Re: ESOPHAGECTOMY OPINION

[Guest guest]

Hi ,

Welcome back home. It seems like forever that you were away, at least in terms that you put it in (the # of posts you were away for). The xrays I had I simply will not forget about anytime soon, so I should have no problem comparing our insides to each other.

You did the right thing having the second surgery, and hopefully with regular monitoring you can maintain your present condition.

Its good to have you back again!

In a message dated 8/29/2006 7:51:08 A.M. Eastern Standard Time, mt4mar@... writes:

, I know that is a lot to take in and digest....so to speak. I am wondering if I will be in your same position the next time I start having problems. As of right now I am doing really well. I have some x-rays that I need to put on the site and I will try and get them on this week. Then you can let me know if my "E" looks like yours. You have to do what is right for you. I think if you can put up with having the dilation's and stuff then that might be the way for you right now. I know it just got old for me to keep going back every 3 months to have a dilation done and that is why I got the surgery. Keep us posted on what route you are going to take. We are here for you.

in Georgiacynmark24aol wrote:

On August 18th, in seeking another opinion for my having an esophagectomy, I saw Dr. Richter (the GI doctor), and Dr. Dempsey, (the thoracic surgeon,) both of Temple University, School of Medicine in Philadelphia. They are both brilliant, caring physicians, and gave me a generous amount of time considering their busy schedules.

Reproduced below is a portion of the letter from Dr. Richter to Dr. Dempsey about my visit and condition.

This letter may be of interest to anyone needing to consider having an esophagectomy.

"His disease presented at age 33 with classic symptoms of dysphagia, regurgitation, and a 20 pound weight loss. After a series of pneumatic dilatations, he underwent an open Heller myotomy through the left chest, with a Belsey antireflux operation in 1991...It is important to note at that time the esophagus even had a sigmoid dilatation.

The operation never relieved his symptoms. In fact, two months post-op physiologic studies still showed poor clearance. Nevertheless, the patient has done generally well with lifestyle changes until January of this year. He then began to note increasing nocturnal regurgitations to go along with his daily dysphagia with every meal. Solids stick, and he must drink large amounts of soda to flush things through. He also has intermittent chest pain responding to nifedipine....

I reviewed the patient's history and the recent barium swallow....studies were excellent, showing a mega-esophagus, measuring 6 - 8 cm. More importantly, there was a right angle deviation in the distal esophagus, with barium actually flowing upwards to empty through a very narrowed EG junction. This would be compatible with his previous endoscopies, which showed this marked tortuosity, along with retained, fermenting food.

I had a long discussion with the patient and his wife. I know they are desperate for alternatives, but I am very confident that an esophagectomy is the only way to approach his end-stage achalasia. Whether this can be done by trans-hiatal approach, or will need to go through the chest because of his previous surgery, is unknown. One could do a laparoscopic Heller myotomy through the abdomen, but I doubt very much it will give him any type of long term relief....He will still need the same esophagectomy in a year or two. Although there are isolated reports of some unusual drainage procedures proposed with mega-esophagus, none of these are definitive, like esophagectomy. We also discussed the potential complications of esophagectomy (stricture, dumping, acid reflux), as well as the need to have this procedure done by a surgeon in a large-volume center."

Dr. Richter was referring to Dr. Rice as his #1 choice to perform the esophagectomy. Having had a history of poor responses to balloon dilatations, bougies (stretches), and the Heller Myotomy, I am presently considering the esophagectomy as the last of three alternatives I was given. My first choice is "not to operate" and if it can help, have periodic dilatations; second choice is an esophagoplasty (somewhat of a reconstruction of the esophagus which will also remove the "bucket"), and then the esophagectomy. Along with continuing to do research, this is the conclusion I have come to after my three month "journey."

I am aware of those members of this board who have had the esophagectomy and have stated that it was the right thing for them to do, and it comforts me to know that they have come through it successfully. It was no walk in the park for them. Like any surgery, but even more so with this one, it carries great risks and should be done when there is no other alternative.

I am very grateful and deeply indebted to everyone who posted messages of their support to me during this period.

