Re: Email from Dr. Richter

[Guest guest]

Wow he agreed 100%, that must feel somewhat comforting to you?  Glad that you

are getting responses, the more the better from these great doctors. 

Julee So Calif.

________________________________

From: spotoca <cspoto@...>

achalasia

Sent: Tue, August 17, 2010 10:03:29 AM

Subject: Email from Dr. Richter

 

So I emailed Dr. Richter all about my situation. Gave him all the pertinent

details and asked his opinion. I may even pay for a consult with him as well.

Here is his response (keep in mind this is a GI, not a surgeon):

Cara:

As you may know, Tom Rice and I worked together for 10 yrs at the Cleveland

Clinic. We saw many patients like you, although generally older. I agree with Dr

Rice 100% that you need a laparoscopic myotmy+- a fundoplication. The goal here

is to try and save your megaesophagus and prevent you from needing an

esophagectomy.

I would be happy to discuss this further. You can call my secretary Liz at the

below number to schedule a time to talk. I really don't need your xrays to

address this issue, but would be happy to review.

So now I have 2 people erring on the side of myotomy....

Lets see what Dr. L has to say...

[Guest guest]

Hi Cara, I just underwent a dilation with Dr. Richter yesterday. I had met with

different doctor at Jefferson before hearing about Dr. Richter at Temple. He

was by far more specialized in the disease than I felt the other doctor was. I

really got the feeling that he truely analizes each case and suggests the best

option is for each specific patient. In my case, he told me I was a good

candidate for myotomy or dilation. I chose dilation cause I wanted to try the

less evasive route first. I can tell you when I had my consulation with him he

spent over an hour talking with me going over all my questions and explaining

everything in detail. I never felt rushed at all.

Vicky in Cape May, NJ

>

> So I emailed Dr. Richter all about my situation. Gave him all the pertinent

details and asked his opinion. I may even pay for a consult with him as well.

Here is his response (keep in mind this is a GI, not a surgeon):

>

> Cara:

>

> As you may know, Tom Rice and I worked together for 10 yrs at the Cleveland

Clinic. We saw many patients like you, although generally older. I agree with Dr

Rice 100% that you need a laparoscopic myotmy+- a fundoplication. The goal here

is to try and save your megaesophagus and prevent you from needing an

esophagectomy.

>

> I would be happy to discuss this further. You can call my secretary Liz at the

below number to schedule a time to talk. I really don't need your xrays to

address this issue, but would be happy to review.

>

>

> So now I have 2 people erring on the side of myotomy....

>

> Lets see what Dr. L has to say...

>

[Guest guest]

Hi Vicky,

I wish Dr. Richter had said that I would be a good candidate for a dilatation

but I guess he is agreeing with Dr. Rice. Not sure if that is out of respect for

a colleague or if its his true opinion.

I am unfortunately in a much more advanced stage of the disease than you are.

My only advice is to follow up with barium swallows every 2 years or so. You

need to monitor and make sure your E is not stretching out. If it is then you

need the myotomy or another dilatation.

As for spams, yes, I got them after my dilatation. I would feel them coming on

and I would immediately shug room temp water and that would stop them in their

tracks. I am not sure that this works for everyone but I could not be anywhere

without my bottle of room temp water.

I remember once I was on the NYC subway going to work and I forgot to take my

water. The subway car was crowded and I got a little claustrophobic which

brought on stress and a spasm. i couldn't stop it because I had no water and the

pain got so intense I just passed out right on the subway floor. Good times.

Back then I thought they were just extreme heart burn pains. Now because of this

group I know what they are.

If water works for you, never leave home without it!!

Cara

> >

> > So I emailed Dr. Richter all about my situation. Gave him all the pertinent

details and asked his opinion. I may even pay for a consult with him as well.

Here is his response (keep in mind this is a GI, not a surgeon):

> >

> > Cara:

> >

> > As you may know, Tom Rice and I worked together for 10 yrs at the Cleveland

Clinic. We saw many patients like you, although generally older. I agree with Dr

Rice 100% that you need a laparoscopic myotmy+- a fundoplication. The goal here

is to try and save your megaesophagus and prevent you from needing an

esophagectomy.

> >

> > I would be happy to discuss this further. You can call my secretary Liz at

the below number to schedule a time to talk. I really don't need your xrays to

address this issue, but would be happy to review.

> >

> >

> > So now I have 2 people erring on the side of myotomy....

