More food for thought

I hinted in my last post that I had seen my gastric consultant and there was much to think about. To recap, I had a tumour removed from my stomach in 2016 and it has caused me various problems ever since.

The tumour shown in red above was removed but left the top of my stomach a thin pointed shape which now pokes through my diaphragm up into the oesophagus (foodpipe) and releases acid into my throat. This is called a hiatus hernia.

The second problem is that on the stomach wall, where the tumour was, runs a nerve which tells the pyloric sphincter at the bottom of the stomach to open. In removing the tumour, that nerve was damaged and now the pyloric sphincter doesn't open easily to let the food out into the duodenum and on to the intestines. So again, food and acid builds up in my stomach. The medical term is "delayed gastric emptying"  (DGE). When I have had to fast for a gastroscopy procedure, I have fasted for at least 18 hours and they have still found food in my stomach when they have put the camera down. Again this can cause the acid to back up into my throat.

My consultant surgeon has done many gastroscopies on me over the last nine years and attempted to stretch the pyloric valve to make it more prone to opening, as it is clearly tensely shut. It helps for a while but then I get another flare-up of acid reflux which makes me ill for about a week at time. The acid often comes up at night when I am asleep and I rear up choking.  On one occasion, the acid came up and went back down into my lungs, so I woke fighting for breath as if I were drowning. It was quite alarming, especially as I live on my own.

About 18 days ago, I had another flare-up which is still going on as I write - the longest bout I have ever had. My throat and stomach are inflamed and I have a cough as the throat is burnt. It means eating bland food such as eggs, custard, plain pasta and plain biscuits. Caffeine is also out of the question, so I am drinking plain water. I can only eat small quantities too as filling the stomach to full capacity just forces the acid up.

As luck would have it, I had an appointment with my consultant surgeon on 4 December. She is a lovely woman and we have a good rapport. She mulled over what I had told her and said that at the last gastroscopy in October, my stomach was more an hour-glass shape. She therefore would like to do a gastric emptying (DGE) study. Stupidly I thought this would involve filling in a form, but I was wrong. It involves eating something with a radioactive tracer and a gamma camera traces its progress through the stomach at intervals over several hours to see where the blockage is. If, as we think, the blockage is because the pyloric sphincter is the problem, then at the very least, she can inject botox into the sphincter to make it looser. If that fails, she can be more drastic and make a small cut in the sphincter to ease the tension a bit. Those options seem fairly risk free and I am going ahead with the botox option in January as well as the DGE study.

If the problem lies with the hour-glass shape of my stomach and food is getting trapped there, then she said she could cut the stomach ABOVE the narrow part, cut BELOW the narrow part, remove said narrow part and join the two other parts together again, thus making my stomach more a bag-shape. The risks to that are immense, obviously involving major surgery and I would not be able to eat normally for months until the stomach recovered. The thought of that petrifies me and I wonder whether that in itself would cause more complications and make things even worse. 

I did ask her whether a repair to the hiatus hernia would be a solution. She categorically refused to do that option. It would involve tightening the diaphragm so the stomach can't poke up through it. Tie it too tight and food might not be able to get down the oesophagus, so I would be forever on liquids! Tie it too tight and the pyloric sphincter below is still too lazy to open, there would be nowhere for the food contents to go - either upwards or downwards - causing my stomach to swell and explode !!!!!

So, I am opting first for the DGE study and the botox injection in January and see how I fare. The other options have been removed from my mind altogether, as they are the stuff of nightmares. Meanwhile I soldier on feeling pretty rotten at the moment and even wondering if I'll be better for Christmas. Not being able to eat normally and join in with the current pre-Christmas (often alcoholic) festivities is annoying as I have had to cancel meals out with friends and may have to cancel Christmas altogether. I can just picture myself curled up in bed in front of the TV on Christmas Day with a plate of scrambled egg and a bowl of custard for company. Bah humbug.