<FONT face="comic sans ms" color=#ff0000 size=5> in Georgia </FONT><IMG src=" ">

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[Guest guest]

Hello cynmark24@...,

In reference to your comment:

My first choice is "not to operate" and if it can help, have periodic dilatations

thanks for the update. I am having a senior

moment and can't remember if Dr. Richter did a dilatation

while you were there. If so has it helped?

Do you are anyone else know if there is a limit to how

many dilatations we can have?

Maggie

Alabama

[Guest guest]

Hi Maggie,

I had what might be called a minor dilatation when I was with my local GI, Dr. Brody. My appointment with Dr. Richter was strictly a consulatation.

Prior to my Heller, I had 5 dilatations, all without any sedation (the caveman days). The last one did nothing at all to help me, which led to my having the HM.

I guess you can have as many as your body will tolerate.

In a message dated 8/29/2006 8:16:29 A.M. Eastern Standard Time, LunaIam2@... writes:

Hello cynmark24aol,

In reference to your comment:

My first choice is "not to operate" and if it can help, have periodic dilatations

thanks for the update. I am having a senior

moment and can't remember if Dr. Richter did a dilatation

while you were there. If so has it helped?

Do you are anyone else know if there is a limit to how

many dilatations we can have?

Maggie

Alabama

[Guest guest]

, I know that is a lot to take in and digest....so to speak. I am wondering if I will be in your same position the next time I start having problems. As of right now I am doing really well. I have some x-rays that I need to put on the site and I will try and get them on this week. Then you can let me know if my "E" looks like yours. You have to do what is right for you. I think if you can put up with having the dilation's and stuff then that might be the way for you right now. I know it just got old for me to keep going back every 3 months to have a dilation done and that is why I got the surgery. Keep us posted on what route you are going to take. We are here for you. in Georgiacynmark24@... wrote: On August 18th, in seeking another opinion for my having an esophagectomy, I saw Dr. Richter (the GI doctor), and Dr. Dempsey, (the thoracic surgeon,) both of Temple University, School of Medicine in Philadelphia. They are both brilliant, caring physicians, and gave me a generous amount of time considering their busy schedules. Reproduced below is a portion of the letter from Dr. Richter to Dr. Dempsey

about my visit and condition. This letter may be of interest to anyone needing to consider having an esophagectomy. "His disease presented at age 33 with classic symptoms of dysphagia, regurgitation, and a 20 pound weight loss. After a series of pneumatic dilatations, he underwent an open Heller myotomy through the left chest, with a Belsey antireflux operation in 1991...It is important to note at that time the esophagus even had a sigmoid dilatation. The operation never relieved his symptoms. In fact, two months post-op physiologic studies still showed poor clearance.

Nevertheless, the patient has done generally well with lifestyle changes until January of this year. He then began to note increasing nocturnal regurgitations to go along with his daily dysphagia with every meal. Solids stick, and he must drink large amounts of soda to flush things through. He also has intermittent chest pain responding to nifedipine.... I reviewed the patient's history and the recent barium swallow....studies were excellent, showing a mega-esophagus, measuring 6 - 8 cm. More importantly, there was a right angle deviation in the distal esophagus, with barium actually flowing upwards to empty through a very narrowed EG junction. This would be compatible with his previous endoscopies, which showed this marked tortuosity, along with retained, fermenting

food. I had a long discussion with the patient and his wife. I know they are desperate for alternatives, but I am very confident that an esophagectomy is the only way to approach his end-stage achalasia. Whether this can be done by trans-hiatal approach, or will need to go through the chest because of his previous surgery, is unknown. One could do a laparoscopic Heller myotomy through the abdomen, but I doubt very much it will give him any type of long term relief....He will still need the same esophagectomy in a year or two. Although there are isolated reports of some unusual drainage procedures proposed with mega-esophagus, none of these are definitive, like esophagectomy. We also discussed the potential complications of esophagectomy (stricture, dumping, acid reflux), as well as the need

to have this procedure done by a surgeon in a large-volume center." Dr. Richter was referring to Dr. Rice as his #1 choice to perform the esophagectomy. Having had a history of poor responses to balloon dilatations, bougies (stretches), and the Heller Myotomy, I am presently considering the esophagectomy as the last of three alternatives I was given. My first choice is "not to operate" and if it can help, have periodic dilatations; second choice is an esophagoplasty (somewhat of a reconstruction of the esophagus which will also remove the "bucket"), and then the esophagectomy. Along with continuing to do research, this is the conclusion I have come to after my three month "journey." I am aware of

those members of this board who have had the esophagectomy and have stated that it was the right thing for them to do, and it comforts me to know that they have come through it successfully. It was no walk in the park for them. Like any surgery, but even more so with this one, it carries great risks and should be done when there is no other alternative. I am very grateful and deeply indebted to everyone who posted messages of their support to me during this period. <FONT face="comic sans ms" color=#ff0000 size=5> in Georgia

