Guest guest Posted December 9, 2011 Report Share Posted December 9, 2011 My balloon dilation is scheduled for Jan. 9. So much for getting in before the holidays. I could have gone in earlier with another dr. in the practice but having never met him, I opted to stick with my current dr. In checking out the other dr.'s bio I saw his special interest is in esophageal disorders. Maybe I should switch? I don't know how you handle that? I am nervous about the procedure. My GI's website said that it is painful. Dr. did not say that. Also worrying about a tear. The practice has their own endoscopy center so I won't have it done in the hospital. I have a whole month to " ponder " now! At least it is a very busy time of year. Lynn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 9, 2011 Report Share Posted December 9, 2011 I would ask  specific questions of the dr.: how many dilitations have you done? (you want this number to be in the  100's) how many perforations have you had? what was the overall success rate? etc...(there may well be other important questions to ask, I'm not as knowledgable about this procedure as some others) Is he published or otherwise recognized for achalasia experience? Hope this helps, Kim ________________________________ From: lynnej73 <lynnej73@...> achalasia Sent: Friday, December 9, 2011 10:45 AM Subject: Re: balloon dilation  Ok...this sounds really dumb but who do I ask to find out which dr. has the most experience? The nurse? The dr.s? > > I would personally use the dr. with the most experience. Perhaps you could schedule a consult with the other that can get you in. Timing of the procedure can be your reason - but you really don't need one. It's what's in your best interest. > I'm not familiar with the pain related - perhaps someone else can comment. > > Good luck, > Kim > > > ________________________________ > From: lynnej73 <lynnej73@...> > achalasia > Sent: Friday, December 9, 2011 10:04 AM > Subject: balloon dilation > > >  > My balloon dilation is scheduled for Jan. 9. So much for getting in before the holidays. I could have gone in earlier with another dr. in the practice but having never met him, I opted to stick with my current dr. In checking out the other dr.'s bio I saw his special interest is in esophageal disorders. Maybe I should switch? I don't know how you handle that? > > I am nervous about the procedure. My GI's website said that it is painful. Dr. did not say that. Also worrying about a tear. The practice has their own endoscopy center so I won't have it done in the hospital. I have a whole month to " ponder " now! At least it is a very busy time of year. Lynn > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2011 Report Share Posted December 10, 2011 lynn wrote: > > In my last scope she talked about possibly having to dilate a > stricture if they found one so I know she does them and she that is > pretty routine. > My GI does a lot of dilatations for strictures but refused to do an achalasia dilatation for me, saying it should be done by someone that does lots of them and they are not common enough for most GI to have enough of them to stay good at them. I really like that about my GI some GIs would be happy to let you be their first achalasia dilatation. I wouldn't want that no matter how many other dilatations they do. Some GIs do not even have an achalasia balloon and will try some other smaller balloon that has little chance of working. You pay either way. The achalasia balloons are usually about twice the size of their other largest balloon. I don't mean to scare you with this, but in a small percentage of cases things go badly wrong. Usually when a rupture happens it can easily be dealt with, but in some cases dilatation can cause an emergency life threatening situation. If the dilatation is not done in a hospital you may have to be moved to one for immediate surgery. The risk of this is small but enough that it would be factor in my not wanting someone who has not done a lot of achalasia dilatations regardless of how many other dilatations had been done. Because the achalasia balloon is so much larger than the other balloons a doctor that does not use them often, especially if not in a hospital, may be overly cautious. He may choose to use the smallest one when a larger one may work better, or he may not inflate it as much or for as long as it would take to get the most benefit. Doing a dilatation can be more complicated than just inflating a balloon at the right place and then removing it. There is an art to it and different doctors do it differently. Some doctors have a certain rate they fill the balloon at, some have certain amounts of time and pressure that they leave the balloon filled. Some may repressurize the balloon a number of times. Some may use more than one size balloon on the