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Home > Archive > Heartburn Support > March 2006 > Time Frame; asking for advice
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Time Frame; asking for advice
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| I'm a 55 year old woman and I usually feel great. About a year ago, I
started have a stomach ache, very high and about the shape and size of
a quarter, sometimes with lateral cramps. I stopped taking a daily
aspirin, thinking perhaps it was irritating. After 6 months I went to a
GP, who took the blood test which checks for ulcers. It came back
negative so she started me on Protonix, which seemed to help the pain,
but gave me terrible indigestion. I've never had indigestion before,
but certainly did on Protonix! It did its job too well! A referral to a
gastroentrologist confirmed that I did not have an ulcer but diagnosed
(endoscopy) a "gaping" esophagus and Barrett's.
So - after some denial (that I've read in these pages, too - along the
lines of "WHAT? No treats?") and lots of research, I've quit drinking
coffee, given away my stashes of Altoids, pass on chocolate, eat
smaller meals (have to - it hurts!), and am trying to sleep on bedwedge
perched precariously on a waterbed. I'm trying Nexum now.
Umm...my question...about how long does all this take? When does the
stomach ache go away? The new regime has been phased in over 6 weeks
now. I suppose the pain is down from a 5 to a 2. Does one just live
with this? Does anyone out there feel really great again?
I'm grateful for this forum, which I've been reading avidly.
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| Howard McCollister 2006-03-22, 1:31 pm |
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"Mary" <marymele@gmail.com> wrote in message
news:1141671292.535553.291490@i40g2000cwc.googlegroups.com...
> I'm a 55 year old woman and I usually feel great. About a year ago, I
> started have a stomach ache, very high and about the shape and size of
> a quarter, sometimes with lateral cramps. I stopped taking a daily
> aspirin, thinking perhaps it was irritating. After 6 months I went to a
> GP, who took the blood test which checks for ulcers. It came back
> negative so she started me on Protonix, which seemed to help the pain,
> but gave me terrible indigestion. I've never had indigestion before,
> but certainly did on Protonix! It did its job too well! A referral to a
> gastroentrologist confirmed that I did not have an ulcer but diagnosed
> (endoscopy) a "gaping" esophagus and Barrett's.
>
> So - after some denial (that I've read in these pages, too - along the
> lines of "WHAT? No treats?") and lots of research, I've quit drinking
> coffee, given away my stashes of Altoids, pass on chocolate, eat
> smaller meals (have to - it hurts!), and am trying to sleep on bedwedge
> perched precariously on a waterbed. I'm trying Nexum now.
>
> Umm...my question...about how long does all this take? When does the
> stomach ache go away? The new regime has been phased in over 6 weeks
> now. I suppose the pain is down from a 5 to a 2. Does one just live
> with this? Does anyone out there feel really great again?
>
> I'm grateful for this forum, which I've been reading avidly.
Here's the mantra - being on Nexium or similar medications does not stop
your reflux, in only changes the nature of the stomach secretions that are
coming back into your esophagus. And the only data we have so far indicates
that all the Nexium in the world won't decrease your risk of esophageal
cancer due to your Barrett's esophagus.
As to the pain, successful symptom management with PPI's like Nexium will
usually manifest itself within a week, assuming that the symptoms can be
managed with PPIs at all.
HMc
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| Thanks, Howard. It helps to hear it so simply put. Yes, the Barrett's
doesn't bother me at all because there's no way to affect it. Get
scoped every 3 years and hope for the best. But the stomach ache!
That's the immediate and constant problem.
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| Mary wrote:
> Thanks, Howard. It helps to hear it so simply put. Yes, the Barrett's
> doesn't bother me at all because there's no way to affect it. Get
> scoped every 3 years and hope for the best. But the stomach ache!
> That's the immediate and constant problem.
Mary...I just googled a bunch of stuff on Barrett's and it makes me want to
ask the following.
What did your gastro recommend as far as any kind of treatment (I don't mean
cure). I read that treating the underlying GERD (which IMO includes the
reduction of stomach acid - I don't mean the stoppage of the reflux which is
the LES valve problem), may help slow down the progression of the Barrett's.
The following was from
http://patient.cancerconsultants.co...ent.aspx?id=719
--------------------------------------------------------------------------------------------
Surgery vs. Medical Management
Surgical management of patients with Barrett's esophagus with or without
low-grade dysplasia is directed at preventing reflux of stomach contents
into the esophagus.
