Re: botox or surgery? what to do? (WARNING -- VERY LONG RESPONSE)

[Guest guest]

Hi Genia! I've been wondering how you've been doing, how your insurance was working out, etc!I'm swamped at work this week, so I can't write up a big long personalized reply right now, but I didn't want to ignore your request, either, so I searched on some relevant info from this group that may help you. I don't have ALL the posts listed here, of course, but you can go back in the archives and read the posts just a few days before/after the ones I've listed here to get an idea what other people had to say, too. These are just some of the messages and links I was able to find quickly.

My own personal choice, as you'll see when you read the old posts below, is to skip all the "temporary" stuff and just get the surgery. I wish I'd been better informed when I started the whole process!

I hope this helps-- lemme know if you have any more questions after reading all this stuff!http://www.medscape.com/viewarticle/407968

BoTox or NoTox - Which Therapy Is Best for Patients With Achalasia ?

(have to register w/ medscape to read the article, but registration is free)

Caution: perforation from dilatation

I had a baloon dilatation about five years ago but after about 31/2 years my symptoms returned and my gastroenterologist recommend it be done again. While the risk of perforation was mentioned in passing I had no idea of the severity of its consequences. A perforation of my esophagus did occur with near fatal results. I was in ICU for six days and was hospitalized for 45 days. The repair of the perforation by an excellent thoracic surgeon required a major open site surgery. While at the site he also performed a Heller Myotomy and since recovering from that nightmare at least all of my symptoms (burping, etc)have gone (and Prilosec has gone OTC, which saves megabucks as I am now on medicare). The GI doc did give me an article before the dilatation which was positively misleading (Vaezi and Richter, "Diagnosis and Management of Achalasia", AGJ, 12/99)This article discusses 3 therapies: Botox injection, balloon dilatation and minimal incision surgery (Heller Myotomy). The article leads one to believe (if one discards the rather ineffective Botox) there is a "Plan A/ Plan B" choice, with "A" being dilatation and "B" being surgery. This is what I gathered from the consultation and the article. NOT TRUE. If the balloon procedure fails because of a perforation of the esophagus, MINIMAL INCISION SURGERY IS NOT THE ANSWER. Instead of the 2-3 days M.I.S. might require, repairing the perforation (which is life threatening) requires major open thoracic surgery. If you're considering a dilatation, even if you have "successfully" experienced one before, give minimal incision Heller Myotomy serious consideration.

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