Guest guest Posted January 14, 2010 Report Share Posted January 14, 2010 notan- sorry second part of question- does prostagladin promote smooth muscle contration. could this substance help with peristalisis? or is the release of this chemical the cause of esophageal spasms- like a COX2 response?...angela question for notan notan- do you have any information on prostaglandin for the treatment of inflammatory reponses?...angela Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2010 Report Share Posted January 14, 2010 I don't have anything off the top of my head that I would want to reply with. I won't have time to look into this until tonight. Things have been really busy for some time now. Which is why my messages have been kind of hit and run lately. Thank for the question though, I will look into it. notan wrote: > notan- sorry second part of question- does prostagladin promote smooth muscle contration. could this substance help with peristalisis? or is the release of this chemical the cause of esophageal spasms- like a COX2 response?...angela > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2010 Report Share Posted January 14, 2010 Thanks notan. No hurry, just curiosity. I have a friend suffering with lyme. He was seen in cleveland over xmas. Wondering implication for A and lyme..angela Sent from my Verizon Wireless BlackBerry Re: question for notan I don't have anything off the top of my head that I would want to reply with. I won't have time to look into this until tonight. Things have been really busy for some time now. Which is why my messages have been kind of hit and run lately. Thank for the question though, I will look into it. notan wrote: > notan- sorry second part of question- does prostagladin promote smooth muscle contration. could this substance help with peristalisis? or is the release of this chemical the cause of esophageal spasms- like a COX2 response?...angela > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2010 Report Share Posted July 14, 2010 Cara wrote: > What I need to understand is, what is considered to be a failure? I think failures mean no or little relief if dysphagia. > When looking at studies that is a very good question to ask. Sometimes it is based on questionnaires that patients are asked before and after treatment. Sometimes it is bases on test results, such as timed barium swallows. It could be based on a combination of those. Sometimes it is the amount of improvement in these kind of things. The thing is what is considered a success or failure can differ from one study to another. To make it even more confusing, there have been studies that found symptoms (which is what the patient reports on the questionnaires) and test result don't always correlate well. You could think your swallowing is better than it is because your esophagus is large enough to hold enough food that it acts like a second stomach. To you it feels like food when down OK but it may actually be sitting in your second stomach. ( " You " being generic and this not necessarily the way things are for you.) If something like this happens after treatment is it a success or a failure? One study may call it a success based on the symptoms you report, and another study may call it a failure based on a barium swallow. When you talk to doctors about their success rates you may want to ask what they consider a success and also a failure. > Here is where my thinking may be off. I was not assuming that most or All of these patients had very high dysphagia scores before the surgery. Then it would make sense to me that someone who has high dysphagia and low les pressure preoperatively would not really benefit from their decrease in lewd pressure. > I think there may be something missing in the way manometry tests are done. The probe used to measure the pressure is small. We all wish it was even smaller. But that means it can only measure pressure at the LES when when it is closed. Imagine that the LES is like an elastic band around a tube. In some people that band may be not as elastic as in others but when closed have the same pressure. As you try to open the band it fights back and begins to push back with more pressure. Because this band is stiffer than expected it pushes back with more pressure than expected as it is opened. If there is limited pressure to open it, you may not be able to open it as much as you would a more elastic one. Remember though that when closed this band does not seem any stronger than the more elastic one. If it can't be opened very far before the pressure become too much to overcome then it is easier to block with bits of food. I am thinking that a myotomy may make so that the LES does not increase in pressure as fast, allowing it to open more with limit peristaltic pressure. Just my thoughts which could be wrong. In secondary achalasia due to scleroderma the LES is stiff and has low pressure. Even so myotomy is sometimes done in these cases too. > For me, my dysphagia score is so low to begin with. Could a myotomy wind up making my dysphagia worse? > There have been people that had myotomies and wished they didn't. There are some things like adhesions and scar tissue that effect some people more than others. A surgeon could damage your vagus nerve. You could end up with more reflux. There are always risks. In good centers the " success " rates are often something like 90% so some of these risk are fairly small. I think you should forget the terms success and failure and focus on your risks, and what you want from the surgery. The experts on " your " risks are going to be your doctors. Assuming they have the experience. and you seem to have chosen some that do, what do they see your risks being if they do the surgery, and what are the chances that it will do for you what you want. It is good to know the studies so you can understand the discussions with your doctors but what matters in the end is what is your situation with " them " is likely to be. Have you seen this one? Preoperative lower esophageal sphincter pressure has little influence on the outcome of laparoscopic Heller myotomy for achalasia. Gorodner MV, Galvani C, Fisichella PM, Patti MG. http://www.ncbi.nlm.nih.gov/pubmed/15054655 notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2010 Report Share Posted July 14, 2010 Thanks Notan, I was eagerly awaiting your post. Thanks for taking the time to walk me through your thinking. I have not seen that study and it does make things look more positive, the only issue is that I have had a previous dilatation. That always makes a myotomy more complicated. Thankfully I have only had I one. So the