There is evidence that surgical prevention of reflux of stomach contents can
prevent the progression of Barrett's esophagus and may prevent progression
to dysplasia. One clinical study demonstrated a decrease in columnar
epithelium and low-grade dysplastic changes after anti-reflux surgery. In
another study involving surveillance of patients with Barrett's esophagus,
none of the patients who had received anti-reflux surgery developed
dysplasia.
---------------------------------------------------------------------------------------------
Also Mary, I don't see why your gastro only recommended every three years
for an EGD. I kept reading 6 - 12 months on my google hits. It sounds like
your not too worried about the Barrett's...Pete
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| Howard McCollister 2006-03-22, 1:31 pm |
|
"Pete" <pete@nospam.net> wrote in message
news:120s132f0iqofaf@corp.supernews.com...
> Mary wrote:
>
> Mary...I just googled a bunch of stuff on Barrett's and it makes me want
> to ask the following.
>
> What did your gastro recommend as far as any kind of treatment (I don't
> mean cure). I read that treating the underlying GERD (which IMO includes
> the reduction of stomach acid - I don't mean the stoppage of the reflux
> which is the LES valve problem), may help slow down the progression of the
> Barrett's.
>
> The following was from
> http://patient.cancerconsultants.co...ent.aspx?id=719
> --------------------------------------------------------------------------------------------
> Surgery vs. Medical Management
> Surgical management of patients with Barrett's esophagus with or without
> low-grade dysplasia is directed at preventing reflux of stomach contents
> into the esophagus.
>
> There is evidence that surgical prevention of reflux of stomach contents
> can prevent the progression of Barrett's esophagus and may prevent
> progression to dysplasia. One clinical study demonstrated a decrease in
> columnar epithelium and low-grade dysplastic changes after anti-reflux
> surgery. In another study involving surveillance of patients with
> Barrett's esophagus, none of the patients who had received anti-reflux
> surgery developed dysplasia.
>
> ---------------------------------------------------------------------------------------------
>
> Also Mary, I don't see why your gastro only recommended every three years
> for an EGD. I kept reading 6 - 12 months on my google hits. It sounds
> like your not too worried about the Barrett's...Pete
>
I recommend followup EGD every 2 years for patients with Barrett's with NO
dysplasia, every 6-12 months if there is mild-moderate dysplasia, and
phototherapy vs esophagectomy if there is severe dysplasia. I *might*
recommend every three years for patients who have documented GERD and no
Barrett's.
In my opinion, Barrett's esophagus is the point where symptomatic treatment
only is no longer appropriate and a reason to do a gastric fundoplication.
HMc
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| Howard McCollister wrote:
> "Pete" <pete@nospam.net> wrote in message
> news:120s132f0iqofaf@corp.supernews.com...
>
> I recommend followup EGD every 2 years for patients with Barrett's
> with NO dysplasia, every 6-12 months if there is mild-moderate
> dysplasia, and phototherapy vs esophagectomy if there is severe
> dysplasia. I *might* recommend every three years for patients who
> have documented GERD and no Barrett's.
>
> In my opinion, Barrett's esophagus is the point where symptomatic
> treatment only is no longer appropriate and a reason to do a gastric
> fundoplication.
> HMc
Thanks Howard...You would make an awesome gastro, and IMO are already more
than qualified, and are smarter than any of the gastro's or general surgeons
that I have been to :-) . Is there such a thing as a general surgeon, who
is also certified in gastroenterology - no laughing please. I don't see why
not, other than more time in residency. There certainly is a powerful
relationship between general surgery and gastroenterology IMO.
Damn it, I had to google the phototherapy for the barrett's you mentioned.
Is this something that your group of doctors does also, or do your patients
have to go out of town...Pete
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| Howard McCollister 2006-03-22, 1:31 pm |
|
"Pete" <pete@nospam.net> wrote in message
news:120sbu1qd323o18@corp.supernews.com...
>
> Thanks Howard...You would make an awesome gastro, and IMO are already more
> than qualified, and are smarter than any of the gastro's or general
> surgeons that I have been to :-) . Is there such a thing as a general
> surgeon, who is also certified in gastroenterology - no laughing please.
> I don't see why not, other than more time in residency. There certainly
> is a powerful relationship between general surgery and gastroenterology
> IMO.
Medical specialists like gastroenterologists and surgical specialists have a
completely different paradigm for dealing with diseases of the human body.
