Achalasia - Five month after surgery

The month are passing so quick, we are in August, 5 month to Christmas and 5 month passed since my surgery. As I wrote in my last blogs I feel better and better, now I can say that the few chest pains I still had went away. Since 7 weeks I do not feel any burning in my chest or other strange things, I would say I’m to 99% absolutely normal.

I still take every day mostly before going to bed one pill of 40mg Pantoprazol, just for safety that no acid liquids will go up my esophagus during I sleep. Around in 8 month I will go to a check up to my doctor and then we will see, if I do have a problem of reflux or not. As far as I can feel, I do not have acid reflux.

By the way, I found a link which does explain very well the method of POEM by the Prof. Dr. Inoue himself and there are a lot of videos just showing the procedure in detail:

achalasia-poem.net

Achalasia - Five weeks after the surgery

Since my last blog entry I have been on holidays. I just had time to relax, to take my life a bit more easy and to do things I wanted to do, but I had no time. I even went on a cruise to the meditarean sea, I just had a great time. But it was also a time where I was able to eat normally and to observe if I have some troubles with some kind of food. Just to say it short, I felt great, I had no problems at all and I was able to eat and drink everything I liked, so I should not wondering why my weight went up for 3 kilos!  The bed on the ship was big and rather plane, so I was a bit afraid that I could get problems with reflux or coughing in the night because some liquids are coming up the esophagus, but this was not at all the case. Only twice I felt around 6 o'clock in the morning a bit acid down there on the stomach, it was not really burning, just a bit strange. So I went for drinking water and the strange feeling went away. All other 9 days I hadn't at all problems.  I was able to eat all kind of food, fruits, salad, fish, meat, bread and even pizza! All went straight down and I never had a feeling that some food is stuck and I have to drink something. Now I am drinking less while I am eating than before the operation. So I have to say that I am very happy about the surgery and that I feel so fine and can do again my normal life. POEM is just a great surgery method and really very soft intervention for the body. I still take twice a day 40 mg of  Pantoprazol and on 28th of may I will have a control of my esophagus, so for then I will tell what my doctor thinks about all the development and if the clips have already gone.

Achalasia - Three weeks after the surgery

Three weeks passed since my POEM surgery. To say it short, I feel great! During the first two weeks I still felt some chest pains from time to time, not  more than 30 minutes in duration. With drinking orange juice I'm able to reduce the pain or even to stop the pain. Few times I feel a strange feeling behind the chest, like a bit burning, it's not strong but just enough for feeling me uncomfortable. But now since last week I'm free of all the pains. I'm eating normal, means I can eat salad, pasta, fish, potatoes, vegetables, chicken and even meat in slices. I do not have pains while eating and the food goes well to the stomach. Even I tried pizza and bread, no problem at all. Wine, beer and coffee are not harming me at all. The only thing I have to be careful is not eating to much at night else I get some strange feelings on my esophagus near the stomach.    During the night I'm not awaking for coughing liquid out of my lungs, all normal. I only still have my head a bit higher, this helps surely.  The only medicament I take is Pantazol 40 mg twice a day, just for security reasons. I have no signs of reflux. When coughing before the surgery I was able to produce the chest pains, this is now not happening anymore! Amazing!   So until now I just can say, that the POEM surgery the way Dr. Inoue does helped me a lot. I'm very optimistic that my state will continue like this and I can do absolutely a normal life.

Achalasia - Back at home

My last night at the hospital passed through. I took another 0.5 mg Temesta to sleep really well. The nurses were ordered by the doctor not to bother me at night. Without the written consent of the doctor, they would have continued to monitor me. I put the upper part of the bed not as high as the other nights. Just in this night I woke up at 3 clock with a light burning behind the breastbone. I took orange juice which I have been reserved for such cases, but it has not really helped me.Then I drank water then the burn went away. I could go back to sleep and then had a good rest.

At 7 o'clock I then got up, made the morning ablutions and dressed me, I wanted to as quickly as possible to leave the hospital. Prof. Seewald visited me for the last time. He  asked me for an appointment in around 2 months for a short follow-up. I also asked him what can I now eat and drink. He told me that I should still wait for another 2 weeks before eating meat, chicken, bread, cheese, etc. I could drink again everything, including beer and wine. Only the strong spirits, I should rather leave, anyway I have no problem with this.