same session others may have the patient return over a period of time for multiple balloons. What is the first time doctor to do? notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 19, 2011 Report Share Posted December 19, 2011 Notan, You have provided me with great advice, as usual!! I had a dilation with 20mm balloon 6 months after my HM. After asking several doctors about this size and asking if this was small for a dilation I could not get a straight answer. Thank you for clarifying 30-40 is the size for Achalasia patients. This site has provided me with more information than specialists have. I continue with daily pain and struggling to eat and function. I am so thankful for the members here for sharing their experiences. BC > > > > Notan, > > > > I didn't know they used different baloons for Achalasia patients. > > > > For the dilators they use on typical strictures, scar tissue, Schatzki > Rings and such, 16 to 20mm are considered to be " Large caliber > dilators. " Achalasia dilators are in their own class and range from 30 > to 40 mm. Another thing to keep in mind is that on other strictures it > is usually connective tissue (scar, fibrotic tissue) that is being > busted or stretched. In achalasia it is muscle tissue that needs to be > stretch and the muscle fibers broke to weaken the LES muscles. So, doing > dilatation is not the same as doing achalasia dilatation. As I have said > before, some GIs will try to treat achalasia by using a " Large caliber > dilator " which is only half as big as needed and won't stretch the > muscles enough to break muscle fibers. > > > It sounds like this has really put you through a lot over the years. > > > > Not as badly as many here have been through it. Somehow I was able to > deal with it for decades without others even knowing I had a problem. > Finally, six years ago it was bad enough that I didn't want to see what > worse would be like and I had the surgery. There were some years just > before the surgery that were bad but over the decades I had grown used > to it. Now, six years after the surgery, symptom wise achalasia is > mostly a memory for me. I stay at this because I like to learn and I > like to share. I also like to be prepared because I know it could all > return. > > notan > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 19, 2011 Report Share Posted December 19, 2011 On 12/19/2011 7:05 PM, Blondie wrote: > > Notan, > You have provided me with great advice, as usual!! > I had a dilation with 20mm balloon 6 months after my HM. After asking > several doctors about this size and asking if this was small for a > dilation I could not get a straight answer. Thank you for clarifying > 30-40 is the size for Achalasia patients. This site has provided me > with more information than specialists have. I continue with daily > pain and struggling to eat and function. I am so thankful for the > members here for sharing their experiences. > BC > I am not sure how often they use the achalasia balloons after a myotomy. What is being stretched and the risks change after a myotomy. I will have to see if I can find that info. A quick check didn't find it. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 20, 2011 Report Share Posted December 20, 2011 Notan, In June this year i had a dilatation and as you know me from my past in that i had the ectomy done back in 2004. My question is in regards with the dilatation balloon size also. The GI who did the dilatation was told of my past medical history of ectomy for Achalasia and he elected to use the 20mm balloon to dilate my anastomosis stricture. This was the time when the balloon burst on me. The GI only inflated the balloon to 20mm for 4 & 1/2 minutes and that was when the balloon burst. Before the dilatation the nurse told me that when the department dilates Achalasia patients the Interventional Radiology Suite in the X-Ray dept normally handles the dilatations but in this instance my dilatation took place in the Gastro Unit. Bearing in mind the balloon bursting and using the 20mm balloon wouldn't it have been better performing my dilatation in the X-Ray Unit in case of rupture? I am still having problems swallowing but i am trying to hold on until after Xmas to contact the department to ra-arrange another dilatation. from the UK ________________________________ From: notan ostrich <notan_ostrich@...> achalasia Sent: Tuesday, December 20, 2011 3:19 AM Subject: Re: Re: balloon dilation  On 12/19/2011 7:05 PM, Blondie wrote: > > Notan, > You have provided me with great advice, as usual!! > I had a dilation with 20mm balloon 6 months after my HM. After asking > several doctors about this size and asking if this was small for a > dilation I could not get a straight answer. Thank you for clarifying > 30-40 is the size for Achalasia patients. This site has provided me > with more information than specialists have. I continue with daily > pain and struggling to eat and function. I am so thankful for the > members here for sharing their experiences. > BC > I am not sure how often they use the achalasia balloons after a myotomy. What is being stretched and the risks change after a myotomy. I will have to see if I can find that info. A quick check didn't find it. