from the

> sphincter slice), this disabled any lower " E " movement. I guess

> this is good and not so good, if you really need to vomit (i.e.

> flu/food poisoning).

>

> What is Phenergen? Is this an " over the counter " sleeping pill?

> What else could one take to stop the heaves - that wouldn't knock

> you out? I should have something in my cupboard - just in case I

> ever need it.

>

> Joyce - WI

>

>

> > Mike

> > Unfortunatly I dry heave...its dreadful...so i keep phenergen

> on hand to

> > take if i start that. It puts me to sleep but at least the heaves

> stop LOL.

> > In Indiana

[Guest guest]

Mike wrote: I was thinking it was real charcoal, like what you use to BBQ with...

Wouldn't that be a tasty treat -- put some cheese spread on it and eat it like a cracker? LOL

I will look for some next time I am at the pharmacy....

Just so you know, you should only take activated charcoal on the advice of a physician. It's used to absorb/neutralize ingested poisons that can't or shouldn't be vomited up (like if a child eats Drano, they don't want the child to vomit because the Drano is caustic and could cause more problems coming up.)

If a doctor (who may be unaware of what your achalasia and myotomy are all about) ever tells you to take Syrup of Ipecac because you can't vomit, DON'T do it until you know the doc understands your predicament -- Syrup of Ipecac induces vomiting, but if you're already trying to vomit and can't, then the heaves will be that much worse after taking the Ipecac! (

Debbi

[Guest guest]

Cathey wrote:

>--I had my surgery August 7th 2003 and no one said I wouldnt be able

>to vomit. I asked. I have vomited and Im happy to say, its just

>like it always was! ...

This is interesting. Did you have the wrap, a partial wrap or no wrap. If

this is a wrap issue it may be one more thing to consider when deciding on

a wrap. Personally, I would be more concerned with acid reflux versus

creating another esophageal restriction, but it could be a factor in the

decision.

notan

[Guest guest]

I had a partial wrap and I am able to vomit. I don't know why some people can

and some can't. It will be two years post myotemy for me in December, and I am

doing great. I hope that you have great success with your surgery, Paige.

in Houston

> >--I had my surgery August 7th 2003 and no one said I wouldnt be able

> >to vomit. I asked. I have vomited and Im happy to say, its just

> >like it always was! ...

>

> This is interesting. Did you have the wrap, a partial wrap or no wrap. If

> this is a wrap issue it may be one more thing to consider when deciding on

> a wrap. Personally, I would be more concerned with acid reflux versus

> creating another esophageal restriction, but it could be a factor in the

> decision.

>

> notan

[Guest guest]

I had a partial wrap and I am able to vomit. I don't know why some people can

and some can't. It will be two years post myotemy for me in December, and I am

doing great. I hope that you have great success with your surgery, Paige.

in Houston

> >--I had my surgery August 7th 2003 and no one said I wouldnt be able

> >to vomit. I asked. I have vomited and Im happy to say, its just

> >like it always was! ...

>

> This is interesting. Did you have the wrap, a partial wrap or no wrap. If

> this is a wrap issue it may be one more thing to consider when deciding on

> a wrap. Personally, I would be more concerned with acid reflux versus

> creating another esophageal restriction, but it could be a factor in the

> decision.

>

> notan

[Guest guest]

I had a partial wrap and I am able to vomit. I don't know why some people can

and some can't. It will be two years post myotemy for me in December, and I am

doing great. I hope that you have great success with your surgery, Paige.

in Houston

> >--I had my surgery August 7th 2003 and no one said I wouldnt be able

> >to vomit. I asked. I have vomited and Im happy to say, its just

> >like it always was! ...

>

> This is interesting. Did you have the wrap, a partial wrap or no wrap. If

> this is a wrap issue it may be one more thing to consider when deciding on

> a wrap. Personally, I would be more concerned with acid reflux versus

> creating another esophageal restriction, but it could be a factor in the

> decision.

>

> notan

[Guest guest]

---My Doctor said that they wrapped part of my stomach around the

esophgas, because I had perforated and had a very thin spot that he

was worried about. (The perforation was during my first dialation

years ago.)

Cathey In

achalasia , notan_ostrich <hastings@d...> wrote:

> Cathey wrote:

> >--I had my surgery August 7th 2003 and no one said I wouldnt be

able

> >to vomit. I asked. I have vomited and Im happy to say, its just

> >like it always was! ...

>

> This is interesting. Did you have the wrap, a partial wrap or no

wrap. If

> this is a wrap issue it may be one more thing to consider when

deciding on

> a wrap. Personally, I would be more concerned with acid reflux

versus

> creating another esophageal restriction, but it could be a factor

in the

> decision.

>

> notan

[Guest guest]

Guidry wrote:

>...no reason why I needed to go back unless I had complications. Well I am

>a bit worried about the cancer part myself, so how often should I get

>checked out? Once a year, bi-yearly, or what?

Hello, Mike.

Doctors disagree on the value of cancer screening. Some believe it should

be done often. Others, don't do it unless they suspect it is there or do it

while looking for something else. The reason is that the value of screening

has not been determined. It could be that of the people screened just as

many will get and die from cancer as would have without it, or they would

save so few that it does not justify putting all the rest through the pain,

expense and fear, and the use of medical tools, space and personnel. A lot

of people would want to have their insurance cover it, which may be hard

for some until the benefit is proven. It seems like it would be common

sense to have a check once in a while, but common sense is often wrong in

medicine.

The following is from a 1995 article.

http://jama.ama-assn.org/cgi/content/abstract/274/17/1359

The risk of esophageal cancer in patients with achalasia. A

population-based study

" Annual surveillance after the first year would require 406 endoscopic

examinations in men and 2220 in women to detect one cancer.

CONCLUSIONS--Patients with achalasia are at markedly increased risk of

developing esophageal cancer. A substantial number of surveillance

examinations might be required to screen for cancers, especially in women.

It is not known whether surveillance will result in improved survival. "

notan