</FONT><IMG src=" ">

Get your own web address for just $1.99/1st yr. We'll help. Small Business.

[Guest guest]

Maggie,

You can have more than 3 dilatations but more dilatations increases the risk of

perforation during surgery,if it is to be performed at a later stage.

Normally ,drs also advise to keep gap of minimum 6 months between 2 dilatations

..

You are also taking a risk of making your esophagus bigger,if you are advised

for surgery and if you do not get it done.

This could lead to more other complications

Before or during surgery.

In my case, dr.had suggested 3 dilatations

And then if problem persists,then to go for

Surgery..I did the same,but after the last-3rd dilatation,I realized that I

should have gone for surgery earlier bcoz esophagus got enlarged in 12 years

time.

Hope this information helps you..

Mukesh

Re: ESOPHAGECTOMY OPINION

Hello cynmark24@...,

In reference to your comment:

My first choice is " not to operate " and if it can help, have periodic

dilatations

thanks for the update. I am having a senior

moment and can't remember if Dr. Richter did a dilatation

while you were there. If so has it helped?

Do you are anyone else know if there is a limit to how

many dilatations we can have?

Maggie

Alabama

[Guest guest]

Maggie, I have had around 12 so far. in GeorgiaLunaIam2@... wrote: Hello cynmark24aol, In reference to your comment: My first choice is "not to operate" and if it can help, have periodic dilatations thanks for the update. I am having a senior moment and can't remember if Dr. Richter did a dilatation while you were there. If so has it helped? Do you are anyone else know if there is a limit to how many dilatations we can have? Maggie Alabama <FONT face="comic sans ms" color=#ff0000 size=5> in Georgia

</FONT><IMG src=" ">

Talk is cheap. Use Messenger to make PC-to-Phone calls. Great rates starting at 1¢/min.

[Guest guest]

Thanks , Muskesh, and for your

response to my question re dilatations.

Maggie

Alabama

[Guest guest]

,

Our disease patterns are so similar. Very reassuring.

STEVE

ESOPHAGECTOMY OPINION

On August 18th, in seeking another opinion for my having an esophagectomy, I saw Dr. Richter (the GI doctor), and Dr. Dempsey, (the thoracic surgeon,) both of Temple University, School of Medicine in Philadelphia. They are both brilliant, caring physicians, and gave me a generous amount of time considering their busy schedules.

Reproduced below is a portion of the letter from Dr. Richter to Dr. Dempsey about my visit and condition.

This letter may be of interest to anyone needing to consider having an esophagectomy.

"His disease presented at age 33 with classic symptoms of dysphagia, regurgitation, and a 20 pound weight loss. After a series of pneumatic dilatations, he underwent an open Heller myotomy through the left chest, with a Belsey antireflux operation in 1991...It is important to note at that time the esophagus even had a sigmoid dilatation.

The operation never relieved his symptoms. In fact, two months post-op physiologic studies still showed poor clearance. Nevertheless, the patient has done generally well with lifestyle changes until January of this year. He then began to note increasing nocturnal regurgitations to go along with his daily dysphagia with every meal. Solids stick, and he must drink large amounts of soda to flush things through. He also has intermittent chest pain responding to nifedipine.. .

[Guest guest]

Dear , Thank you so much for posting the comments by your doctor. It made me face up to what all of us have, and, what you are now facing with end-stage A. I am sending you my best thoughts and wishes. It feels a bit mind-boggling to try to figure out what to do: I read and reread a lot of the posts on esophagectomy, and, whoa, after boogies and dilations and Hellers, I suppose the major surgery is all one could do in the end-stage. I guess it's just a matter of when one does it, am I right?! So, whatever you decide, whatever you do about this disturbing A stuff, I wish you very, very well and the best of health. As for me, had a Hellers in late January of this year, I go up and

down and so does liquid in my E. But I feel pretty lucky at this point and carbonated sodas still get stuff down. Meat and bread are the bigger culprits in my life so I tend to avoid them. But, your surgery is BIG. I hope you feel better and better if and when you do this and are on the other side of it all. Best wishes to everyone else out there. Deborah, still at the beach, for a while....