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 20, 2011 Report Share Posted December 20, 2011 notan ostrich wrote: I am not sure how often they use the achalasia balloons after a myotomy. > What is being stretched and the risks change after a myotomy. I will > have to see if I can find that info. A quick check didn't find it. Found this, FWIW ~~ this is *after* myotomy failure: " Endoscopic Dilation Technique In patients with recurrent symptoms, pneumatic dilation of the cardia was performed using a Rigiflex balloon dilator under direct endoscopic visual control. Patients fasted for at least 8 hours before the procedure and were sedated with intravenous midazolam and, if necessary, with propofol. All patients were given topical anesthesia to the pharynx. A dilator was passed over a guidewire positioned in the stomach, and the correct location of the dilator was checked by maintaining the scope above the balloon and controlling its position across the cardia through the transparent membrane of the dilator. In the first three patients, a 30-mm balloon was initially used and it was necessary to repeat the procedure with a larger-diameter balloon in all three; in the other seven patients, a 35- or 40-mm balloon was used from the beginning. The balloon was inflated to a median 6 psi (range 5–10) for 1 minute. Further dilations with a 35-mm-diameter Rigiflex dilator or 40-mm Rigiflex balloon were performed if the patient's symptoms persisted or recurred. " http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422413/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2011 Report Share Posted December 26, 2011 Thanks - the hospital I go to for treatment is a teaching hospital and he is going to call me this week with the results from my last Esophagram. I have a new list of questions for him.  And I never thought about the scaring issue at all. I am glad you brought that up. Technically I had one Achalasia dilation am really don't intend on making that a treatment option. I had to seriously think about things I am eating and maybe will always need to keep a much softer , blander diet. I am hoping that if I change some bad eating habits I developed over the holidays, I can keep it under control for awhile. I am hoping to wait a year or two, longer would be better- before I consider surgery options. It is not a matter of if but rather when I will have that done. But I will jump off that bridge when I get there........ \ Kim A ________________________________ From: Mueller IV <mt4mar@...> " achalasia " <achalasia > Sent: Thursday, December 22, 2011 12:40 PM Subject: Re: Re: balloon dilation  Kim, I know just how you feel. Just some advice from my personal experience. I would look into getting the surgery. I say this because it is better to try and prevent a lot of stretching as well as scar tissue build up. I know you feel frustrated and a lone. We are here for you though. Sent from my iPhone On Dec 22, 2011, at 13:15, Kim Abrams <xploring37@...> wrote: > My last dilation was 7 weeks ago and went pretty well until the last week. I got yet another cold as I seem to be susceptible to everything lately. I went in for an Esophagram on Monday and he said I still had food in me E. I was having real bad chest pain and I guess that would be why. He suggested drinking pop as well as some others have suggested on this site. It seems to help but boy is it hard getting it down. It makes me burp, just a little but then I seem to get these spasms, like in my throat. Not just from pop but lately when I eat. This is so frustrating!!! I just feel like there isn't a day that goes by and Achalasia is just constantly staring me in the face. The radiologist at Froedert Hosp mentioned surgery could help this and that my E is still very tight. My doctor used a 30 mm balloon for the last dilation so I am wondering if he did not go big enough. It looked like it was barely open. My doctor is supposed to call me back hopefully this > week to discuss. > > I am so grateful for this sight becasue it has given me a ton of information and whether I want to or not , I like everyone else here has to face this day after day. It is just stressing me out because I hoped to feel a lot better. I have been having regular chest for the last week and have another prescription for that. > > Sorry -I am just venting!!! > > Kim A > > > ________________________________ > From: Blondie <bagwoman52@...