The day of the "Procedure" has arrived...

Ian's gastroenterologist wanted to do a series of Upper Endoscopies with Esophageal Dilations; 2-3 procedures total, each one week apart. Oh, and he only had the "Endoscopy Suite" on Wednesdays.

That was a problem for Ian because, well, he's in college, and this semester, Wednesdays were a packed day for him. Lectures all morning, lab in the afternoon. He did speak with his lab T.A. and would have been able to make the lab up earlier in the week (of whatever week he was able to schedule his procedures.)

On top of that, he was super busy with studying and when I'd ask him if he'd called to set up the procedure, he'd tell me "I remembered to call, but by the time I did, the office was closed." Then Thanksgiving came and he didn't want to do the procedure the day before Turkey-day. Then, Doug and I went to Vegas for my software conference and, although Ian would be able to get a roommate to drive and take care of him, I didn't want him to burden a friend with that task. Then, he had exams. Before we knew it, two months had passed and it was time for Winter break.

Ian, home on break, finally had a chance to call while the office was open and arrange his procedure. "Wednesdays are booked; but we can get you in at our "other" Endoscopy Suite on a Thursday."

Wait, WHAT? We also had a Thursday option??? Ian scheduled for the 9:00 am slot (meaning he would have to be in Raleigh at 8:00 am for prep.)

We left the house at 4:30 am for the drive. Traffic was a dream! A little help from the GPS on my cell phone and arriving at the Endoscopy Suite was a breeze!

When they called Ian back, I thought I'd have a chance to see him before he went into the procedure, but I was wrong. I knew that there was a chance of a complication that could be pretty nasty; tearing of the esophagus is not a good thing. So, after 9:00 am, when I realized I wouldn't be seeing him until he was in recover, I regretted not fussing a little more over him. Prayers and "I Love You, Ian" thoughts were running through my head as I worried.

Around 10:00 am, they called for me. Ian was sleeping, peacefully. So sweet. My eyes started leaking. I sat in the chair next to him and rubbed his head. Not a movement. I tugged on his blond hair and massaged his forehead; he gently purred as he slept. His Gastro walked by and stopped to talk; the Eosinophils are still present, but Ian's esophagus didn't look as inflamed as it did back in October. The doctor was able to dilate with no problems, but said that if he had to do the procedure again, he wanted to do it in a hospital (as opposed to the Endoscopy Suite.) He said he did not want to do another procedure unless Ian has more swallowing difficulties and that he (the Gastro) would work with Ian's allergist and get him started on a swallowed steroid; it's the same steroid as asthmatics use, but instead of inhaling the meds, he'll squirt in in his mouth and swallow it.

The nurse showed back up and said, "I need you to talk to him and wake him up. Here," and she adjusted the head of his bed so that he was sitting up a little more.

His eyes popped open, he took a look at me and furrowed his brow. "How did you get here?" He was amazed at how the general anesthetic they gave him really knocked him out. The last thing he remembers was feeling a little drunk and the anesthesiologist telling him he'd be out within 30 seconds. He didn't believe it, but then, there I was, sitting beside him. He came to pretty quickly. I was thankful for that. Within 15 minutes, he'd had a small cup of water and was up and getting dressed. Still a little wobbly, but in good spirits.

"Feels like I have Strep Throat," he said.

"I'm sure! After what they just did?"

Dismissal was quick and easy and there were no restrictions, except that when he starts eating, start with mild foods like scrambled eggs.

Traffic on the way home was not such a dream; two days before Christmas and the highways were thick with cars and trucks... On the drive home, Ian was feeling more pain in his throat. We had stopped at his apartment in Raleigh to pay his rent. He took a look at the back of his throat and noticed that his uvula (the hangy-down thing in the back between the tonsils) was huge and had a black, blood-blister thing on the end. From there, things went down hill... The pain got worse along the way home. And while I was sympathetic to what he'd been through, I couldn't imagine just how rotten he felt. We had to stop at a convenience store to pick up some over-priced meds. They had Advil, but it wasn't the liquid capsules. So I got him (4) packs of the quick-release Tylenol. He said his pain (on a scale of 1 to 10, 10 being the worst) was at a 9. NINE!!! This kid has a pretty high pain tolerance. I've never heard him give ANY pains anything more than a 5. I opened two packs of the Tylenol for him and told him to take it. I told him to try to take a nap while I drove and if it wasn't any better in an hour, we'd open one more pack.