risks for me seem to be regrowth or fibrosis or adhesions that may impede my swallowing over time. Possibly even reflux (but there are meeds for that). Should I take from your post that with the top Dr.s these risks are minimized? Out of these people who wish they never had the myotomy, how many of them went to top doctors? And were they swallowing very well before surgery? (not sure if you know their details). The case of ottenheimer is discouraging because he made a comment that he was swallowing better before the myo. And his E was in pretty bad shape (it seems from his post) just like mine. And he went to Rice. Funny how this information is so readily available to me right before I need to make a decision. I will most likely be going through with the myo because if I don't, I run the risk of more major complications down the road and most definitely an ectomy. If anyone can save my E it should be Rice. I mean he is supposed to be the best, right? I'll keep you posted. Thanks again Notan, Cara > > What I need to understand is, what is considered to be a failure? I think failures mean no or little relief if dysphagia. > > > > When looking at studies that is a very good question to ask. Sometimes > it is based on questionnaires that patients are asked before and after > treatment. Sometimes it is bases on test results, such as timed barium > swallows. It could be based on a combination of those. Sometimes it is > the amount of improvement in these kind of things. The thing is what is > considered a success or failure can differ from one study to another. To > make it even more confusing, there have been studies that found symptoms > (which is what the patient reports on the questionnaires) and test > result don't always correlate well. You could think your swallowing is > better than it is because your esophagus is large enough to hold enough > food that it acts like a second stomach. To you it feels like food when > down OK but it may actually be sitting in your second stomach. ( " You " > being generic and this not necessarily the way things are for you.) If > something like this happens after treatment is it a success or a > failure? One study may call it a success based on the symptoms you > report, and another study may call it a failure based on a barium swallow. > > When you talk to doctors about their success rates you may want to ask > what they consider a success and also a failure. > > > Here is where my thinking may be off. I was not assuming that most or All of these patients had very high dysphagia scores before the surgery. Then it would make sense to me that someone who has high dysphagia and low les pressure preoperatively would not really benefit from their decrease in lewd pressure. > > > > I think there may be something missing in the way manometry tests are > done. The probe used to measure the pressure is small. We all wish it > was even smaller. But that means it can only measure pressure at the LES > when when it is closed. Imagine that the LES is like an elastic band > around a tube. In some people that band may be not as elastic as in > others but when closed have the same pressure. As you try to open the > band it fights back and begins to push back with more pressure. Because > this band is stiffer than expected it pushes back with more pressure > than expected as it is opened. If there is limited pressure to open it, > you may not be able to open it as much as you would a more elastic one. > Remember though that when closed this band does not seem any stronger > than the more elastic one. If it can't be opened very far before the > pressure become too much to overcome then it is easier to block with > bits of food. I am thinking that a myotomy may make so that the LES > does not increase in pressure as fast, allowing it to open more with > limit peristaltic pressure. Just my thoughts which could be wrong. > > In secondary achalasia due to scleroderma the LES is stiff and has low > pressure. Even so myotomy is sometimes done in these cases too. > > > For me, my dysphagia score is so low to begin with. Could a myotomy wind up making my dysphagia worse? > > > > There have been people that had myotomies and wished they didn't. There > are some things like adhesions and scar tissue that effect some people > more than others. A surgeon could damage your vagus nerve. You could end > up with more reflux. There are always risks. In good centers the > " success " rates are often something like 90% so some of these risk are > fairly small. > > I think you should forget the terms success and failure and focus on > your risks, and what you want from the surgery. The experts on " your " > risks are going to be your doctors. Assuming they have the experience. > and you seem to have chosen some that do, what do they see your risks > being if they do the surgery, and what are the chances that it will do > for you what you want. It is good to know the studies so you can > understand the discussions with your doctors but what matters in the end > is what is your situation with " them " is likely to be. > > Have you seen this one? > > Preoperative lower esophageal sphincter pressure has little influence on > the outcome of laparoscopic Heller myotomy for achalasia. > Gorodner MV, Galvani C, Fisichella PM, Patti MG. > http://www.ncbi.nlm.nih.gov/pubmed/15054655 > > notan > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2010 Report Share Posted July 14, 2010 Notan, I just found another study from the series you linked to in your post (patti et al) that shows low les pressure AND prior pneumatic dilatation having excellent or good results after myotomy. This is encouraging and supportive of my decision to move forward. http://www.ncbi.nlm.nih.gov/pubmed/11591969 > > What I need to understand is, what is considered to be a failure? I think failures mean no or little relief if dysphagia. > > > > When looking at studies that is a very good question to ask. Sometimes > it is based on questionnaires that patients are asked before and after > treatment. Sometimes it is bases on test results, such as timed barium > swallows. It could be based on a combination of those. Sometimes it is > the amount of improvement in these kind of things. The thing is what is > considered a success or failure can differ from one study to another. To > make it even more confusing, there have been studies that found symptoms > (which is what the patient reports on the questionnaires) and test > result don't always correlate well. You could think your swallowing is > better than it is because your esophagus is large enough to hold enough > food that it