> > achalasia > Sent: Monday, December 19, 2011 8:05 PM > Subject: Re: balloon dilation > > > > > Notan, > You have provided me with great advice, as usual!! > I had a dilation with 20mm balloon 6 months after my HM. After asking several doctors about this size and asking if this was small for a dilation I could not get a straight answer. Thank you for clarifying 30-40 is the size for Achalasia patients. This site has provided me with more information than specialists have. I continue with daily pain and struggling to eat and function. I am so thankful for the members here for sharing their experiences. > BC > > > > > > > > Notan, > > > > > > I didn't know they used different baloons for Achalasia patients. > > > > > > > For the dilators they use on typical strictures, scar tissue, Schatzki > > Rings and such, 16 to 20mm are considered to be " Large caliber > > dilators. " Achalasia dilators are in their own class and range from 30 > > to 40 mm. Another thing to keep in mind is that on other strictures it > > is usually connective tissue (scar, fibrotic tissue) that is being > > busted or stretched. In achalasia it is muscle tissue that needs to be > > stretch and the muscle fibers broke to weaken the LES muscles. So, doing > > dilatation is not the same as doing achalasia dilatation. As I have said > > before, some GIs will try to treat achalasia by using a " Large caliber > > dilator " which is only half as big as needed and won't stretch the > > muscles enough to break muscle fibers. > > > > > It sounds like this has really put you through a lot over the years. > > > > > > > Not as badly as many here have been through it. Somehow I was able to > > deal with it for decades without others even knowing I had a problem. > > Finally, six years ago it was bad enough that I didn't want to see what > > worse would be like and I had the surgery. There were some years just > > before the surgery that were bad but over the decades I had grown used > > to it. Now, six years after the surgery, symptom wise achalasia is > > mostly a memory for me. I stay at this because I like to learn and I > > like to share. I also like to be prepared because I know it could all > > return. > > > > notan > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2011 Report Share Posted December 26, 2011 Hi , Yep, straight up it just really sucks. It is hard enough to get food down slowly, but I am able to eat a lot of softer foods and they will go down, Then it is exercising portion control ( which is tough sometimes when you are hungry) But I have had what I am calling "  rock gut " for 7 weeks now. It's like the food will go down and I can feel it going in my stomach and then just sitting there. When does this part go away???? Do you get that too? I have gained back between 5-8 pounds since then so I am keeping weight on but sometimes I feel all that is is mu stomach!! Yikes - my GI doctor said to drink Miralax daily but not sure for how long!!  Did you have a nice Christmas?  Kim A ________________________________ From: puddleriver13 <puddleriver13@...> achalasia Sent: Thursday, December 22, 2011 2:35 PM Subject: Re: balloon dilation  Kim, youse gots all my sympathies. Over the course of this " experience " for me, it's been all over the place: first spasms, but not much else. Then occasionally drooling/spitting. Then periods of spitting. Then, real pain on swallowing, right up around the pharynx. Then a clutchy feeling about half way down, where the spasms used to be. All of it coming in/out for days or weeks at a time, then just disappearing. Then spitty came to stay. The highest rating on any of the symptom forms is " daily " -- well I promise you, fifty or sixty times a day WAY outpaces the form. And there's NO figuring out WHY. Tuesday I was fine. Yesterday, I was fine until noon. Since then, for 24 hours NOT ONE DAMNED THING STAYED DOWN. Now I'm sitting here, hungry, tired, and dehydrated. Thing is: it ain't going to go away. We can keep messing around with low level stuff, or go for the gold. I'm with : go ahead and go for the gold. And check out Vitamin D3 for colds/flu. . . . http://jackkruse.com/the-sunshine-of-your-life/ AND this is a *terrific* place to vent. xox > > > > > > Notan, > > > > > > I didn't know they used different baloons for Achalasia patients. > > > > > > > For the dilators they use on typical strictures, scar tissue, Schatzki > > Rings and such, 16 to 20mm are considered to be " Large caliber > > dilators. " Achalasia dilators are in their own class and range from 30 > > to 40 mm. Another thing to keep in mind is that on other strictures it > > is usually connective tissue (scar, fibrotic tissue) that is being > > busted or stretched. In achalasia it is muscle tissue that needs to be > > stretch and the muscle fibers broke to weaken