The temperment and basic personalities of the people who go into those
specialties is likewise different. The mantra of the medical specialist --
"pills, prayers, promises, and post-mortems".
I jest. There are diseases that are best addressed by medical therapy,
diseases that are best addressed by surgery, and some diseases that sit in
the middle ground. It's those middle-ground diseases that represent a lot of
the day-to-day controversy in medicine.
GERD, however, isn't in that middle ground. It is a surgical disease. It's
caused by a functional and/or anatomic defect of the body and curing GERD
therefore revolves around fixing that defect. That can't be done with
medicine or other therapy. The *symptoms* of GERD can be managed with
medicine or other machinations though, and often quite successfully (for
awhile, anyway). The trick is to know when to throw in the towel - when
those things just don't work any more, or when actually curing the problem
is more appropriate. Patients often don't get it. Often, neither do
gastroenterologists. Occasionally, neither do surgeons. An inguinal hernia
can be managed symptomatically too - you can treat it with pain medication,
you can restrict physical activity, you can wear a truss - but without an
operation, you just can't fix it, only treat the symptoms. On this
newsgroup, there are so many people whose GERD simply rules their lives.
They forego an interesting diet, they obsess over wierd homeopathic
nostrums, they sleep sitting up, this pill/that pill/yet another pill -- and
those for whom these things only work a little, they persist..continuing to
look for yet one more ginger root recipe.
As I've said many times here, symptomatic management of surgical disease can
be entirely appropriate in many circumstances. I do that daily. I'll bet I
prescribe more PPI medication than any three primary care doctors you can
name. But there's a point where gastroenterologists are just doing their
patients a huge disservice. I see that daily, and it kind of pisses me off.
> Damn it, I had to google the phototherapy for the barrett's you mentioned.
> Is this something that your group of doctors does also, or do your
> patients have to go out of town...Pete
>
We don't do photodynamic therapy. The equipment is expensive and my partners
and I can't afford it. We refer patients to the Twin Cities, about 2 hours
away. We used to send them down to the Mayo Clinic for highly dysplastic
Barrett's, but no matter what gastroenterologist we sent them to, they
somehow ended up getting an esophagectomy. The data coming in now on
photodynamic therapy for Barrett's is promising and it would be nice to
spare those patients that huge operation.
HMc
| |
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| Thanks Howard...See my inline comments...Pete
Howard McCollister wrote:
> "Pete" <pete@nospam.net> wrote in message
> news:120sbu1qd323o18@corp.supernews.com...
>
> Medical specialists like gastroenterologists and surgical specialists
> have a completely different paradigm for dealing with diseases of the
> human body. The temperment and basic personalities of the people who
> go into those specialties is likewise different. The mantra of the
> medical specialist -- "pills, prayers, promises, and post-mortems".
That it is interesting that you mention temperment and personalities. Try
this one on for size. I asked a podiatrist I went to once for bunion
surgery, why he chose to became a podiatrist, and he basically told me that
was all that was available at the time after med school. So much for
temperment and personalities :-) . But I can see your point Howard :-) .
>
> I jest. There are diseases that are best addressed by medical therapy,
> diseases that are best addressed by surgery, and some diseases that
> sit in the middle ground. It's those middle-ground diseases that
> represent a lot of the day-to-day controversy in medicine.
>
> GERD, however, isn't in that middle ground. It is a surgical disease.
> It's caused by a functional and/or anatomic defect of the body and
> curing GERD therefore revolves around fixing that defect. That can't
> be done with medicine or other therapy. The *symptoms* of GERD can be
> managed with medicine or other machinations though, and often quite
> successfully (for awhile, anyway). The trick is to know when to throw
> in the towel - when those things just don't work any more, or when
> actually curing the problem is more appropriate. Patients often don't
> get it. Often, neither do gastroenterologists. Occasionally, neither
> do surgeons. An inguinal hernia can be managed symptomatically too -
> you can treat it with pain medication, you can restrict physical
> activity, you can wear a truss - but without an operation, you just
> can't fix it, only treat the symptoms. On this newsgroup, there are
> so many people whose GERD simply rules their lives. They forego an
> interesting diet, they obsess over wierd homeopathic nostrums, they
> sleep sitting up, this pill/that pill/yet another pill -- and those
> for whom these things only work a little, they persist..continuing to
> look for yet one more ginger root recipe.
> As I've said many times here, symptomatic management of surgical
> disease can be entirely appropriate in many circumstances. I do that
> daily. I'll bet I prescribe more PPI medication than any three
> primary care doctors you can name. But there's a point where
> gastroenterologists are just doing their patients a huge disservice.