> >

> > Lets see what Dr. L has to say...

> >

>

[Guest guest]

Cara, the impression I got from Dr. Richter is that he would want to advise you

to do what's best for you. I hope you get the treatment you need.

I told my husband that the pain from a spasm is the kind of pain that makes you

want to pass out. Your story proved that!

I gradually started with symptoms last year but got to the point 6 months ago

that I couldn't get food or liquids down with out taking smooth muscle relaxers

every 4 hours. If I didn't take them I'd end up regurgitating my own saliva some

days. So far so good with the dilation. I'm just hoping it lasts. Good luck to

you in your treatment and thanks for the advise on the room temp water for

spasms. I'll have to try that next time.

Vicky

> > >

> > > So I emailed Dr. Richter all about my situation. Gave him all the

pertinent details and asked his opinion. I may even pay for a consult with him

as well. Here is his response (keep in mind this is a GI, not a surgeon):

> > >

> > > Cara:

> > >

> > > As you may know, Tom Rice and I worked together for 10 yrs at the

Cleveland Clinic. We saw many patients like you, although generally older. I

agree with Dr Rice 100% that you need a laparoscopic myotmy+- a fundoplication.

The goal here is to try and save your megaesophagus and prevent you from needing

an esophagectomy.

> > >

> > > I would be happy to discuss this further. You can call my secretary Liz at

the below number to schedule a time to talk. I really don't need your xrays to

address this issue, but would be happy to review.

> > >

> > >

> > > So now I have 2 people erring on the side of myotomy....

> > >

> > > Lets see what Dr. L has to say...

> > >

> >

>

[Guest guest]

Blicky said:

" Cara, the impression I got from Dr. Richter is that he would want to advise you

to do what's best for you. I hope you get the treatment you need. "

Different doctors leave different impressions with different patients. When it

comes to personalities, some of the surgeons and GI doctors should be judged

more for their skills than for their bedside manners.

There is no question as to how knowledgeable Dr. Richter is.  I will not engage

in personality bashing on this site for I feel it is non-productive. However, I

will just say that Dr. Richter was well aware of my aversion to having the

ectomy, so after he gave me his opinion that I should have one, I did not

appreciate his next statement to me that I would be returning to him " in a

year

or two begging to have the esophagectomy done. " It seemed to me to be a form of

intimidation.

That was 4 years ago. Still no return to Dr. Richter, still no ectomy

and still

feeling fine.

________________________________

From: blicky77 <blicky77@...>

achalasia

Sent: Wed, August 18, 2010 10:29:53 PM

Subject: Re: Email from Dr. Richter

 

Cara, the impression I got from Dr. Richter is that he would want to advise you

to do what's best for you. I hope you get the treatment you need.

I told my husband that the pain from a spasm is the kind of pain that makes you

want to pass out. Your story proved that!

I gradually started with symptoms last year but got to the point 6 months ago

that I couldn't get food or liquids down with out taking smooth muscle relaxers

every 4 hours. If I didn't take them I'd end up regurgitating my own saliva some

days. So far so good with the dilation. I'm just hoping it lasts. Good luck to

you in your treatment and thanks for the advise on the room temp water for

spasms. I'll have to try that next time.

Vicky

> > >

> > > So I emailed Dr. Richter all about my situation. Gave him all the

pertinent

>details and asked his opinion. I may even pay for a consult with him as well.

>Here is his response (keep in mind this is a GI, not a surgeon):

> > >

> > > Cara:

> > >

> > > As you may know, Tom Rice and I worked together for 10 yrs at the

Cleveland

>Clinic. We saw many patients like you, although generally older. I agree with

Dr

>Rice 100% that you need a laparoscopic myotmy+- a fundoplication. The goal here

>is to try and save your megaesophagus and prevent you from needing an

>esophagectomy.

> > >

> > > I would be happy to discuss this further. You can call my secretary Liz at

>the below number to schedule a time to talk. I really don't need your xrays to

>address this issue, but would be happy to review.

> > >

> > >

> > > So now I have 2 people erring on the side of myotomy....

> > >

> > > Lets see what Dr. L has to say...