[Guest guest]

Hi

I admire your courage as well as your approach to problem-solving.

This is a tough one. I am grateful, too, for all that you have shared

through your (very well written) posts to the group.

I value what you have written so much that I have saved much of it via

copying & pasting in the event I find myself in a similar situation.

.... just wanted to say " thanks " ..

Rich (Chicago USA)

>

> On August 18th, in seeking another opinion for my having an

esophagectomy,

> I saw Dr. Richter (the GI doctor), and Dr. Dempsey, (the thoracic

surgeon,)

> both of Temple University, School of Medicine in Philadelphia.

They are both

> brilliant, caring physicians, and gave me a generous amount of time

> considering their busy schedules.

>

> Reproduced below is a portion of the letter from Dr. Richter to Dr.

Dempsey

> about my visit and condition.

>

> This letter may be of interest to anyone needing to consider having

an

> esophagectomy.

>

> " His disease presented at age 33 with classic symptoms of dysphagia,

> regurgitation, and a 20 pound weight loss. After a series of

pneumatic dilatations,

> he underwent an open Heller myotomy through the left chest, with a

Belsey

> antireflux operation in 1991...It is important to note at that time

the

> esophagus even had a sigmoid dilatation.

>

> The operation never relieved his symptoms. In fact, two months

post-op

> physiologic studies still showed poor clearance. Nevertheless, the

patient has

> done generally well with lifestyle changes until January of this

year. He

> then began to note increasing nocturnal regurgitations to go along

with his

> daily dysphagia with every meal. Solids stick, and he must drink

large amounts

> of soda to flush things through. He also has intermittent chest pain

> responding to nifedipine....

>

> I reviewed the patient's history and the recent barium

swallow....studies

> were excellent, showing a mega-esophagus, measuring 6 - 8 cm. More

> importantly, there was a right angle deviation in the distal

esophagus, with barium

> actually flowing upwards to empty through a very narrowed EG

junction. This

> would be compatible with his previous endoscopies, which showed

this marked

> tortuosity, along with retained, fermenting food.

>

> I had a long discussion with the patient and his wife. I know they

are

> desperate for alternatives, but I am very confident that an

esophagectomy is the

> only way to approach his end-stage achalasia. Whether this can be

done by

> trans-hiatal approach, or will need to go through the chest because

of his

> previous surgery, is unknown. One could do a laparoscopic Heller

myotomy through

> the abdomen, but I doubt very much it will give him any type of

long term

> relief....He will still need the same esophagectomy in a year or

two. Although

> there are isolated reports of some unusual drainage procedures

proposed with

> mega-esophagus, none of these are definitive, like esophagectomy.

We also

> discussed the potential complications of esophagectomy (stricture,

dumping,

> acid reflux), as well as the need to have this procedure done by a

surgeon in a

> large-volume center. "

>

> Dr. Richter was referring to Dr. Rice as his #1 choice to perform the

> esophagectomy. Having had a history of poor responses to balloon

dilatations,

> bougies (stretches), and the Heller Myotomy, I am presently

considering the

> esophagectomy as the last of three alternatives I was given. My

first choice is

> " not to operate " and if it can help, have periodic dilatations;

second choice

> is an esophagoplasty (somewhat of a reconstruction of the esophagus

which

> will also remove the " bucket " ), and then the esophagectomy. Along

with

> continuing to do research, this is the conclusion I have come to

after my three month

> " journey. "

>

> I am aware of those members of this board who have had the

esophagectomy and

> have stated that it was the right thing for them to do, and it

comforts me

> to know that they have come through it successfully. It was no

walk in the

> park for them. Like any surgery, but even more so with this one,

it carries

> great risks and should be done when there is no other alternative.

>

> I am very grateful and deeply indebted to everyone who posted

messages of

> their support to me during this period.

>

>

>