I've been reading here for a while and have summoned up the courage to post.
I'm 60 and despite having a couple well-managed autoimmune conditions and a small chapter in the book of medical conundrums
I thought I was in pretty good health.
I've been under a lot of stress for a protracted period (death of several family members, reduction in income, freak, and costly dental incident, and more). Gosh, care to meet me for coffee?!
Bottom line. Asymptomic until about
eight or nine months ago after traumatic cough/cold and than began to experience a few episodes of dysphasia and regurg; body appearance changed with fullness in breastbone area; occasional pain in back (not chest). A few months ago I changed gastroenterologists (I have ulcerative colitis and it was time for a colonoscopy) and also decided to have the upper endoscopy since health insurance situation not stable (had day after barium after shocking diagnosis from GI.)
I was completely unprepared for the outcome.
Diagnosed type 3 hernia, with 50% of stomach in my chest. I had made some lifestyle changes last summer as incidental diagnosis of hiatal hernia came from a breast MRI that I get annually because I'm high-risk breast cancer. This eliminated some symptoms.
I've seen one surgeon who is considered one of the best in the country (here in Seattle). It was an abbreviated visit and I had little time to ask questions. I do have have a public health background and know how to read research. And I have been reading a lot on this topic.
In a past life I was a medical writer and I've done health care quality assurance. I know the limits of my knowledge, however. Some doctors are welcoming if I mention my background and others are not. This fellow was almost the stereotypical type - condescending and dismissive and I felt terrible after the appt. If I went the surgical route, he would not be available until spring.
I will likely not have my current good health insurance and will be on the Exchange and not have access to any of the three doctors I'm been referred to if I wait several months.
I have another appt. at the end of this month with a second surgeon. It takes a long time to get into these people. Already I'm hearing different views on manometry (both the approach and timing), ph test applicability in my case. One doctor requires I have the manometry and ph before he will see me. Another (who I will see on Dec. 30th) asks that I wait until the visit. He may even want the upper or barium done again! The first doc said absolutely no ph needed.
I'm overwhelmed. I'm told l'm not in an emergency situation but from my reading and first surgical consult, I think they will all recommend elective surgery. Some days I feel terrible - malaise; fullness in sternum, etc. hoarseness in voice; coughing in bed.
Other days I'm fine. No history of heartburn-type symptoms.
Here are some findings from barium test I've had.
- gastroesophageal junction located along posterior aspect of the hernia sac
- esophageal mucosa normal in appearance; no evidence of mass, stricture, or ulceration
- esophageal motility is mildly decrearsed w/evidence of intraesophageal reflux (I think means nonerosive)
- bolus of marshmallows passes readily into the stomach; 13mm barium tablet passes readily into distal -esophagus.
-contrast passes readily into proximal small bowel; no masses, etc.
-large HH w/paraesoph component
-hiatal narrowing 40 cm from incisor
-z-line 31 cm from incisors
Already, I've gone on forever. I do apologize. I hope someone has some words of wisdom to offer.
I really don't know if I should rush into this surgery now just because I have insurance. The first surgeon wants manometry with the wire placed endoscopically first - he gave me absolutely no information on what approach he would use.
Should I do watchful waiting and drop the extra 15 or 20 pounds I'm carrying in hopes of minimizing symptoms?
I'm in Seattle and I know these three surgeons all know one another and are considered the best. But this surgery is nothing to sneeze at. I'd be lying if I said I wasn't terrified.
Again, my apologies for the length.
I will be grateful for any feedback.