Giggity, Giggity, Giggity, Let's Have an Endoscopy!

I had the pleasure of upper endoscopy December 6th at the VA hospital. It was performed without a hitch because I had a great team. During an Endoscopy, the patient is sedated, but awake and instructed to swallow a tube with a camera on the end. The gastroenterologist performing the procedure examines the tissue of the esophagus, stomach, upper intestine, and takes biopsies for further diagnoses. It’s one of my annual routine tests to monitor the progression of Scleroderma, Sarcoidosis and its complications. I don’t mind endoscopies because I never remember a thing and I wake up feeling very relaxed, but there was one time that was not the case. In 2002, because of a lousy IV placement and an overscheduled doctor at Hemet Hospital more concerned about his quota, I was conscious during my endoscopy procedure. (I had an HMO. This has NEVER happened at the VA.) If you are ever asked to do one of those awake because your doctor is a douche bag, just say no, but I digress.

Diagnostic procedures have become as routine as annual dentist visits and flu shots. My GI tract doesn’t get any special treatment. I have routine tests every year for my heart and lungs. My liver, blood platelets, white cell count and kidneys are monitored by frequent blood work, but tests for my GI tract are the most invasive. I don’t remember much about my first GI test in 1996, but it did involve a dark room and two radiologists (Giggity). While lying face down on an x-ray table, one radiologist fed me a drink, while the other operated a camera and kept telling me to hold still and swallow. The camera was an x-ray machine, the cocktail was a chalky barium drink that felt like Pop-Rocks going down my throat and the procedure was called a barium esophagram. Luckily, I only needed to take the test once. The radiologists worked hard to provoke reflux symptoms and unfortunately, they were very successful. The good news; no more chalky Pop-Rock cocktails, the bad news; it only took one of these tests to determine Scleroderma was targeting my upper digestive tract and my doctors needed more information. I had been promoted to upper endoscopy.

I don’t remember my first endoscopy. Probably because of the great drugs they gave me to forget about it. (Roofies?) Eventually, a world of ways to view my digestive tract was opened and an endoscopy was just the beginning.

In 2005, I was given a test to determine my ability to swallow called a barium swallow study. A swallow study is performed by a speech pathologist and a radiologist. I was given barium-laced banana, chocolate pudding and juice while filming the food traveling down my throat made possible by x-ray. The radiologist doing the study was surprised it took four seconds for food to travel down my esophagus. That doesn’t sound like a long time, but next time you’re eating, take a bite and swallow, then count one one-thousand, two one-thousand, etc… It’s longer than you think. Later, an endoscopy confirmed what the radiologist and speech pathologist hypothesized: My esophagus had slow motility due to scar tissue caused by reflux. In addition, I had a hiatal hernia which prevented my stomach from closing and causing stomach acid to flow into my esophagus while sleeping. I also received the diagnosis of Barrett’s Esophagus, a pre-cancerous condition where the white lining of the esophagus is replaced by red tissue. It is caused by long term repeated damage from chronic acid reflux. The pre-cancerous part of it sounds ominous, but the percentage of Barrett’s becoming cancerous is low and treatable if diagnosed the early stages.

Barrett’s Esophagus must be watched by my doctors, but maintaining my esophagus is a full time job. After the swallow study, I was given a series of exercises I practice every day in the shower and techniques to protect my airway when swallowing. I have to sleep in an elevated position. The current medication prescribed for treatment of my symptoms is Nexium- 40 mg twice a day and Ranitidine (Zantac) 300 mg twice a day. The Ranitidine was prescribed by my physician as an as-needed med. My diet (mostly) consists of foods that will not cause reflux. I start out my day with a protein shake to assist with swallowing of my meds and allow an easily digestible form of protein to jump start my day. I keep my meals small. Size really does matter and too large a meal can cause reflux. I love Mexican food and have switched my salsa from a chilie-base to a mango or fruit salsa. Ranitidine is great before meals with ingredients that can cause reflux. It’s different for everyone but for me it’s anything with garlic. For my own sanity, I have to have some of the foods I love but shouldn’t eat once in a while. Things with onions in them etc… Nothing too crazy, but when I do, I plan the meal in the middle of the day or stay up very late, take my Zantac and drink lots of water the rest of the day. Regular exercise is also helpful, but movement is always a good idea- as long as it’s not upside down on a full stomach. Stress management has helped me manage my symptoms with a great deal of success. Divorce almost cured my reflux, but because I have to share custody of my son, the Ranitidine really comes in handy along with a good sedative- but that’s a whole other entry.

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