Re: /RICHARD

[Guest guest]

RICHARD -

We're seeing Dr. Dempsey and Dr. Richter on Monday for my boyfriend's

achalasia....thanks for your information. We were told Dr. Richter

was the best. The first appointment with Dr. Richter is leaning us

toward surgery but he wants yet another endoscope and a

manometry,etc., first (which will be on 3/12/07). (The other

endoscope was done at Christiana Hospital in DE.) Thanks to all on

this board -- I've got a lot more reading to do!!

>

>

> Hi ,

>

> You made some excellent points regarding my condition, where

I am now

> and what might be in the future. I want to quote from the report

Dr. Dempsey

> sent my local GI doctor so you might better understand my present

thinking.

>

> Dr. Dempsey, Dept. of Surgery of Temple University, works

closely with

> Dr. Richter, the chief gastroenterologist there. Dr. Richter

previously spent

> around 10 years at the Cleveland Clinic colleagues with Dr. Rice.

>

> Dr. Richter, the gastroenterologist and Chairman of Medicine,

said to me

> that within a year or two I would come back asking that the

esophagectomy be

> done. His decision seemed to be solely based on the films I

brought with me.

>

> Dr. Dempsey, the surgeon, on the other hand, viewed the films

but also

> listened to me more, wrote the following. I had expected Dr.

Dempsey to say

> the same thing as Dr. Richter, which taught me the lesson never to

assume you

> know what a doctor is going to say.

>

> " I told Mr. Friedman that in my opinion he had 4 options.

>

> 1 Do nothing.

> 2. Have a laparoscopic esophagomyotomy with DOR hemi-wrap.

(Heller

> Myotomy)

> 3. Have an open abdominal procedure either an extended

esophagomyotomy

> down on the stomach or perhaps an old fashioned, esophagoplasty

(also called

> cardioplasty) with partial wrap.

> 4. Esophagectomy.

>

> My preference would be option #3, that is to do an open operation

and

> explore the area of the GE junction and hiatus. If there is an

obvious stricture

> hanging up there that we can adequately open up with an extended

mytomy. I

> would recommend we do this; if not, I would recommend a

cardioplasty. Of

> course, either of these options could be associated with

postoperative

> gastroesophageal reflux disease, but I would predict that there

would be about a 65-75%

> improvement in his symptioms with this approach with an operative

mortality

> risk of about 1%. If the approach failed, he could then go on to

have an

> esophagectomy without significant increase in the morbidity and

mortality of that

> procedure in my opinion. I quoted him a 4-5% operative mortality

risk for

> esophagectomy. I would recommend against the laparoscopic approach

and I

> reitereated to him that although I thought it was likely that

sometime over the

> next decade that he would need something done for symptomatic

relief,

> certainly there was no urgency to get anything done if he was able

to manage his

> symptoms. "

>

> , I agree with what you said in a previous post about

the 'plasty. It

> is an extremely rare operation, much more uncommon than

the 'ectomy is, and

> more often performed on either cancer patients or patients having

suffered

> chemical damage (eg. lye) that destroyed their esophagus.

>

> If it was done, and successfully, you raised the point as to how

long would

> it last and wouldn't I end up being where I am now, after a

certain length of

> time? Maybe. I am hoping that certain life style changes I began

as sort

> of a New Year's resolution may make a difference for me. Perhaps

being more

> careful about myself this time around, may extend the " life " of my

> non-functioning esophagus. Being 24 years apart we have a

different perspective looking

> forward. I feel that you are doing the right thing for yourself,

and that

> if I can maintain my status quo, that I am doing the right thing.

Certainly

> there are a few options I can fall back on should I have to.

>

> Your children are young and you'd like to start a career, while

mine are

> grown (one being a year younger than you), and I will be ending a

career in the

> next three years. I no longer have regurg problems in my sleep

like I did

> last year. I am not any better, just better to myself, and it is

making a

> difference. Another point is that I feel fine. Just give

me " Lake " to

> drink and I can get my food down in a reasonable amount of time

and I won't

> regurgitate it unless I want to. For me, , there is far

more quality of

> life risks by having the surgery at this time, than by not having

it and

> being very careful with myself. If my condition worsens, and it

may, I will act

> accordingly at that time.

>

> I still may see Dr. Rice (though not while you are there, since

being a CPA

> I work 24/7 these days, except of course, when I am posting to

this Board).

> I see that you are still awake at 2am. What I am curious about

seeing him

> and is my question to you - can I bring along test results or will

he want to

> have it done at TCC? Will he want to do a manometry on me, even

though I

> (obviously) have achalasia?

>

> Funny, your latest post came thru talking about just those issues.

>

> We will also meet in person at some point, maybe when you have

your followup

> visit in April or May back at TCC.

>

> Time for me to go to sleep now.

>

> Love,

>

>

>

>

>

>

>

>

> In a message dated 3/4/2007 1:27:35 A.M. Eastern Standard Time,

> tracylb@... writes:

>

>

>

>

>

> Pippa,

> Thanks for the support. It is hard, while I can be so positive one

minute,

> then I feel like I’m crazy to do this drastic step, and why not

wait a little

> longer.

> Then I think, why? So I can get really sick and not be in the best

health to

> go through with it? That’s even crazier. Fact is it’s not

going to change

> by waiting, only get riskier. But I know it’s the normal

emotional ups and

> downs, and it’s normal to be scared and nervous.

> Thanks for all your good thoughts †" it means so much right now

to have

> everyone keeping me pointed in a positive direction.

> in NY

>

>

> ____________________________________

>

> From: <ST1>achalasia [mailto: [mailto:<ST1>a [] On Behalf Of

Pippa

> Sent: Saturday, Saturday, <ST <S

> <ST1>achalasia

> Subject: [ach

>

>

>

> Hi Hi I have been reading your post to everyone over the past

few

> days.

>

> I am sorry that Dr Rice gave you the news that you were hoping not

> to hear although as you say it was possibly on the cards, but as

you

> say he is an excellent doctor and must have thought long and hard

> over his decision before telling you.

>

> Its so great to see you talking so positive about the sugery

please

> keep this up. I understand that at quiet times in the night you

> start to panic that is only natural.

>

> I think if we are all honest some of us who were due to have

surgery

> be it open or keyhole have woken in the middle of the night in

> panic. So many things go through your mind it always seams worse

in

> the early hours of the morning.

>

> Its pleasing to see that you have got so much support here in the

> group from members that have already had the surgery that you are

> about to have and I am sure you will continue to find a lot of

> support from many of the members here.

>

> Please know that I am and will be thinking of you in the up and

> coming weeks and months and wish you a quick recovery please keep

us

> all informed on how things go.

>

> Keep a record of how things go after your surgery on how you feel

> and eat and so on and you will I promise see small improvement on

a

> regular basis. I did this after my open surgery last year and some

> days I thought that things were not getting any better but going

> back through my notes I could see that in fact there had been

steady

> improvements on a weekly basis.

>

> Take care

>

> Pippa (Pippa )

>

>

>

>

>

>

>

>

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