Guest guest Posted March 21, 2006 Report Share Posted March 21, 2006 I have had two surgeries so far. The first one was done in March of 2003 and my second was done in May 2005. in Suffolk Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2006 Report Share Posted March 21, 2006 Yesterday my son and I met with Richter, a gastroenterologist at Temple University Hospital in Philadelphia who sees many achalasia patients. I had a long list of questions. Here are some of his answers: Surgery is the best option for an adolescent. For medication to relax the sphincter prior to surgery on days when he just can't get the food to go down, nitrates (isosorbide dinitrate, sold as Isordil) are better than nifedipine. They take effect faster (15 minutes) and help more people with achalasia than nifedipine. Dr. Richter thinks Dor fundoplication is best. After a myotomy with fundoplication, it is normal to not be able to vomit, but that may resolve over time. Some are fine for 15-20 years after surgery, but there are no very long-term studies. Richter supposes part of the reason is that people don't publish their long-term studies if the results are bad. However, they now know that some trouble with swallowing recurs in 60% (sixty percent!) within 5 years after surgery. I asked what causes this decline. He thinks it is for two reasons: Either the myotomy isn't long enough, or there is acid damage. Acid damage to the esophagus does occur even with a wrap (fundoplication). The resultant scarring will cause problems with solids but usually not with liquids. After surgery, patients should continue to take a proton pump inhibitor to increase the lifetime of the wrap. It's also not a bad idea to keep the head of the bed elevated all one's life. For follow-up after surgery, a barium swallow every one or two years is the easiest way to monitor function. My son also learned something by watching the monitor during his timed barium swallow. He drank a cup of barium, and it mostly just sat there. But when the radiologist told him to do a " dry swallow " (swallowing motion without anything to swallow), the resulting pressure did move a good bit of the barium down into his stomach. He saw this happening on the monitor although he couldn't feel anything different inside. So now he has another strategy. Unfortunately it didn't work at the Indian restaurant where we stopped on the way home from Philadelphia. in Lancaster, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2006 Report Share Posted March 21, 2006 Thanks very much for sharing that . that is very interesting information and the clearest description of what to do and what to expect after the surgery that I have seen. Liz > > Yesterday my son and I met with Richter, a > gastroenterologist at Temple University Hospital in Philadelphia > who sees many achalasia patients. I had a long list of > questions. Here are some of his answers: > > Surgery is the best option for an adolescent. For medication to > relax the sphincter prior to surgery on days when he just can't > get the food to go down, nitrates (isosorbide dinitrate, sold as > Isordil) are better than nifedipine. They take effect faster (15 > minutes) and help more people with achalasia than nifedipine. > > Dr. Richter thinks Dor fundoplication is best. After a myotomy > with fundoplication, it is normal to not be able to vomit, but > that may resolve over time. > > Some are fine for 15-20 years after surgery, but there are no > very long-term studies. Richter supposes part of the reason is > that people don't publish their long-term studies if the results > are bad. However, they now know that some trouble with > swallowing recurs in 60% (sixty percent!) within 5 years after > surgery. > > I asked what causes this decline. He thinks it is for two > reasons: Either the myotomy isn't long enough, or there is acid > damage. Acid damage to the esophagus does occur even with a wrap > (fundoplication). The resultant scarring will cause problems > with solids but usually not with liquids. After surgery, > patients should continue to take a proton pump inhibitor to > increase the lifetime of the wrap. It's also not a bad idea to > keep the head of the bed elevated all one's life. > > For follow-up after surgery, a barium swallow every one or two > years is the easiest way to monitor function. > > My son also learned something by watching the monitor during his > timed barium swallow. He drank a cup of barium, and it mostly > just sat there. But when the radiologist told him to do a " dry > swallow " (swallowing motion without anything to swallow), the > resulting pressure did move a good bit of the barium down into > his stomach. He saw this happening on the monitor although he > couldn't feel anything different inside. So now he has another > strategy. > > Unfortunately it didn't work at the Indian restaurant where we > stopped on the way home from Philadelphia. > > in Lancaster, PA > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2006 Report Share Posted March 21, 2006 If a few years after the surgery you begin to have strong symptoms can you have the surgery again? It alarms me that up to 60% have problems within the first 5 yrs after surgery. > > > > Yesterday my son and I met with Richter, a > > gastroenterologist at Temple University Hospital in