And so after the breakfast, which was served at 08:30, I made my way back home, I was very happy. Everything went well during the last 6 days, no pain, I felt again strong enough and with the lovely day, pure sunshine, I even felt better.

From Zurich to my home, I took the train and then bus. The last 25 minutes I was walking uphill. When I got home I was a little sweaty, but I felt very well again and very happy!

My wife had been cooked a soup with carrots, potatoes, onions, milk, broth and chopped meat. Then everything in the blender and done. I digested the meal very well.

The afternoon I enjoyed outside in the sun, total relax.

Now let's see how I will feel during the first night at home, my upper part of the bed is not so high as in the hospital. What will happen? Will I have problems with swallowing?

to be continued ....

Achalasia - My last day at the hospital

Now there passed six days since I've joined the hospital, today is the last day. Tomorrow I will go home at 9 o'clock. But first what happened to me last night.

I have again taken a Temesta, but this time only 0.5 mg and slept like a bear. In the morning I felt a bit dizzi.

Sometimes in the evening I feel a slight pull to the right side of my body which goes up to my chin. Nothing unpleasant, but it did occur to me after the surgery. Before I never felt something like this. Otherwise I have no pain, nothing at all. The bowel is now behaving quite normal.

For breakfast I had received a  Pantoprazol  40 mg, 1 multi-vitamin juice, yogurt and two servings of chocolate. The morning went smoothly. I had  a look to my blogs and answered the comments which my followers have written. It now seems that there are some people following my story, I am very pleased. Only I do not know if my blog meets the expectations of the people and how I could improve it.

The day before my blood was examined, the results were fine, no infections, everything fine, I'm happy.

For lunch I had mashed potatoes, ground meat, mashed vegetables and multivitamin juice. I could eat everything without problems.

I spent the afternoon outside the hospital. I walked a little bit up the hill to see how about my condition. Well, I guess because of the surgery and not walking a lot I'm more slowly walking. So I'm at least able to pay off my bike at home again.

At 18:10 was dinner time, they served me perch fillet with risotto and spinach. Everything went down without problems. Dessert was a pineapple. Sometimes I forget that I still have this clip in me, I just trust that they already hold.

Now I'll stop reporting from the hospital and no longer report every day, but only from time to time, or if something special happen to me.

Achalasia - The 3rd day after the POEM surgery

Well, I think I must choose another title, it will start to be boring. But what was going on this Saturday.

During the night I had no pains at all, I could not sleep very well, probably because of sitting around and lack of exercise. Prof. Seewald made a short visit, asked me if everything is OK, and then he discussed the days to come and what I can eat. Mainly soups, puree, fish  and minced meat. The infusion he also dropped from the program.

Then, when the infusion was away I was able to take untroubled showers. After that, I've got the best clothes from the closet and dressed me, I felt 100% normal again, where I am, in a hospital? I can not believe myself that 3 days after the surgery, I feel so well. Of course, what I still can not say is how good the food slips (especially larger pieces of meat, bread, fruits, etc.) through the esophagus into the stomach later on in some weeks. But for that I have to have patience. What should not happen now is that the hemostatic clips which were used to close the opening in the esophagus, fall off too early.

Okay, so freshly dressed, I made a little reconnaissance tour out of the hospital, because I knew that my father and my wife come to visit me, I was waiting for them outside. I did this well, they did not expect me to see me in the open air, enjoying the spring sunshine and welcome them like this.

Lunch was already richer than the last few days. I started with a tomato soup, then a cup carrot puree, broccoli puree, mashed potatoes and enough gravy. Then for dessert a vanilla ice cream. The only problem that I have is diarrhea after eating. The whole of the soft stuff just slips up through the intestine and is processed there. This is the following of the antibiotics. I think tomorrow I will return to normal conditions.

The afternoon was marked by my stories I have experienced with my surgery and how great everything was. The subject came up when actually I can go out of the hospital. If I just sit around and be careful what I eat, then I can do this also at home. I'll talk to my doctor when he sees a possible withdrawal date. I hope so, that would be on Monday or Tuesday at the latest.