> I see that daily, and it kind of pisses me off.
Howard...Even though you are a general surgeon, I get the feeling that you
may act as a primary physician for some of your older patients. I'm sure
you are aware that there are many specialists who are also dual hatted in
internal medicine - pulmo's and gastro's being the main two that come to
mind). And I have noticed that the older doctor's in these fields have
quite a few patients (older patients) that they are their primary physician
for, in addition to being their specialist, but the specialist is just an
extra. But if you are a new patient they won't take you on as being a
primary care doctor, only as their specialist. I have seen this several
times and I have asked if the specialist would become my primary also, and
got a "no", but yet the doctor had older patients that he was their primary
care doctor for (in other words he didn't want to increase his workload
anymore and only wanted to be "a specialist" for all new patients. I hope
you see what I am getting at. Another good example is internal medicine
doctors tend to be certified in cardiology also (I had an internist for 20
years, and he was also a cardiologist - but in his case the internal
medicine was the main specialty). I don't understand why an internal
medicine doc is supposed to be a step above a GP, since they both only need
to do a three year residency (maybe you can explain that).
Anyway, do you act as primary care doctor for some of your patients. I know
the senior most general surgeon in the town where I live does that (so I
have been told). And have you ever seen a general surgeon that is also
certified in gastroenterology (I was serious when I mentioned that before).
>
>
>
> We don't do photodynamic therapy. The equipment is expensive and my
> partners and I can't afford it. We refer patients to the Twin Cities,
> about 2 hours away. We used to send them down to the Mayo Clinic for
> highly dysplastic Barrett's, but no matter what gastroenterologist we
> sent them to, they somehow ended up getting an esophagectomy. The
> data coming in now on photodynamic therapy for Barrett's is promising
> and it would be nice to spare those patients that huge operation.
I was googling about esophagectomies, and that *is* some major, and scary
shit.
>
> HMc
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| Howard McCollister 2006-03-22, 1:31 pm |
|
"Pete" <pete@nospam.net> wrote in message
news:120v5idoendmg8d@corp.supernews.com...
> Thanks Howard...See my inline comments...Pete
>
> Howard McCollister wrote:
>
> That it is interesting that you mention temperment and personalities. Try
> this one on for size. I asked a podiatrist I went to once for bunion
> surgery, why he chose to became a podiatrist, and he basically told me
> that was all that was available at the time after med school. So much for
> temperment and personalities :-) . But I can see your point Howard :-) .
>
> Howard...Even though you are a general surgeon, I get the feeling that you
> may act as a primary physician for some of your older patients. I'm sure
> you are aware that there are many specialists who are also dual hatted in
> internal medicine - pulmo's and gastro's being the main two that come to
> mind). And I have noticed that the older doctor's in these fields have
> quite a few patients (older patients) that they are their primary
> physician for, in addition to being their specialist, but the specialist
> is just an extra. But if you are a new patient they won't take you on as
> being a primary care doctor, only as their specialist. I have seen this
> several times and I have asked if the specialist would become my primary
> also, and got a "no", but yet the doctor had older patients that he was
> their primary care doctor for (in other words he didn't want to increase
> his workload anymore and only wanted to be "a specialist" for all new
> patients. I hope you see what I am getting at. Another good example is
> internal medicine doctors tend to be certified in cardiology also (I had
> an internist for 20 years, and he was also a cardiologist - but in his
> case the internal medicine was the main specialty). I don't understand
> why an internal medicine doc is supposed to be a step above a GP, since
> they both only need to do a three year residency (maybe you can explain
> that).
>
> Anyway, do you act as primary care doctor for some of your patients. I
> know the senior most general surgeon in the town where I live does that
> (so I have been told). And have you ever seen a general surgeon that is
> also certified in gastroenterology (I was serious when I mentioned that
> before).
>
No, all I do is surgery. I'm not qualified to do primary care and I've never
done it, other than a few locum tenens stints as a primary ER doctor when I
was a resident.
The tempermental differences between surgical and medical specialists is
very real and my temperment doesn't suit primary care. A podiatrist doesn't
go to medical school, they go to podiatry school. At the end of that
training, they get a DPM degree (Doctor of Podiatic medicine) and foot
surgery is all they can do. I think what your podiatist was saying was that
he couldn't get into medical school, so podiatry was all that was available
to him.
HMc
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