the LES muscles. So, doing > > dilatation is not the same as doing achalasia dilatation. As I have said > > before, some GIs will try to treat achalasia by using a " Large caliber > > dilator " which is only half as big as needed and won't stretch the > > muscles enough to break muscle fibers. > > > > > It sounds like this has really put you through a lot over the years. > > > > > > > Not as badly as many here have been through it. Somehow I was able to > > deal with it for decades without others even knowing I had a problem. > > Finally, six years ago it was bad enough that I didn't want to see what > > worse would be like and I had the surgery. There were some years just > > before the surgery that were bad but over the decades I had grown used > > to it. Now, six years after the surgery, symptom wise achalasia is > > mostly a memory for me. I stay at this because I like to learn and I > > like to share. I also like to be prepared because I know it could all > > return. > > > > notan > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2011 Report Share Posted December 26, 2011 , I can't believe you struggled with it for 22 years! That must have been aweful for you. I am happy that you finally got some relief. Your doctor is probaly right about the years of eating such small amounts taking a toll of other digestive issues. It will probably take some time to readjust and find the right foods that give you not only nutrition but that you are able to digest. I am still working on that and I think it is different for all of us.  I hope everyone had a good holiday!  Kim A ________________________________ From: Montoya <medhelpinfo@...> " achalasia " <achalasia > Sent: Thursday, December 22, 2011 10:32 PM Subject: Re: Re: balloon dilation  Hi Kim and others that are struggling!  There is such a wealth of knowledge here on this site for all of you to find some comfort that " we " are out there and can relate to the daily struggles of Achalasia! I suffered for 22yrs before I finally had the surgery. I think my achalasia developed slowly and during the course I always adapted to new ways of trying to cope with it. As stated on one of his comments, everyday is different, somedays the food may go down for a particular meal and other times it's regurg and start over....so frustrating!!!! We starve alot...no one understands this, but us!!!!  I can't begin to tell you all the false hope that doctors gave me over the years, they did NOT understand achalasia nor did they believe that I had it until this group armed me know knowledge to get the help I needed. Life has changed BIG TIME since surgery for me....I can EAT!!! I am enjoying this status for as long as it stays this good, it's been wonderful to eat and sleep and have no problems....my only issue since surgery is having to eat smaller portions because my stomach seems to not agree with my colon now!!!! My doctor feels that is because of all the years of eating such small amounts...perhaps, but regardless I will take this anyday compared to the hell I went through for years!  As everyone here will tell you, the most important thing is to find the best surgeon and ask questions.  Best wishes!  Merry Christmas and happy holidays!  Julee in Oregon!  From: Kim Abrams <xploring37@...> " achalasia " <achalasia > Sent: Thursday, December 22, 2011 10:15 AM Subject: Re: Re: balloon dilation  My last dilation was 7 weeks ago and went pretty well until the last week. I got yet another cold as I seem to be susceptible to everything lately. I went in for an Esophagram on Monday and he said I still had food in me E. I was having real bad chest pain and I guess that would be why. He suggested drinking pop as well as some others have suggested on this site. It seems to help but boy is it hard getting it down. It makes me burp, just a little but then I seem to get these spasms, like in my throat. Not just from pop but lately when I eat. This is so frustrating!!! I just feel like there isn't a day that goes by and Achalasia is just constantly staring me in the face. The radiologist at Froedert Hosp mentioned surgery could help this and that my E is still very tight. My doctor used a 30 mm balloon for the last dilation so I am wondering if he did not go big enough. It looked like it was barely open. My doctor is supposed to call me back hopefully this week to discuss.   I am so grateful for this sight becasue it has given me a ton of information and whether I want to or not , I like everyone else here has to face this day after day. It is just stressing me out because I hoped to feel a lot better. I have been having regular chest for the last week and have another prescription for that.  Sorry -I am just venting!!!  Kim A ________________________________ From: Blondie <bagwoman52@...