Friday, January 11, 2008

records check

Yesterday I saw my ENT, today I saw my endo. Between those two appointments and a recorded message, I have a whole bunch of tests results, because my ENT had all my test results from my g/e doc, and kindly gave me copies.

So, here's the rundown, chronologically.

November 20: Gastric Emptying Study. This is where I had to eat a radioactive hard-boiled egg and then lie on a scanner bed for 90 minutes while they watched the radioactive tracer leave my stomach. Only it didn't: "FINDINGS: Over the course of the examination, for the entirety of 90 minutes, there was relatively no emptying of radiotracer from the stomach." Impressions indicate gastroparesis or a gastric outlet obstruction, which explains why the EGD was ordered.

November 28: EGD, as previously discussed here. The EGD itself was unremarkable except for some redness, but now I have the biopsy results. The stomach samples showed "mild changes suggestive of a chemical gastropathy;" a "careful search" was made for H. pylori, and none was found. "Taken in aggregrate, the changes that are present are likely due to chemical or drug injury. There is no evidence of intestinal metaplasia or neoplasia." The esophageal biopsies were completely normal as well; no signs of Barrett's esophagus or any other pre-cancerous conditions. No signs of ulcers, either. This is all very good -- no obstructions or ulcers or pre-cancerous changes.

December 11: Video Stroboscopy
My right vocal fold and right arytenoid/TVF are slightly paralyzed (hypofunctioning), and this has caused other structures in my throat to hyperfunction to compensate. I've also got lumpy cricoid and arytenoid cartilage because of the gastric reflux. "Speech pathology services are recommended in conjunction with medical management to address the following: 1) vocal hygiene and hydration 2) laryngeal reposturing and relaxation 3) vocal function tasks 4) resonant treatment." Therapy recommended for 6-8 weeks, once a week; I'm scheduled to start Jan 30.

(This week in between tests I got DS1's horrid stomach virus, recovered, and went to Boston for the weekend.)

December 17: Air-contrast Upper GI - Small Bowel Series (fluoroscopy)
My reflux extends all the way up to the level of the carina (???), otherwise, I'm normal. Apparently, "to the level of the carina" is bad; the first thing my ENT said to me is "you have really extensive reflux," emphasis his. I thought we knew that already?

Jan 3: In to see the g/e doc, as discussed. So far, I am unimpressed by both Nexium and Aciphex, but Nexium works marginally better than Aciphex. Then again, I didn't drink about a quart of regular (that is, non-decaf) coffee accidentally when I was on the Nexium, so I don't know how it would've handled at. I got into a conversation about the new sugar free ("skinny") mocha at Starbucks and completely forgot to order it decaf. I didn't even realize my mistake until about an hour later when the jitters set in.

Jan 7: Labs drawn for complete blood count (CBC), liver function, and thyroid tests. I don't have the numbers for the CBC and liver functions yet, but I did get a call telling me everything was in normal range. I should get my copy of those tests early next week. I got my thyroid numbers today at the endo's. My TSH is 0.09, and it was the same back in November (11/19).

I had an ultrasound of my neck today, and will go back to my endo's office next Friday for my results, at which time I will beg for an increase in my meds. Historically, I've kept my TSH more suppressed than 0.09; I'm usually somewhere around 0.07, it seems to me. (I really have to get my records organized.) I don't know whether that slight difference in TSH can be causing or effecting the gastroparesis, but it's my first preference for treatment. I'd also like to not have freezing hands and feet all the time.

I know it's a teeny, tiny difference, but my TSH hasn't been down in the basement where it belongs for quite a while, and I'm hoping that bumping up the meds can resolve the gastroparesis and that the reflux will calm down.

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