Plumbing Update

I had the esophageal dilation procedure done on Tuesday and for the most part it went well. There were some minor problems but as I have said in the past I am working on making sure I experience all the possibilities. :-)

The first issue that came up was how much I could open my mouth. Because radiation makes the tissues in the area affected more fragile they were going to put in a airway tube to protect my breathing. Unfortunately due to lack of use and strictures from the radiation my mouth doesn't open up as much as they would have liked. This meant that they had to use a different type of sedation in order to put in the tube. No big deal but one more thing that would take some extra time.

The larger problem was with finding an opening to thread the balloon through. In order to do the dilation they need to fin some opening that they can thread the deflated balloon through and then inflate it. If they couldn't find one going in from the mouth then they would have to go in from the stomach. Of course I already have a ready made opening in my stomach where the PEG tube is.

So around 8:00 AM they put we under for what is normally a 30 minute procedure and I woke up in the recovery room around 11:00 AM. Why the extra time? Part was from putting in the airway tube but unfortunately they couldn't find an opening going in from the mouth so they had to go through the stomach. To do that they had to remove the PEG tube and then dilate the hole that went in so the scope and dilator could fit. Basically they had to widen the stoma (aka the hole in my stomach) to fit the tools through. Then they were able to find a opening from below and successfully dilated the esophagus to 8 millimeters. Not as much as I hoped for but enough to make some difference in swallowing liquids.

The major side effects from the procedure were being out of it for the rest of the day due to the anesthesia, soreness in the stoma (aka the hole in my stomach. :-)), (they did put the PEG tube back in) , and a very sore throat from the procedure. Fortunately the soreness in the stoma area and the throat have subsided by today.

The first day due to the sore throat and being out of it I didn't do much testing of swallowing. I did drink some water right when I got home and it was easier to swallow. When the meds they gave me during the procedure wore off and the sore throat really kicked in I stopped testing.

The next day we went to the Roswell Park Cancer Institute for a follow up appointment now that I have completed the treatment plan. One of the goals was to get more information on esophageal dilation in cancer cases like mine. Based on what the doctor said the goal for normal swallowing function is to get the esophagus to open up to at least 15 millimeters. It will take a few procedures to get there and it may take a few o keep it there. Sometimes the esophagus will start to close back up. Aside from opening up the esophagus to swallow there is a certain amount of coordination between muscles in the throat in order to swallow. Fortunately it appears as if that part is working OK. I meet next week with the GI doc for a check up on this procedure and the plan is to schedule the next one in 3 weeks.

The initial results have been positive. I can swallow liquids in a "normal" manner. I am also starting to test liquids with some solids in them. Egg drop soup seems to be going down fine. prior to the procedure the egg strands would give me problems. The only major issue so far is I need to water down any liquids that are acidic. They tend to burn the throat. I did try some tomato bisque that I couldn't swallow at all prior to the procedure. I can swallow it now but it is too acidic to eat at this point. Later this weekend I plan to try cream soups like shrimp or crab bisque. As much as I would like to hurry the process along I need to be careful and take it slow at first. Hopefully when I have the next procedure in August I will be able to move on towards solid foods. Then I start to attack the recovery food list.

Other News From Our Visit To Roswell

A few other questions I had for the doctors up at Roswell were regarding other side effects, follow up testing, recurrence and milestones. Starting with milestones the major ones are 6 months, 2 years and 5 years. They took a look at the latest test results and also used the scope to look in the nasal area (Really, I think all doctors in this area of medicine just look for reasons to use that thing. :-)) Based on the results and what they saw they also felt I responded well to the treatment plan. Regarding dry mouth there are some drugs that are available but they are only about 30% effective. For now the dry mouth is a problem but not so much that I want to start taking drugs for it. First I want to solve the swallowing and other throat problems. Even just being able to drink more water is helping with the dry mouth. The other question I had was about fatigue. He did order up some additional blood tests to check my thyroid function. One of the comments that he did make was that basically I won't know where I will end up at until about a year after the end of treatment. That basically means I should continue to improve for awhile yet.

A Twisted View Of Food Labels

One thing I don't think I have mentioned is I have been searching for higher calorie foods in liquid form. I have found some like Carnations Instant Breakfast that you add to milk and smoothies in a bottle. The other day I found in the dairy section a Chocolate Milk Shake in a bottle. It was over 400 calories! Yep, now I get excited by things with high calorie counts. At the current point in time I need to consume somewhere around 3,000 calories to maintain my weight.