Re: Monomitry test

[Guest guest]

Here are a couple of posts I've written about my own manometry

experiences. After having typed this info up a few times for different

people who asked about the procedure, I saved these two emails so I could

just copy/paste it w/o having to take the time to type it all up again.

(Shortcut Suzy is my nickname at the office!)

I hope this helps you some -- let me know if you have any questions!

Debbi in Michigan

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I found this post I wrote a month or so ago. Some background: I've

probably had the esophageal manometry procedure done 5-7 times in the past

ten years. The first one was done by a GI doc himself during the same

session when he did endoscopy, so I was SEVERELY sedated and mostly

unconscious (I remembered two things from the manometry, and just 5-second

bits of those two things -- him putting a tube in my nose and him telling

me to take a drink). You are NOT supposed to be unconscious for this test

-- he just was a quack of a doctor. The next 3-5 or so times the test was

done at the University of Michigan. This was before they had their

computerized equipment (the machine looked like a seismograph or polygraph

machine, with a roll of paper that was continuously fed under three pens,

which squiggled when my esophagus contracted), and the probe was larger,

so they put it through my mouth when they couldn't get it through my nose.

The last two times I had manometry done (once at U of M, once at TCC) it

was using the new, computerized machines with the smaller probe, and both

times they were able to get it through my nose with very little

difficulty. The only differences between these two were the

administration technique for the anesthetic in my nose and the position of

my body.

The UM technician used a long cotton swab to gradually introduce more and

more anesthetic gel to my nostril (see description below), while at TCC

the nurse had me take " hits " or " snorts " of a combination

anesthetic/decongestant gel. She had it in a special syringe, and she put

the tip in my nostril and squirted in a bit and had me sniff it in as much

as possible, then we waited 60 seconds or so for it to take effect, then

we did it again. I think I probably took 3-4 hits off it altogether (it

was great, b/c I had a cold that day and the decongestant cleared one side

of my head so I could breathe again! I meant to ask if I could have a few

hits of it when we were done for the other nostril!), and each time it

numbed more and more -- we stopped doing sniffs of it when my sniffing

brought it all the way to the back of my nose and I could feel/taste the

stuff dripping in my throat. (note for those who hate the " nasty tasting

spray " -- when using the sniffer method, they don't use the spray AT

ALL!!!!)

At U of M, they have a chair that kinda reminds me of an Electric Chair

for the death penalty! It has arms and a headrest and it's elevated so

the technician when standing is at the right height for pulling/pushing

the tube and giving you drinks. At TCC, they had just an exam table that

was propped up on one side so my body was at about a 30-degree angle, and

I was lying on my side.

Here's my post from about 6 weeks ago:

------------------------------------------------------------

My joke about booze in the bottle aside, I really DON'T think the

manometry is all that bad. I think the skill level of the technician

makes a world of difference in your comfort level and the quality of the

test results.

For people who find the " going through the nostril " just too

uncomfortable, ask if it's at all possible for them to go through your

mouth (the run the tube along your cheek, between the teeth and the inner

cheek, and then down behind your last molars and into your throat). Also

as if they have the " new " probes or the " old " ones. Five years ago, the

Univ. of Michigan clinic only had the older probe, which is bigger and

less flexible. They weren't able to get that one through my nostril (I

have a deviated septum and sinus problems, etc). When I was there a year

ago, they had a newer probe that was smaller and more flexible, and with

patience they were able to get that one in through my nose. Make sure

they use LOTS of the lidocaine gel and only take it one step at a time. I

don't know if everyone does it this way, but this is my experience with

going through the nose:

Swab gel into front of the nostril with the biggest Q-tip you've ever

seen; wait a few seconds (30? 60? 90?) for that to numb up.

Push the swab with gel a bit further into the nostril.... moan a little

when it gets uncomfortable and the tech will stop, twirl the swab to coat

the entire area with lidocaine, and wait for the numbing to happen.

Push the swab with gel a bit further into the nostril.... moan a little

when it gets uncomfortable and the tech will stop, twirl the swab to coat

the entire area with lidocaine, and wait for the numbing to happen.

Push the swab with gel a bit further into the nostril.... moan a little

when it gets uncomfortable and the tech will stop, twirl the swab to coat

the entire area with lidocaine, and wait for the numbing to happen.

Push the swab with gel a bit further into the nostril.... moan a little

when it gets uncomfortable and the tech will stop, twirl the swab to coat

the entire area with lidocaine, and wait for the numbing to happen.

Then when the tech has reached all the way back through the nostril, he

slowly removes it, twirling it a bit for kind of an " unscrewing a

lightbulb " effect and to further spread around the lidocaine gel.

At that point, the entire pathway is numbed up and the probe can be slowly

inserted without much discomfort.