> achalasia Sent: Monday, December 19, 2011 8:05 PM Subject: Re: balloon dilation  Notan, You have provided me with great advice, as usual!! I had a dilation with 20mm balloon 6 months after my HM. After asking several doctors about this size and asking if this was small for a dilation I could not get a straight answer. Thank you for clarifying 30-40 is the size for Achalasia patients. This site has provided me with more information than specialists have. I continue with daily pain and struggling to eat and function. I am so thankful for the members here for sharing their experiences. BC > > > > Notan, > > > > I didn't know they used different baloons for Achalasia patients. > > > > For the dilators they use on typical strictures, scar tissue, Schatzki > Rings and such, 16 to 20mm are considered to be " Large caliber > dilators. " Achalasia dilators are in their own class and range from 30 > to 40 mm. Another thing to keep in mind is that on other strictures it > is usually connective tissue (scar, fibrotic tissue) that is being > busted or stretched. In achalasia it is muscle tissue that needs to be > stretch and the muscle fibers broke to weaken the LES muscles. So, doing > dilatation is not the same as doing achalasia dilatation. As I have said > before, some GIs will try to treat achalasia by using a " Large caliber > dilator " which is only half as big as needed and won't stretch the > muscles enough to break muscle fibers. > > > It sounds like this has really put you through a lot over the years. > > > > Not as badly as many here have been through it. Somehow I was able to > deal with it for decades without others even knowing I had a problem. > Finally, six years ago it was bad enough that I didn't want to see what > worse would be like and I had the surgery. There were some years just > before the surgery that were bad but over the decades I had grown used > to it. Now, six years after the surgery, symptom wise achalasia is > mostly a memory for me. I stay at this because I like to learn and I > like to share. I also like to be prepared because I know it could all > return. > > notan > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2011 Report Share Posted December 26, 2011 Hi Kim, Yikes -that is where I was at but only lost 35 pounds. If I get that bad again I will definitely be back. I had bad eating habits before I got sick and I found that I really need to keep my diet a lot simpler and I seem to feel better. Holidays did not help that! I am keeping an open mind about the surgery. I think when I am ready I will know but I am learning some other homeopathic things on this sight that have definitely helped. I am not sure how well I would handle this without this sight. I have friends that know someone that might have had something like I do but not Achalasia. It really has turned my life upside down like I am sure everyone else on this sight can relate to that. I am grateful for the wealth of knowledge and the support I get from this group.   Kim A ________________________________ From: Kim <kimellenbailey@...> " achalasia " <achalasia > Sent: Friday, December 23, 2011 9:44 AM Subject: Re: balloon dilation  Go for the surgery. Don't suffer needlessly. I lost 70 pounds in short time. Was choking. Drooling all night keeping spit cup in purse and with at all times. Was not eating.liquid not going down taking 2 big bags plus more IV fluid w potassium every week. Hemoglobin low. Looked like death warmed over literally. Could. Not even drink h20. Got lapro surgery. Sept 8. Now worry I gain too much. Life is good. Get surgery Sent from my iPhone Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 27, 2011 Report Share Posted December 27, 2011 What do you mean " disrupt scar tissue " ?  Kim A ________________________________ From: puddleriver13 <puddleriver13@...> achalasia Sent: Saturday, December 24, 2011 1:55 PM Subject: Re: balloon dilation  What scares me a little is it seems that people who get the HM still need dilations later. This is definitely not a textbook disease. I'm thinking, and Notan could prolly give you chapter and verse on this, that dilations before surgery are to tear the actual LES. Dilations *AFTER* surgery (if needed) are to disrupt *scar tissue*. . . . It's us, individually, that form scar tissue how we will, NOT this damned disease. xox Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2011 Report Share Posted December 29, 2011 wrote: > > ... The GI who did the dilatation was told of my past medical history > of ectomy for Achalasia and he elected to use the 20mm balloon to > dilate my anastomosis stricture. This was the time when the balloon > burst on me. ... > They wouldn't be using an achalasia balloon on the anastomosis, those would only be used on the LES. The 20mm is on the large size for other esophageal work but may be right for your anastomosis. > The