In the evening I received my dinner. I've digested very well and after a bit of TV shows, I took a sleeping pill 1mg Temesta. I slept very well, deep and up to 8 o'clock. No pains at all!

Warning:
Temesta can be addictive, so use only occasionally and deliberately, then steer clear.

Achalasia - The 2nd day after the POEM surgery

The day went smoothly. The sore throat went away and so I could now drink "painless", but only up to 11 clock. Because Prof. Seewald would again in the evening perform a gastroscopy and look to the inside of the esophagus how it looks like, check the hemostatic clips and check the passage to the stomach. So I had to stay sober. Thanks to the infusions this is not really a problem.

With a little delay of 1 hour, I was driven by the bed to the examination room, it was already 18 o'clock. There were still fully operational and the beds with some other patients were a snake. I recognized the back of my assistant which have often sent me into the land of dreams. A cool guy, always set up and even though he has been working all day, he is still friendly, smiles and makes his jokes. I had to go from my bed over to the examination table and was wired with electrodes to monitor and they gave me a tube of oxygen.

So now I have again received my dose of propofol, with time I suspect this is addictive.The feeling is totally cool. The assistant injected me with a  catheter into the vein, look at me and says I will asleep in 15 seconds and I should choose a nice dream. I look at him and shake my head to say, this one I hold on longer. He laughed and said that in less than 5 seconds I will be dreaming and so it was! I then woke up again in my bed just in front of the examination room.

Warning about propofol:
Do not try it yourself, otherwise you can end up like one of these pop stars, then you can see the radishes from below.

After the investigation Prof. Seewald stated briefly that everything is fine, the passage to the stomach is enlarged and the clips are in the right position. These clips will fall in the next weeks itself and excreted in the stomach and intestines. As a gift I have received the images of gastroscopy, and indeed before the surgery and after surgery, the difference is obvious.

When I arrived back in the room, I could take a tomato soup, a cream of chicken soup, yogurt and a multi-vitamin juice to me. I digested everything without problems and had no feeling that something is going back into the esophagus. Let's see how the night will be.

Sweet dreams.

Achalasia - The day after the POEM surgery

The night I spent quite well, I woke up 3 times, as the nurse changed my infusions and antibiotics. She also gave me a new injection of  Pantoprazol  and painkillers. The last phase of sleep was 3:30 to 8:30, I had no pains at all. Only I have a sore throat from the intubation, but may disappear in the next 2 days.

The day passed quietly. I spent the time on the laptop, watch TV or listen to music. In the evening I was allowed to eat for the first time tea and soup. I ordered a chicken soup and chamomile tea. I could swallow very well and was not feeling bad.
Since I have a room to the south, the sun appears from the afternoon. Although I have the shutters down, it is quite warm. As I was then measured my temperature of body at 19 clock I had about 37.4 degrees celsius. I've thought about infection, etc. But it was nothing. By 2 clock in the morning they have me re-measured the temperature and there was all back in the green zone, 36.6 degrees celsius.

In the evening I had received no more pain medication, let's see how I will survive the night.

In the night I had a pain the first time, nothing special, just like before the surgery this burn behind the chest. Previously, I had the feeling of gastricflui, and I really had to swallow again, but now I'm not so sure. Anyway, I woke up at 23 o'clock suddenly with the burn in my chest. I thought what is going on now, should I call the nurse, but I have decided to drink some tea and wait. After about 30 minutes the pain was gone and I tried to go back to sleep. About 3 clock again, I got a pain, it was not as strong, relatively weak. These passed after about 30 minutes and then I could go back to sleep until about 7 clock in the morning.

Achalasia - The day of the operation using POEM

At 6:00 I was awakened, I slept well during the night, thanks to the 1mg Temesta. I had a 1/2 hour time left for the morning toilet. At 06:30 I received a relaxation pill. I only noticed that I became quiet, but I'm not asleep. At 06:45 2 nurses have picked me up and brought me into the operation room. I was once more asked by my name, date of birth and why I am here, security check!