> > >

> >

>

[Guest guest]

,

I agree with you, everyone has different experiences with different doctors. I

wouldn't of liked having that said to me either. I sort of experienced a

similar situation when I met with Dr. Cohen at Jefferson University Hospital

(prior to meeting Dr. Richter). Dr. Cohen told me that my only option was to

have surgery and to get botox to hold me over in the meantime. He said he

didn't do dilations because he didn't want to deal with the 5% change of

perferation. I did some research and found out that getting botox prior to

surgery could possibly cause scar tissue which could potentially make surgery

more difficult. That lead me to find another doctor to talk find out what other

options I had. That's when someone on this board told me about Dr. Richter. I

emailed him my story and to my surprise he actually emailed me back so I made an

appt and met with him. After he told me I was a candidate for dilaiton or

surgery he told me to think about it. I decided to try the less invasive option

first and since I knew his perferation rate was 1.9% I felt comfortable having

him do it. If I had just gone along with what the first doctor had told me I

would of had surgery already and not felt like I had been given all the options.

I'm not the type of person to jump into having surgery as a first option so I

totally don't blame you for jumping into having an ectomy, especially since

that's a big surgery from what I've read on here. I'm glad to hear that you're

going well w/out having had an ectomy!

> > > >

> > > > So I emailed Dr. Richter all about my situation. Gave him all the

pertinent

> >details and asked his opinion. I may even pay for a consult with him as well.

> >Here is his response (keep in mind this is a GI, not a surgeon):

> > > >

> > > > Cara:

> > > >

> > > > As you may know, Tom Rice and I worked together for 10 yrs at the

Cleveland

> >Clinic. We saw many patients like you, although generally older. I agree with

Dr

> >Rice 100% that you need a laparoscopic myotmy+- a fundoplication. The goal

here

> >is to try and save your megaesophagus and prevent you from needing an

> >esophagectomy.

> > > >

> > > > I would be happy to discuss this further. You can call my secretary Liz

at

> >the below number to schedule a time to talk. I really don't need your xrays

to

> >address this issue, but would be happy to review.

> > > >

> > > >

> > > > So now I have 2 people erring on the side of myotomy....

> > > >

> > > > Lets see what Dr. L has to say...

> > > >

> > >

> >

>

>

>

>

>

>

>

>

[Guest guest]

Chonaki and Cohen, at Jefferson did my myotomy, and a hernia operation at the

same time. I think well of them, but they have inherent biases towards surgery.

They ARE surgeons, after all. & nbsp;

Jefferson surgery and their docs do have an assembly line approach. They tend

not to want to share much test data with patients. I won'tg o back to them for

follow up. I will contact Richter's office.

His paper was informative: about achalasia and about how much he's kept abreast

of it.

Dan

-- Sent from my Palm Pre

On Aug 19, 2010 2:07 PM, blicky77 & lt;blicky77@... & gt; wrote:

& nbsp;

,

I agree with you, everyone has different experiences with different doctors. I

wouldn't of liked having that said to me either. I sort of experienced a

similar situation when I met with Dr. Cohen at Jefferson University Hospital

(prior to meeting Dr. Richter). Dr. Cohen told me that my only option was to

have surgery and to get botox to hold me over in the meantime. He said he

didn't do dilations because he didn't want to deal with the 5% change of

perferation. I did some research and found out that getting botox prior to

surgery could possibly cause scar tissue which could potentially make surgery

more difficult. That lead me to find another doctor to talk find out what other

options I had. That's when someone on this board told me about Dr. Richter. I

emailed him my story and to my surprise he actually emailed me back so I made an

appt and met with him. After he told me I was a candidate for dilaiton or

surgery he told me to think about it. I decided to try the less invasive option

first and since I knew his perferation rate was 1.9% I felt comfortable having

him do it. If I had just gone along with what the first doctor had told me I

would of had surgery already and not felt like I had been given all the options.

I'm not the type of person to jump into having surgery as a first option so I

totally don't blame you for jumping into having an ectomy, especially since

that's a big surgery from what I've read on here. I'm glad to hear that you're

going well w/out having had an ectomy!

& gt; & gt; & gt; & gt;

& gt; & gt; & gt; & gt; So I emailed Dr. Richter all about my situation. Gave him

all the pertinent

& gt; & gt;details and asked his opinion. I may even pay for a consult with him as

well.

