Couldn't handle manometry/impedance, now what?

Hi all

I just came from the hospital where I was supposed to have a manometry and impedance test for 24 hours. I was gagging very bad when he inserted the tube and he said we had to wait a while for me to settle down. Unfortunately it didn't really settle and in the end I was gagging and wretching so much I just pulled out the tube and said I couldn't do it.

Now I'm so upset by it, I really needed this test to find out whether my symptoms are related to reflux. I had a pH test a couple of years ago and somehow I made it through that time but just couldn't this time. The pH test was normal but my Dr said maybe I hadn't been off PPIs long enough, it had been 5 days. So I don't really know what to think.

Now I don't really know where to go from here, the Dr warned me not to pursue anything like surgery without this test and he is right, he said he had seen people rush into surgery and it turned out the symptoms weren't caused by it and it just made them feel worse. But my symptoms are pretty bad at the moment and having a huge impact on my life. I'm depressed and have anxiety because of them, all I can do really is try to treat the depression and anxiety, and hope that my digestive issues settle down over time. They have seemed to settle down in the past so I at least have that hope that maybe one day they will again.

Yeh they used the gel and it was a real struggle getting the tube down, I retched a lot but he made it in eventually. I settled a bit and sat for a few minutes without issue but then after a few minutes just started gagging and retching again and couldn't stop.

I've done the test once before and was OK but this time just couldn't make it. I didn't bother to book another try because I don't think I will be able to get through it again. Just feeling very down about the whole thing and mad at myself for not being able to put up with it. Given I already had a negative pH test I think I will just pursue treatment for NERD, don't think surgery is on the table at all, I don't think I could cope with it anyway if I can't even handle the manometry tbh

The Dr was actually quite nice afterwards, he had a lot of problems getting the tube down, not due to gagging just something else but we got it eventually and it seemed to be going OK, just after a few minutes I started retching again and couldn't stop. When I'd failed he was pretty nice about it. He could see I was devastated that I hadn't been able to see it through and said don't worry, today wasn't your day but we haven't given up on you, go back to see the Gi and we can always try again in the future. He did stress I absolutely must have this test before surgery though which I agree. Just so mad at myself, always thought I could handle this kind of thing, I have no idea how I made it through the 24 hour test a couple of years ago. Ah well I think for now it's just back to symptom management, I'm seeing a psychiatrist in the next few weeks too to get my depression sorted, my meds aren't working and that really isn't helping matters.

I'm hoping that once my depression meds get sorted that the reflux symptoms settle, I don't mind the occasional heartburn but this chronic nausea I'm getting from my esophagus is completely debilitating, only been since I was on antibiotics so I hope it will get better with time but 4 months and still struggling through.

My Dr had serious trouble getting the manometry tube in, now know after seeing an ENT its because the nostril he tried first was the side my septum deviated to and theres not much room for anything in there. But what it meant was that I was in a ton of pain during the test from the attempt to put the tube in the other nostril, so any time I gagged it sent blinding pain through my head.

Without a doubt the gagging is what makes the test unbearable, and it gets harder the more stressed you are about it, I know I was freaking out especially when the gagging started. What it took was putting every ounce of concentration into my breathing, making sure it was smooth, slow and even, and that I was breathing through my diaphragm, I still had the occasional gag if my concentration wavered, but that got me through it.

It probably doesn't help that you are coming off antidepressants either, I know no matter how slow I go with it I still get withdrawal symptoms.

Now I'll preface this by saying I'm only asking because this is how my anxiety presents itself, but is it possible that the nausea is being caused, or made worse by your anxiety? When I first started having anxiety attacks, mine manifested as horrific nausea, heart palpitations, and lucky me, the urgent need for a bowel movement. It was an absolute nightmare because I thought something was wrong with my digestive tract, which stressed me out, making my anxiety worse and so on. So it all became cyclic. Even just finding out it was caused by anxiety was enough to lessen the attacks, because I knew when they started up that I had to try and stay calm instead of freaking out about. In saying that though medication was what helped the most, and I went through a bunch before finding one that worked.

Have you tried venlafaxine? None of the other antidepressants or antianxiety meds I tried have been as effective as venlafaxine has been, it did absolute wonders for my anxiety, I still get the odd niggle from it now and then, but not the severe attacks I used to have. It does have a tendency to cause headaches and give you twitchy limbs, but when those symptoms started it was always a sign that I needed to drop to a slightly lower dose, and it resolves itself almost straight away. Its still been much better than other ones I've taken for the side effects.

Treating your depression will help too, its so much harder trying to deal with health problems when you have that dark shadow constantly looming. I really hope that your psychiatrist can nail it in the first go and get you a good plan of attack. Depression is such a horrible condition to deal with, I think by far thats been harder than dealing with LPR.

I hated mirtazapine, has the worst side effects from that one. Did you find you'd get really spacey, like you had been sedated, about half an hour after taking it? If I wasn't near the bed when that hit I would end up asleep on the floor. It also gave me mega munchies and I put on a reasonable amount of weight from it. Luckily it came off when I stopped taking it but still weird.

The typical advice is not to take tricyclics in conjunction with SNRIs but I found out when given the option of amitryptaline for my migraines that it's safe to do so at the levels required just for pain/nerve problems so maybe you could see if that's an option alongside venlafaxine?

It was described as the marijuana of antidepressants to me before I started taking it, and I can say I 100% agree with it. I must admit though the sedating effect was good overall, I have chronic insomnia but it doesn't bother me so much these days because its been going on for so long now its more of an annoyance. Doesn't help with healing though, being constantly sleep deprived.

Is there something you could have to supplement your sleep while you are coming off the mirtazapine? I used to have herbal sleeping tablets which contain valerian, they are good if your problem is getting to sleep in the first place but you'd need to check how they sit with your other meds of course. My problem is staying asleep so stuff like that doesn't even scratch the surface these days. Low dose quetiapine is also used as a sleep supplement, though thats more of a "tried everything else" solution because it can pack a bit of a mental punch, it is after all an antipsychotic.

That's awful, LAWCHICK, if you can manage it and really want the surgery, I would reschedule and see if you could bring a support person. I know for me having my mom there was key.(but I'm 17) Best of luck with whatever you decide

I tried manometry PH test and didn't last more than a couple hours. Same issues as you. Gagging and retching like crazy. Luckily I found a Dr who did Bravo capsules as an alternative. It's basically a tiny capsule that they attach to the inside lining of your esophagus during an EGD which monitors the PH fluctuations and reflux episodes. The capsule monitors for 48 hours and then after a few days it'll natural slough off and you'll pass it like anything else you'd swallow. And no, you don't have to retrieve it lol. You wear a monitor that looks like a pager which records everything. Believe me, I was distraught and hopeless when the manometry didn't work. I had to search Dr's and drive about 2 hours out of town to a Dr that did the Bravo capsule though. It was because of the Bravo that it verified the reflux and prompted them to schedule surgery right away. You have to be off PPI's for at least 2 weeks prior but you can take Carafate up to 2 days before and I think maybe Tums up to a week before if I remember right...so that helps a little but you'd have to double check with your Dr. You log everything u eat and drink, if you burp, if you vomit, etc. with the Bravo just like u would with manometry.

Hope this helps!!