acts like a second stomach. To you it feels like food when > down OK but it may actually be sitting in your second stomach. ( " You " > being generic and this not necessarily the way things are for you.) If > something like this happens after treatment is it a success or a > failure? One study may call it a success based on the symptoms you > report, and another study may call it a failure based on a barium swallow. > > When you talk to doctors about their success rates you may want to ask > what they consider a success and also a failure. > > > Here is where my thinking may be off. I was not assuming that most or All of these patients had very high dysphagia scores before the surgery. Then it would make sense to me that someone who has high dysphagia and low les pressure preoperatively would not really benefit from their decrease in lewd pressure. > > > > I think there may be something missing in the way manometry tests are > done. The probe used to measure the pressure is small. We all wish it > was even smaller. But that means it can only measure pressure at the LES > when when it is closed. Imagine that the LES is like an elastic band > around a tube. In some people that band may be not as elastic as in > others but when closed have the same pressure. As you try to open the > band it fights back and begins to push back with more pressure. Because > this band is stiffer than expected it pushes back with more pressure > than expected as it is opened. If there is limited pressure to open it, > you may not be able to open it as much as you would a more elastic one. > Remember though that when closed this band does not seem any stronger > than the more elastic one. If it can't be opened very far before the > pressure become too much to overcome then it is easier to block with > bits of food. I am thinking that a myotomy may make so that the LES > does not increase in pressure as fast, allowing it to open more with > limit peristaltic pressure. Just my thoughts which could be wrong. > > In secondary achalasia due to scleroderma the LES is stiff and has low > pressure. Even so myotomy is sometimes done in these cases too. > > > For me, my dysphagia score is so low to begin with. Could a myotomy wind up making my dysphagia worse? > > > > There have been people that had myotomies and wished they didn't. There > are some things like adhesions and scar tissue that effect some people > more than others. A surgeon could damage your vagus nerve. You could end > up with more reflux. There are always risks. In good centers the > " success " rates are often something like 90% so some of these risk are > fairly small. > > I think you should forget the terms success and failure and focus on > your risks, and what you want from the surgery. The experts on " your " > risks are going to be your doctors. Assuming they have the experience. > and you seem to have chosen some that do, what do they see your risks > being if they do the surgery, and what are the chances that it will do > for you what you want. It is good to know the studies so you can > understand the discussions with your doctors but what matters in the end > is what is your situation with " them " is likely to be. > > Have you seen this one? > > Preoperative lower esophageal sphincter pressure has little influence on > the outcome of laparoscopic Heller myotomy for achalasia. > Gorodner MV, Galvani C, Fisichella PM, Patti MG. > http://www.ncbi.nlm.nih.gov/pubmed/15054655 > > notan > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 15, 2010 Report Share Posted July 15, 2010 Cara wrote: > I just found another study from the series you linked to in your post ... > There is a collection of links of this type at: http://www.zotero.org/groups/achalasia_atheneum/items/collection/2179041 And for information on long-term results see: http://www.zotero.org/groups/achalasia_atheneum/items/collection/2179157 If those pages come up blank try again later. I have never gotten any feedback about these collections so if you have any thoughts about them let me know. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 15, 2010 Report Share Posted July 15, 2010 Cara wrote: > So the risks for me seem to be regrowth or fibrosis or adhesions that may impede my swallowing over time. Possibly even reflux (but there are meeds for that). Should I take from your post that with the top Dr.s these risks are minimized? Those are risks in general with the myotomy. In general, statistically speaking the best docs and centers should be the lowest risk. You are not just a statistic though and your personal risks with your specific conditions and your doctor's choice of technique and skill means you will have to get the finer points on these risks evaluated by each doctor. > Out of these people who wish they never had the myotomy, how many of them went to top doctors? And were they swallowing very well before surgery? (not sure if you know their details). > I don't have those numbers. But the stories of people that just rushed into surgery with just any doc are classic here and I know many of the old timers of this group must cringe when they read that someone has just had the myotomy at their local modestly staffed hospital. > The case of ottenheimer is discouraging because he made a comment that he was swallowing better before the myo. And his E was in pretty bad shape (it seems from his post) just like mine. And he went to Rice. There are limits to what even the best can do and there are no guarantees. Not even the best can predict 100% what the outcome will be. They should be able to say what they believe the chances are for a certain outcome are. > I will most likely be going through with the myo because if I don't, I run the risk of more major complications down the road and most definitely an ectomy. I can't tell you what is best for you. It is hard for me to guess what is best for me. I tell people to do their homework and then with their doctors make the best guess they can and then never look back. > If anyone can save my E it should be Rice. I mean he is supposed to be the best, right? > I don't get into that who is best kind of thing. I figure there are a number of them that should be very good. Probably some we haven't even heard of here. One may be best in one way and another best in another. All the doctors you have discussed have great amounts of experience and have people in this group that are their fans. I would say they seem to be among the best from what I hear in this group. notan Quote Link to comment Share on other sites More sharing options...
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