Pre-Operative Narrative
I want to start a post about
my experience with LPR (Laryngopharyngeal Reflux) and Nissen Fundoplication.
Background
For several years now, I have been, by and large, atypical when it comes to having any of the traditional symptoms of acid reflux: copious amounts of acid coming up into my mouth, heartburn, etc.
For as long as I can remember, I have had the following symptoms: continuous postnasal drip, thick mucous in my throat, coughing, wheezing from time to time, and hoarseness that has grown progressively worse.
So, I have made the rounds to a variety of specialists: ENT's, GI's, Allergist's, Laryngologists, etc.
It seems that anytime I would eat something, I would get all of this mucous in my throat and I would begin to become progressively hoarser and hoarser. I attributed this to having year round allergies and went to an allergist for the second time in my life. The allergist quickly put me on a series of allergy shots, prescribed a sinus medicine, encouraged me to do saline nasal rinses, and use Mucinex. However, after dutily doing all of this, I still continued to have major mucosal production and I was still hoarse.
Some of my other symptoms included getting a runny nose while eating and hearing a 'gurgling' sound at the back of my throat. From time to time, I would experience 'traditional' reflux and feel food or beverages coming back up into my mouth.
The worst offenders in terms of food were green peppers and onions.
about
five years ago, I changed primary care doctors and began to see a physician who practices medicine from his home and he does not accept medical insurance. I found him to be one of THE most approachable physicians who took 2.5 hours to complete a physical. During my physical, I gave him a complete list of my 'disparate' and seemingly 'unconnected' symptoms and he told me that he thought that I was suffering from acid refux. I was a bit incredulous because I have never suffered from the traditional symptoms of the disease.
So, I set out on my own and found a GI to whom I explained all of my symptoms. This GI had the bedside manner of a rock and agreed to do an upper and lower endoscopy. I went to the hospital on the prescribed day and underwent the procedure. I then underwent a 48 hour BRAVO test. The doctor told me that he would contact me with a 'firm' diagnosis. Weeks went by and I never heard anything from him and I mentioned it to my family one night at dinner. My youngest son said, "Dad, the doctor did call and said that you had 'significant' reflux.'. " I was dumbounded that a physician would disclose a diagnose for an adult patient to a 12 year old!
I lost all confidence in this GI and decided to go see a Laryngolgist (voice specialist). He diagnosed me with 'Spasmodic Dysphonia' and told me that it was 'incurable' and could only be treated with botox injections into my vocal cords. I reluctantly agreed to have the injections but I told the doctor to use the weakest dose as I was suspicious that this was the correct diagnosis.
To make a long story short, I completely lost the ability to talk and could not even whisper after 24 hours. I was told that I would regain my voice in a week. Seven days went by and I was mute. Two weeks passed and I was mute. Then three, then four, five, six weeks. So, I e-mailed the Laryngologist totally panicked because I could barely whisper. He told me to make an appointment to see him which I did.
At my next appointment with the Laryngologist, he told me that I might be suffering from 'Muscle Tension Dysphonia' and that I should consider going to the Mayo Clinic or to a Voice Center at Vanderbilt University.
I began speech therapy at that point in time and it helped a little. I later found another Laryngologist who was more experienced through a friend. This Laryngologist told me that I definitely did not have Spasmodic Dysphonia, but Muscle Tension Dysphonia and prescribed two visits with a speech therapist. Not once did he inquire about
acid reflux.
I went to the Speech Therapist and the therapy helped up to a certain point except that I continued to experience hoarseness.
Fast forward to 2013 - A friend of mine commented on the poor condition of my voice and I decided to go back to my trusted primary care physician. This time, I asked him to 'coordinate' my care with the GI of his choosing and recommend a surgeon. Before I knew it, I was scheduled to have an upper endoscopy, a 24 hr PH test, and a swallowing study.
The upper endoscopy provided tremendous insight as to why none of the PPI inhibitors or natural products were helping my voice: I had a 'gaping' lower esphogeal sphincter. Basically, he said that my stomach, my throat, and my voicebox were basically one 'cavity' instead of separate entities.
Then the 24 hr pH test revealed that I had had 82 episodes of acid reflux during this time frame. I wore a monitor that revealed a ph as low as 1.9 at times which is highly acidic!
Finally, I completed the swallowing study - this was worse then the worst form of torture. I won't even go into all of the details here.
After completing these three tests, I finally was able to get an appointment with a surgeon. He explained the Nissen Fundoplication surgery to me and spent about
30 minutes answering all of my questions.
I am scheduled to have the Nissen Fundoplication this Friday, October 18th. I can't say that I have ever looked forward to surgery except in this case.
I plan on keeping a log like many of you have to help others learn more about
this surgery. Hopefully, someone reading this blog will benefit from my experience - especially if you are suffering from unexplained hoarseness that never goes away.
One thing that I have learned about
the medical establishment is this: doctors don't communicate with one another. I am so glad that I found a primary care physician who has excellent diagnostic abilities and made me think outside of the box. Otherwise, I would be trying the same old things and never improving.
Post Edited (Mr. Matt) : 10/23/2013 9:01:08 AM (GMT-6)