Then I was put on the operating table and wired, placed the infusion a venous catheter and thus also the input for the anesthetic syringe. On the face they placed me an oxygen mask so that the lungs are filling up properly with oxygen. The anesthetic equipment controls based on my height and weight automatically the necessary amount of anesthesia. Monitored by a headband which measures the brain waves, thus indicating how deep I sleep. They also injected me a painkiller. Because the esophagus does not have as many pain-sensitive regions, I received a relatively small amount. Now came the anesthetic  syringe. I felt like the drug went up the arm,  I felt dizziness in my head, no pain, it was not unpleasant and I was already gone, sweet dreams.

2 hours later, according to plan, I woke up in the recovery room. My wife was already present. I was not bad, I felt no pains, no signs of dizziness, maybe a little sleepy still. As the anesthesia physician told me later, I opened my eyes in the operating room as soon as the anesthesia was turned off. The breathing tube was removed, I myself moved from the operation table over to my bed. All this I can not remember at all, amazing!

In the recovery room I had to stay about 6 hours. The monitors have monitored my overall condition. All clear. I had no pain. At most if I moved a bit, I felt like a muscle ache in the abdomen, as if you train too hard. I was very relieved that everything went so well, my wife too.

Both of my surgeons, Prof. H. Inoue and Prof. Seewald came by to ask how I feeld.  I wanted to find out more how the surgery went, "... everything was on schedule" they answerd. The muscle was very strong and Prof. Inoue had to cut several times. But the technology has been victorious in the end. It was a sign that the muscle has developed a lot of strenght and therefore I had always again the same problems of dysphagia even after balloon dilatation.

After the 6 hours in the recovery room, I could go back to my room, where it was much quieter. I have received infusion, antibiotics, painkillers and acid blockers ( Pantoprazol  ). I think the painkillers were not really necessary, but they help to obtain a general sedative. Eating as well as drink was still not allowed,  I must still have a little patience. I felt absolutely no side effects. At night, I once believed to have a fever, but when the temperature was measured, it was 36.3 degrees celsius, absolutely normal.

I survived the first day much better than I could have imagined.

Achalasia - The POEM Method as a surgery alternative

I have achalasia since 2008. In the past I had some 5 balloon dilation. Because this was not really helping me out of my achalasia problems, I searched for another alternative. I spoke to my surgery on February 2012 and he told me about a new method called POEM  (Peroral Endoscopic myotomy).

So I started to investigate in the internet about POEM. I did find some references searching Google using POEM, but more I found using 'Peroral Endoscopic myotomy'. Like this I found some good articles and even videos. And a lot of people as well as physicians were positively impressed by this new method.

POEM was invented by Prof. H. Inoue (JAP). So far he did POEM procedure in 205 consecutive cases in the hospital at Yokohama. Including the experinece in oversea countries it reaches more than 240. Patients who received POEM in his early series are all fine with no sign of recurrence of dysphasia.

Two weeks later I decided to apply the new method POEM. I hope POEM will help me in reducing the chest pain, difficulty swallowing and regurgitation during the night.

But how I got to the decision appling to me the surgery method POEM?

Well, as life goes one just get nothing for free. Well, there are a few exceptions, but that's another topic. I wanted to know where the hook is the catch. Otherwise POEM would be really revolutionary. The only I found negative about the method is that there are no long-term results available. The first operation was done about 3-4 years ago. What happened to this patients and how are they feeling today? I could not find to many information. But it seems that patients which undergone such a treatment had at least for 2 years a much better quality of life. I would estimate that can be extrapolated to another 2 - 4 years, so I think if an intervention using POEM runs perfectly, then you can get about 6-8 years with minor achalasia problems or even cured. These are my personal impressions. Not too bad I thought.

What is the alternative? Balloon dilatation is okay, but it has risks because of perforation, and it can not be repeated to many times. Then there is still the surgical interventions in a traditional fashion. Not controversial and although today these procedures are very well known in the implementation and minimally invasive, it is for the body a much greater trauma (multiple layers must be cut by the operators until they locate the right place of the muscle) as using the method POEM.

Well, POEM seems to me a very sensitive, highly technical supported and gentle way of doing a surgery. After all these positive comments on the internet, knowing that Prof. H. Inoue will personally perform the operation to me, I can not decide otherwise. Also I can contribute more on the long-term experience knowledge.