& gt; & gt;Here is his response (keep in mind this is a GI, not a surgeon):

& gt; & gt; & gt; & gt;

& gt; & gt; & gt; & gt; Cara:

& gt; & gt; & gt; & gt;

& gt; & gt; & gt; & gt; As you may know, Tom Rice and I worked together for 10 yrs

at the Cleveland

& gt; & gt;Clinic. We saw many patients like you, although generally older. I

agree with Dr

& gt; & gt;Rice 100% that you need a laparoscopic myotmy+- a fundoplication. The

goal here

& gt; & gt;is to try and save your megaesophagus and prevent you from needing an

& gt; & gt;esophagectomy.

& gt; & gt; & gt; & gt;

& gt; & gt; & gt; & gt; I would be happy to discuss this further. You can call my

secretary Liz at

& gt; & gt;the below number to schedule a time to talk. I really don't need your

xrays to

& gt; & gt;address this issue, but would be happy to review.

& gt; & gt; & gt; & gt;

& gt; & gt; & gt; & gt;

& gt; & gt; & gt; & gt; So now I have 2 people erring on the side of myotomy....

& gt; & gt; & gt; & gt;

& gt; & gt; & gt; & gt; Lets see what Dr. L has to say...

& gt; & gt; & gt; & gt;

& gt; & gt; & gt;

& gt; & gt;

& gt;

& gt;

& gt;

& gt;

& gt;

& gt;

& gt;

& gt;

[Guest guest]

Dan, the other thing that Dr. Cohen said to me that made me a little skeptical

was that if I got the myotomy it would be a permanent fix to my problem and

would never have to worry about it again...I think we all know that isn't that

case as we've all heard about so many poeple who have had to have dilations

after surgery because it didn't work for them. So that comment along with the

" I don't deal with dilations anymore " made me feel like he was maybe not as well

informed or plugged in as I would like. The other main difference between Cohen

and Richter is that Dr. Cohen likes to do annual endoscopies to monitor

progression while Dr. Richter likes to do timed barium swallows to see the

progression in time that the E empties to slow down any stretching of the E as

long as possible. Dr. Richter told me that Dr. Cohen is just more of an old

school type of doctor. I personally prefer Dr. Richter's methods. He said with

me and showed me my barium swallow results and we talked for over an hour in my

initial consultation. I had a successful dilation with Richter on tuesday and am

scheduled to go back in 6 weeks to have a follow up timed barium swallow to make

sure things look ok. He said a normal person's E empties in one minutes. Mine

took over 5 in my initial x-ray. Needless to say it's been wonderful to be able

to eat and drink again w/out taking muscle relaxers! Keeping my fingers crossed

that it lasts.

Good luck to you Dan, I hope you have easy eating!

>

> & gt; & gt; & gt; & gt;

>

> & gt; & gt; & gt; & gt; So I emailed Dr. Richter all about my situation. Gave him

all the pertinent

>

> & gt; & gt;details and asked his opinion. I may even pay for a consult with him

as well.

>

> & gt; & gt;Here is his response (keep in mind this is a GI, not a surgeon):

>

> & gt; & gt; & gt; & gt;

>

> & gt; & gt; & gt; & gt; Cara:

>

> & gt; & gt; & gt; & gt;

>

> & gt; & gt; & gt; & gt; As you may know, Tom Rice and I worked together for 10 yrs

at the Cleveland

>

> & gt; & gt;Clinic. We saw many patients like you, although generally older. I

agree with Dr

>

> & gt; & gt;Rice 100% that you need a laparoscopic myotmy+- a fundoplication. The

goal here

>

> & gt; & gt;is to try and save your megaesophagus and prevent you from needing an

>

> & gt; & gt;esophagectomy.

>

> & gt; & gt; & gt; & gt;

>

> & gt; & gt; & gt; & gt; I would be happy to discuss this further. You can call my

secretary Liz at

>

> & gt; & gt;the below number to schedule a time to talk. I really don't need your

xrays to

>

> & gt; & gt;address this issue, but would be happy to review.

>

> & gt; & gt; & gt; & gt;

>

> & gt; & gt; & gt; & gt;

>

> & gt; & gt; & gt; & gt; So now I have 2 people erring on the side of myotomy....

>

> & gt; & gt; & gt; & gt;

>

> & gt; & gt; & gt; & gt; Lets see what Dr. L has to say...

>

> & gt; & gt; & gt; & gt;

>

> & gt; & gt; & gt;

>

> & gt; & gt;

>

> & gt;

>

> & gt;

>

> & gt;

>

> & gt;

>

> & gt;

>

> & gt;

>

> & gt;

>

> & gt;