Philadelphia > > who sees many achalasia patients. I had a long list of > > questions. Here are some of his answers: > > > > Surgery is the best option for an adolescent. For medication to > > relax the sphincter prior to surgery on days when he just can't > > get the food to go down, nitrates (isosorbide dinitrate, sold as > > Isordil) are better than nifedipine. They take effect faster (15 > > minutes) and help more people with achalasia than nifedipine. > > > > Dr. Richter thinks Dor fundoplication is best. After a myotomy > > with fundoplication, it is normal to not be able to vomit, but > > that may resolve over time. > > > > Some are fine for 15-20 years after surgery, but there are no > > very long-term studies. Richter supposes part of the reason is > > that people don't publish their long-term studies if the results > > are bad. However, they now know that some trouble with > > swallowing recurs in 60% (sixty percent!) within 5 years after > > surgery. > > > > I asked what causes this decline. He thinks it is for two > > reasons: Either the myotomy isn't long enough, or there is acid > > damage. Acid damage to the esophagus does occur even with a wrap > > (fundoplication). The resultant scarring will cause problems > > with solids but usually not with liquids. After surgery, > > patients should continue to take a proton pump inhibitor to > > increase the lifetime of the wrap. It's also not a bad idea to > > keep the head of the bed elevated all one's life. > > > > For follow-up after surgery, a barium swallow every one or two > > years is the easiest way to monitor function. > > > > My son also learned something by watching the monitor during his > > timed barium swallow. He drank a cup of barium, and it mostly > > just sat there. But when the radiologist told him to do a " dry > > swallow " (swallowing motion without anything to swallow), the > > resulting pressure did move a good bit of the barium down into > > his stomach. He saw this happening on the monitor although he > > couldn't feel anything different inside. So now he has another > > strategy. > > > > Unfortunately it didn't work at the Indian restaurant where we > > stopped on the way home from Philadelphia. > > > > in Lancaster, PA > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2006 Report Share Posted March 21, 2006 Thanks for answering my question. It is an alarming thought but if I could have the surgery repeated in the future, that makes me feel better. I hope your son Mark gets better soon - I am 23 and its hard, I can't imagine being his age and having this frightening disease. All the best to you:) <1x2y3z@...> wrote: > If a few years after the surgery you begin to have strong > symptoms> can you have the surgery again? It alarms me that up to 60% > have> problems within the first 5 yrs after surgery.That alarms me too, especially because it's about my teenage son! I suppose my alarm is obvious to the doctors I've talked to, because they do reassure me that it's a nuisance but it's not life-threatening. He may need dilations or further surgery in the future, but he'll take care of it and get on with his life.I think it also makes sense to make every effort to prevent future problems by learning a lot in advance, finding a good surgeon, and doing anything that might help to preserve your health, like taking proton pump inhibitors after surgery (if advised by your doctor), changing eating habits if necessary, keeping fit, not smoking or drinking to excess, etc., Mark's mom in Lancaster, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2006 Report Share Posted March 21, 2006 Dr. Richter was my doc at CC when he was there. I liked his frank but nice way of putting things!!! He admitted that i may not have much success with my myotomy, done in 2002, I've had one stretch since (2003) and I'm going back in May of this year. I've had good results for me he said! I had a toupet fundoplecation because of my damage that was done before and they thought that was best for me. He is a good doc!!!! Take his advice!!! Wish i could see him again, but that's a long haul for me LOL. in Indiana From: achalasia [mailto:achalasia ] On Behalf Of Sent: Tuesday, March 21, 2006 12:34 PMachalasia Subject: answers from Dr. Richter Yesterday my son and I met with Richter, agastroenterologist at Temple University Hospital in Philadelphiawho sees many achalasia patients. I had a long list ofquestions. Here are some of his answers:Surgery is the best option for an adolescent. For medication torelax the sphincter prior to surgery on days when he just can'tget the food to go down, nitrates (isosorbide dinitrate, sold asIsordil) are better than nifedipine. They take effect faster (15minutes) and help more people with achalasia than nifedipine.Dr. Richter thinks Dor fundoplication is best. After a myotomywith fundoplication, it is normal to not be able to vomit, butthat may resolve over time.Some are fine for 15-20 years after surgery, but there are novery long-term studies. Richter supposes part of the reason isthat people don't publish their long-term studies if the resultsare bad. However, they now know that some trouble withswallowing recurs in 60% (sixty percent!) within 5 years aftersurgery.I asked what causes this decline. He thinks it is for tworeasons: Either the myotomy isn't long