GI only inflated the balloon to 20mm for 4 & 1/2 minutes and that > was when the balloon burst. > It is rare but balloons do burst sometimes. > Before the dilatation the nurse told me that when the department > dilates Achalasia patients the Interventional Radiology Suite in the > X-Ray dept normally handles the dilatations but in this instance my > dilatation took place in the Gastro Unit. > They were not doing an " achalasia " dilatation though. That would have been with a 30 to 40mm balloon and do at the LES. Your's was only 20mm and not at the LES. > Bearing in mind the balloon bursting and using the 20mm balloon > wouldn't it have been better performing my dilatation in the X-Ray > Unit in case of rupture? > I would guess that they had no reason to see this as being any different from any other anastomosis dilatation. Safe enough for most. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2011 Report Share Posted December 29, 2011 wrote: > > > notan ostrich wrote: > I am not sure how often they use the achalasia balloons after a myotomy. > > What is being stretched and the risks change after a myotomy. I will > > have to see if I can find that info. A quick check didn't find it. > > Found this, FWIW ~~ this is *after* myotomy failure: > Thanks for finding that. It looks like even after a myotomy the 30 to 40mm balloons are still standard for dilating the LES. They are also recommended for fundoplications that are too tight. Sometimes a doctor may not be comfortable with using one that big though. He may want to try something smaller, like 20mm, before trying the large ones. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2011 Report Share Posted December 29, 2011 wrote: > > What scares me a little is it seems that people who get the HM still > need dilations later. This is definitely not a textbook disease. > > I'm thinking, and Notan could prolly give you chapter and verse on > this, that dilations before surgery are to tear the actual LES. > Dilations *AFTER* surgery (if needed) are to disrupt *scar tissue*. . > . . It's us, individually, that form scar tissue how we will, NOT this > damned disease. > After a myotomy some people may go for many years without needing any dilatations, or even go the rest of their lives. Others need help quickly. Again, we are all different and there are no guarantees. There are a few reasons why a dilatation may be needed. Scar tissue and adhesions could have formed after the surgery that cause the LES to become harder and tight. These kinds of tissues tend to be harder, less flexible, and pull together (shrink). As that happens it can cause a stricture. Acid reflux may damage the esophagus near the LES and cause scarring on the inside of the lower esophagus. Again this can lead to an esophageal stricture. The myotomy may not have been complete, either not long enough or high pressure points remain in it where some muscle fibers were not completely cut through. It is also possible that the muscle that was cut could reattach somewhat or scar together enough so that the ring of muscles is once again a more complete ring. For those that have fundoplications it may be too tight, either made to tight or because of scarring and adhesions. Also, a fundoplication that is not a problem may become one if peristalsis becomes weaker. They can try dilatations on all these problems. Sometimes a fundoplication will have to be taken down and a myotomy that is not complete may need to be redone if dilatation does not help enough. People vary in how they scar and produce adhesions. The same trauma one two different people can produce very different patterns of scarring and adhesions. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2011 Report Share Posted December 30, 2011 Thank you notan, A lot of what you say makes sense. May need another dilatation in the same area again soon. from the UK ________________________________ From: notan ostrich <notan_ostrich@...> achalasia Sent: Thursday, December 29, 2011 11:20 PM Subject: Re: balloon dilation  wrote: > > ... The GI who did the dilatation was told of my past medical history > of ectomy for Achalasia and he elected to use the 20mm balloon to > dilate my anastomosis stricture. This was the time when the balloon > burst on me. ... > They wouldn't be using an achalasia balloon on the anastomosis, those would only be used on the LES. The 20mm is on the large size for other esophageal work but may be right for your anastomosis. > The GI only inflated the balloon to 20mm for 4 & 1/2 minutes and that > was when the balloon burst. > It is rare but balloons do burst sometimes. > Before the dilatation the nurse told me that when the department > dilates Achalasia patients the Interventional Radiology Suite in the > X-Ray dept normally handles the dilatations but in this instance my > dilatation took place in the Gastro Unit. > They were not doing an " achalasia " dilatation though. That would have been with a 30 to 40mm balloon and do at the LES. Your's was only 20mm and not at the LES. > Bearing in mind the balloon bursting and using the 20mm balloon > wouldn't it have been better performing my dilatation in the X-Ray > Unit in case of rupture? > I would guess that they had no reason to see this as being any different from any other anastomosis dilatation. Safe enough for most. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2011 Report Share Posted December 30, 2011 Kim wrote: > > What do you mean " disrupt scar tissue " ? > In the context of dilatation it means stretch it until it breaks. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 2, 2012 Report Share Posted January 2, 2012 Oh - I am truly amazed at how much you know about this disease. Thank you.  By the way, I just got a letter from Froedert after I had the Esophagram and they said the results of my last couple Esophagrams were compared and I showed an improvement of almost 50% in the emptying of my E. Is this considered a good result? Still many things I cannot eat or have trouble with but am overall happy I am able to eat and drink anything really. I have been having trouble the last couple of days with spasms and heartburn but think that all the food that I ate over the hoidays ( and really shouldn't have ) caught up with me. I can't help but think at this rate I would be lucky to make it to the end of the year without full symptoms returning. Kim A ________________________________ From: notan ostrich <notan_ostrich@...> achalasia Sent: Friday, December 30, 2011 9:58 AM Subject: Re: Re: balloon dilation  Kim wrote: > > What do you mean " disrupt scar tissue " ? > In the context of dilatation it means stretch it until it breaks. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2012 Report Share Posted January 7, 2012 Kim wrote: > > ... the results of my last couple Esophagrams were compared and I > showed an improvement of almost 50% in the emptying of my E. Is this > considered a good result? > ... I can't help but think at this rate I would be lucky to make it to > the end of the year without full symptoms returning. > Three of the best predictors treatment results and risk of failure are: the remaining pressure of the LES <10mmHg predicts good results, the reduction in LES pressure >50% predicts good results, timed barium esophagram with <50% improvement predicts bad results and faster failure. Don't think of these as sharp hard numbers. They are fuzzy statistical numbers. As many as a third of patients with excellent results have a bad score on at least one of these numbers. Specific esophagogram to assess functional outcomes after Heller's myotomy and Dor's fundoplication for esophageal achalasia. http://www.ncbi.nlm.nih.gov/pubmed/21385281 " Esophageal emptying assessed by 'barium and bread' and 'timed barium' esophagogram correlated well with symptomatic outcome after laparoscopic myotomy for esophageal achalasia. Complete symptomatic relief does not necessarily reflect complete esophageal emptying. " Timed barium oesophagram: better predictor of long term success after pneumatic dilation in achalasia than symptom assessment http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773230 " Thirty four patients with complete symptom relief post pneumatic dilation were identified. In 22/34 (65%) patients, the degree of symptom and barium height improvements was similar (concordant group). In 10/34 (30%) patients, there was < 50% improvement in barium height (discordant group). Significantly (p<0.001) more discordant (9/10; 90%) than concordant (2/22; 9%) patients failed therapy at the one year follow up. Seventeen of 22 (77%) concordant patients were still in remission while all discordant patients had failed therapy by six years of follow up. " Evaluation of the response to treatment in patients with idiopathic achalasia by the timed barium esophagogram: results from a randomized clinical trial. http://www.ncbi.nlm.nih.gov/pubmed/19431219 " significant correlations were found between the height of the barium column at 1 min and the symptom scores at the end of follow up for 'dysphagia for liquids' (P < 0.05, rho = 0.47), 'chest pain' (P < 0.05, rho = 0.42), and the ' dysphagia score' (P < 0.05, rho = 0.46). Patients with less than 50% improvement in this TBE-parameter (height at 1 min) post-treatment had a 40% risk of treatment failure during follow-up. " A Review of Factors Predicting Outcome of Pneumatic Dilation in Patients With Achalasia Cardia http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042226 notan Quote Link to comment Share on other sites More sharing options...
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