The main thing I've found with the manometry is that you HAVE to

communicate with the tech -- each person's nose is constructed a bit

differently, and he has no way of knowing exactly what he can and cannot

do in your nose unless you tell him. Work out a code before you start so

he knows to stop when you moan, etc. Same for during the procedure itself

-- if you have a burp or a gurgle, tell him so he can mark it on the chart

(b/c it will show up on the manometry readout). If you're to the point

that you simply cannot take in any more water, let him know -- they do NOT

want to torture you! But they don't know you need to take a break or that

you need to gurge before you can take in any more water unless you tell

them.

If you've had a manometry test before and considered it a fate worse than

death, ask to have a different tech do it the next time, or at a different

hospital/clinic. My WORST experience was when the GI himself performed it

(of course, he was a quack -- told me it was all in my head, etc). My

BEST experiences have been when " just a technician " did it -- they get

paid the same whether it takes them one hour or four, so they have no

reason to rush you through it. Also, if you have the Bernstein done

afterwards, the tech gets to just sit around and chat with you for 45

minutes (you can't talk during manometry b/c it shows up on the readout,

but you CAN talk (or just read a book) during the Bernstein.) B/c the

techs have that " face to face " time with the patients, I think they have a

better understanding of what we feel, emotionally and physically, and so

they tend to be more compassionate.

------------------------------------------------------------

During the procedure, they will identify the depth at which your LES lies

by slowly pulling the tube up and down and monitoring the pressures they

get at different positions. When they push the tube back down, you'll

need to swallow to try to help it go down again (I know, it doesn't help

much when we're aperistaltic, but every little bit helps!)

Once they have the LES identified and the probe in the right position,

they'll give you tiny sips of water at specific times, wait to see what

happens on the monitor/readout, then pull it up a centimeter and give you

another sip, etc. This is the most time-consuming part of the test, b/c

they have to wait in between each swallow before they can move the probe a

cm and do another swallow. Sometimes the esophagus is feeling REALLY

frisky and just keeps doing a boogie-dance for a minute or so, and they

don't like to move the probe again until the esophagus has finished the

boogie-dance and settled down again.

You should try not to swallow or talk unless they ask you to, and if at

any time during the procedure you swallow accidentally, just say " swallow "

and they'll mark it on the readout as such. I do the same when I have a

" gurgle/burp " -- just say " burp " so they know what the funny reading was

caused by.

When they have their measurements for the length of the esophagus, they

pull out the probe and give you a tissue to blow your nose and you're on

your way! Honestly, with my last one, since I had a cold and they had

used a decongestant along with the anesthetic gel, I felt better AFTER the

procedure than I did before! )

I hope this helps, and if you have any questions about any of this, feel

free to ask me anything!

Debbi in Michigan

> My nurse at the UCLA Harbor hospital stated the she might not be

> able to get anaesthesia for the procedure if this is so how painful

> is the procedure? Any information will be helpful. My test is next

> tuesday.

>

> Ramon

[Guest guest]

Ramon,

I'm just now getting to my email, so you've undoubtedly already gotten many responses to your question, already. The manometry test isn't painful, but I would characterize it more as very uncomfortable. You should not be under anesthesia for the test. It involves the insertion of a tiny catheter type tubing with electronic probe attached to the end of the tubing.

It goes "usually," into your nose, down into your esophagus, and they usually insert it all the way down into your stomach and back up to the LES. You are given a series of small dropperfulls of water to swallow, as they ask you to, at which point the probe sends messages to the computer. It is able to graph the pressure inside the LES and the peristaltic activity of your esophagus.

Like I said above, it really is not "painful". It is however uncomfortable, but the people who administer the test are usually really trying to make you as comfortable as is possible.

Jan in Northern KY

[Guest guest]

Ramon,

My biggest problem with the monometry was a hyper-responsive gag

reflex. All I did was hold my hand up, they gave me a second and a

sip of water, and down it slid. I also have had both the new and

old tubes.... YOU WANT THE NEW TUBES! Like previously said, the new

ones are much smaller, and go down easier. Just remember, if the

tube hurts going down, tell them. They don't know if you suffer in

silence. If it hurts you can always get more of that wonderful,

yummy, gooey gel squirted up your nose *grin*

[Guest guest]

Thanks

Ramon

On Fri, 26 Mar 2004 18:39:44 EST JMB000001@... writes:

Ramon,

I'm just now getting to my email, so you've undoubtedly already gotten many responses to your question, already. The manometry test isn't painful, but I would characterize it more as very uncomfortable. You should not be under anesthesia for the test. It involves the insertion of a tiny catheter type tubing with electronic probe attached to the end of the tubing.

It goes "usually," into your nose, down into your esophagus, and they usually insert it all the way down into your stomach and back up to the LES. You are given a series of small dropperfulls of water to swallow, as they ask you to, at which point the probe sends messages to the computer. It is able to graph the pressure inside the LES and the peristaltic activity of your esophagus.

Like I said above, it really is not "painful". It is however uncomfortable, but the people who administer the test are usually really trying to make you as comfortable as is possible.

Jan in Northern KY