enough, or there is aciddamage. Acid damage to the esophagus does occur even with a wrap(fundoplication). The resultant scarring will cause problemswith solids but usually not with liquids. After surgery,patients should continue to take a proton pump inhibitor toincrease the lifetime of the wrap. It's also not a bad idea tokeep the head of the bed elevated all one's life.For follow-up after surgery, a barium swallow every one or twoyears is the easiest way to monitor function.My son also learned something by watching the monitor during histimed barium swallow. He drank a cup of barium, and it mostlyjust sat there. But when the radiologist told him to do a "dryswallow" (swallowing motion without anything to swallow), theresulting pressure did move a good bit of the barium down intohis stomach. He saw this happening on the monitor although hecouldn't feel anything different inside. So now he has anotherstrategy.Unfortunately it didn't work at the Indian restaurant where westopped on the way home from Philadelphia. in Lancaster, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2006 Report Share Posted March 22, 2006 > > Yesterday my son and I met with Richter, a > gastroenterologist at Temple University Hospital in Philadelphia > who sees many achalasia patients. I had a long list of > questions. Here are some of his answers: > > Surgery is the best option for an adolescent. For medication to > relax the sphincter prior to surgery on days when he just can't > get the food to go down, nitrates (isosorbide dinitrate, sold as > Isordil) are better than nifedipine. They take effect faster (15 > minutes) and help more people with achalasia than nifedipine. > > Dr. Richter thinks Dor fundoplication is best. After a myotomy > with fundoplication, it is normal to not be able to vomit, but > that may resolve over time. > > Some are fine for 15-20 years after surgery, but there are no > very long-term studies. Richter supposes part of the reason is > that people don't publish their long-term studies if the results > are bad. However, they now know that some trouble with > swallowing recurs in 60% (sixty percent!) within 5 years after > surgery. > > I asked what causes this decline. He thinks it is for two > reasons: Either the myotomy isn't long enough, or there is acid > damage. Acid damage to the esophagus does occur even with a wrap > (fundoplication). The resultant scarring will cause problems > with solids but usually not with liquids. After surgery, > patients should continue to take a proton pump inhibitor to > increase the lifetime of the wrap. It's also not a bad idea to > keep the head of the bed elevated all one's life. > > For follow-up after surgery, a barium swallow every one or two > years is the easiest way to monitor function. > > My son also learned something by watching the monitor during his > timed barium swallow. He drank a cup of barium, and it mostly > just sat there. But when the radiologist told him to do a " dry > swallow " (swallowing motion without anything to swallow), the > resulting pressure did move a good bit of the barium down into > his stomach. He saw this happening on the monitor although he > couldn't feel anything different inside. So now he has another > strategy. > > Unfortunately it didn't work at the Indian restaurant where we > stopped on the way home from Philadelphia. > > in Lancaster, PA > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2006 Report Share Posted March 22, 2006 Hi , Isn't he a great listener? He answered every one of my questions and even called me back when I sent him a follow up email with additional questions. He's very straight forward and he's has a very confident manner when he speaks which is relieving. I guess I'm one of those 60% people. I'm mulling over the decision to have a dilation this summer when I'm on break from classes with either Dr. Richter at Temple or Dr. Kadska at Presbyterian. Dr. Richter thinks it's acid damage even though I had a partial wrap and have been off/on PPI's since surgery in Summer 04. I'm having my surgeon who did the myotomy look at the Barium results for a 3rd opinion. I suppose it could be worse news so I can't complain. > For follow-up after surgery, a barium swallow every one or two > years is the easiest way to monitor function. I've had bariums + endoscopies. > My son also learned something by watching the monitor during his > timed barium swallow. He drank a cup of barium, and it mostly > just sat there. But when the radiologist told him to do a " dry > swallow " (swallowing motion without anything to swallow), the > resulting pressure did move a good bit of the barium down into > his stomach. He saw this happening on the monitor although he > couldn't feel anything different inside. So now he has another > strategy. Dry swallowing for me causes stuff to rush up and then level down. I'm so glad you had the appointment and had a chance to talk to him. Did you meet Liz his assistant? She is very helpful and so nice! She sent me a map of the hospital and directions to get there. The hospital map was great because you tend to get lost in there! Lisbeth in Philly. It better warm up soon because my bulbs are starting to frost. Quote Link to comment Share on other sites More sharing options...
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