Had my follow up with gastroenterologist yesterday. He's done all he can, medically. I'm seeing a top doctor in this type of problem at a local university hospital. There are only a few options available, even surgically:
1. Remove band, evaluate gastro-esophageal junction, hiatal hernia repair, vagus nerve damage/injury.
2. Remove band, take down HH repair and redo it along with Heller Myotomy.
3. Remove band, implant feeding tube for 3-6 months to rest the esophagus.
4. Remove band, remove esophagus with reconstructive surgery (horrible option)
The achalasia is "end stage" based on the manometry, but since pseudo achalasia is gaining prevalence in the banded population, I might get lucky and just end up with #1. Fingers crossed.
My motility was 0%
My appointments at the university start on May 17.
Wish me luck
I really appreciate all my band has done for me. Not that it's been easy, I did the work, stayed focused and exercised discipline. Unfortunately, my heart (and GI tract) are telling me its time to quit fighting and wave the white flag. Time to see my band surgeon and seriously discuss my options for removal/revision.
I've lost 90 lb, but my digestive system just isn't working correctly, 9 months after having all fill removed. Time to make the call and determine the next step.
I was doing better...medication for IBSc is working, I was able to eat without issue and Friday night without warning I found myself having a hard time. My daughter made lasagna, I took a small piece, didn't eat the noodles, so probably had a half cup of sauce, cheese and lean chicken Italian sausage. I stopped eating because I realized I was uncomfortable. Not full, not stuck, just slightly uncomfortable and a bit nauseous. After about a half hour, up it all came. By then I was in real pain...a burning feeling and I started having pain at my port area. Since then, I've had continuous discomfort and I'm on a soft/liquid diet.
I emailed my band doctor and requested an appointment to discuss my options for removal/revision. I feel defeated...I really thought I was going to get to keep my band.
May 2010 Realize Band implanted, hiatal hernia repair, uneventful recovery
Aug 2010 fill 3 cc
March 2011 fill .5 cc
Summer 2011 began to have epigastric pain at night.
Sept 2011 stomach virus
Sept 2011 pain upper right quadrant, duration 2-5 hours increasing, then subside quickly
Oct 2011 barium swallow, band fine, slow esophageal emptying
Oct 2011 upper abdominal ultrasound positive for gallstones
Oct 2011 gallbladder removal
Feb-May 2012 increasing GERD symptoms, nighttime epigastric pain radiating to shoulder, neck, jaw, back. Palpitations gradually increasing in frequency
May 2012 had cardiac work up, stress test, echocardiogram, negative for heart disease. BP was elevated, so new drug Rx, resolved palpitations/hypertension. Epigastric pain persisted.
June 2012 upper GI with barium shows stoma at band is nearly closed. Barium drips through, but no stream. Barium is backed up into esophagus. PA removes all saline (3.5 cc confirmed, clear, no sign of infection). Under flouro, barium is still in esophagus, emptying slowly. PA and Radiologist are concerned, but decide after I drink 8 oz water to schedule me for follow up 5 @ weeks.
July 2012 follow up, lost 4 lb. still having problems eating anything fibrous, but able to eat, at least. Barium swallow shows smaller than expected stream thru band, but also shows slow esophogeal motility, but not so slow as to require follow up. PA states that since I'm tolerating food, losing and have a bit of a motility issue, she won't fill me, but cautions me to stay on the band diet and if I'm able to eat everything and quantity increases over 1 cup, to come in for another evaluation.
Oct-Dec 2012 In early October, became very intolerant to most foods and started having nighttime pain again, GERD symptoms. Symptoms subsided for two weeks, then returned. Taking PPIs for GERD, probiotics and experiencing extreme constipation. BMs only every 8-10 days. Bloated miserable, having pain, feeling like food is stuck. November, saw GI doctor and he ordered EGD, soft low fiber diet. December EGD negative for Hpylori, celiac, erosion, Barrett's. Prescribed Amitiza for constipation. Antispasmodic for GI spasms.
Symptoms improved.
Feb symptoms (intolerance of meals, feeling stuck, etc) returned. Consult with GI doc, schedules GES. Results normal gastric emptying times, but abnormal esophageal retention. GI doctor follow up in 2 weeks.
March 2013: barium swallow:Dx achalasia, severe esophageal dilation due to LES failure to open in response to swallowing. Discussed options for removal/revision and further testing.
April 2013: esophageal manometry test to determine if achalasia is primary or secondary. If secondary, band IS the problem and it will have to come out. If primary, surgery may exacerbate the condition.
Update: GI doctor has done all he can for me. I'm scheduled in late May for evaluation with one of the top esophageal surgeons in the nation to discuss band removal, redoing my HH repair and looking to see if my vagus nerve has been damaged.
High weight 290 lb
Surgery weight 281.5
Band emptying weight 225
Current weight 202
Goal weight 170
At all times my PCP, Gastroenterologist, Cardiologist and Bariatric Surgeon were in communication. Procedures, records and test findings were shared.
Preexisting IBSd. Hypertension, hyperlipidemia, sleep apnea, GERD.
Sacroiliac Joint Dysfunction/Spinal Stenosis
Left knee osteoarthritis-replacement recommended
Still taking all medications I was taking pre-band + amitiza, antispasmodic and additional hypertensive drug
This describes a high pressure system with banding. It's not good for our esophagus. It was published on a competing website, so left off that portion of the link. I also posted a link to his blog, which this is a part.
articles/choice-of-bariatric-procedure-a-philosophy-obtained-in-20-years-of-bariatric-practice-2/ Dr Michael Roslin
http://nwhsurgicalweightloss.org/blog/choice-of-bariatric-procedure-part-1-a-philosophy-obtained-in-20-years-of-bariatric-practice/
Excerpt:
Most importantly, the band does not impact any of the hunger signals that we have been able to study. I also question its mechanism of action. The band functions to create a high pressure zone just past the esophagus, the tube that transports food from the mouth to stomach. As the pressure is raised, the esophagus has to work harder. Until the pressure reaches a certain point, the patient feels little restriction. Once too high, the pressure has an adverse impact on the muscular esophagus. This results in patients having heartburn or dysphagia when the band is too tight, and then feeling no restriction when loosened. Proponents of banding believe that there is an ideal point, or green zone. My experience has shown that this exists for some people. For others, the band can be frustrating to both patient and provider.