He did rest. In an hour, his head was up and he was looking around. I asked him how he felt and if he needed more meds. "No, I'll wait until we get home." Once we got home, swallowing his own saliva was nearly impossible. Eating a meal was torture. Poor kid.

Ian's first follow-up visit with the Gastroenterologist

Ian had his follow-up visit with his Gastroenterologist, Dr. Narahari, this morning. He got there early and they were able to see him early. The doc is very straight forward and Ian's a little overwhelmed. The doctor phoned me while Ian was still in the exam room to discuss things with me, too.

Dr. N's office will call an allergist to refer him so that the two offices will coordinate diagnosis and treatment. Once we discover the food that is causing the allergic reaction, and the inflammation in the esophagus goes away, Ian's dosage of Prilosec will drop back to a normal daily dose for the rest of his life.
Until then, Ian must still continue a "soft-food" diet. In other words, no meat! Foods that are not soft, like meat, would risk another obstruction and could cause the esophagus to tear.

The normal opening of the esophagus is greater than 18 (units;) Ian’s is currently at about 10 (units.) So, Dr. N wants to perform a series of Esophageal Dilations. Dr. N explained that this has to be done slowly so as to not stress the inflamed esophagus and cause it to tear, so he can expand the esophagus, at most, 3 (units) in each procedure. We’re looking at at least two, maybe three procedures. (i.e., the first one will take him to ~13 (units) and the second one will get him to ~16 (units)… hopefully the allergist find the offending food and Ian will remove it from his diet and the rest of the inflammation will recede to normal esophagus diameter.) Each procedure should last no longer than 30 minutes. If all goes as planned and Ian eliminates the offending food from his diet, he will be able to avoid a steroid swallow that asthmatics take. As said before, the Prilosec will continue but at normal doses.

Next problem: Dr. N has access to the Endoscopy suite on Wednesdays. Dr. N would have liked to start the first procedure tomorrow or next Wednesday. Ian has classes and labs all day on Wednesdays. Ian needs to see if he can do his lab on a different day and talk to his professors about missing lectures. If Ian is unable to work things out, his first open Wednesday is the day before Thanksgiving (no classes that day.) He also needs someone to drive him on days he has the procedure(s) because he’ll be under general anesthesia for the procedures.

So, that’s where we are as of right now.

Eosinophilic Esophagitis

(originally written as an email to family members on Tuesday, October 5, 2010)
...what a mouthful.

Evidently, my son has it.

He called around lunchtime on Sunday, telling me he had taken a bite of lunch and it went down real hard. When he took a sip of tea to help it down, nothing went down. His throat filled up and he ended up spitting it all out (except for the piece of food still stuck in his throat.) He couldn't swallow anything else down and he couldn't cough the food up, so he was on his way to the Urgent Care or the ER. He'd call me back. Luckily, he was still breathing and talking normally. A fraternity brother was with him, driving him.

Next call was from a PA at the ER. They couldn't do anything for him so they were sending him to the Operating room. The Gastroenterologist on call would be there within an hour. We asked Ian if he wanted us to come; he knew we'd want to see him so he didn't tell us not to come.

We hopped in the car for the 3-hour trip to Raleigh and got the call from his Gastro... Ian is a healthy young guy so he didn't expect any problems with the Endoscopy or general anesthesia. He expected the procedure to last about 30 minutes and he'd call us when he was done.

Still en route, the procedure finished and the doc called us back. As expected, the procedure was successful. The doc pulled a couple of bits of pork barbecue from Ian's throat and was able to gently push the rest down into his stomach. However, he noticed signs of Ian having a condition called Eosinophilic Esophagitis; basically, an allergy to something that presents itself in the throat. The gastro took some samples for biopsy.

Gastro doc wants to see Ian back in a week. He'll also need to start with an allergist to find out what it is he's allergic to.

Since Douglas lives in Raleigh, we tried calling and texting him. A little later, when he finally called us back, we found out he was in Raleigh this day (he travels a lot,) so we were able to send him over to the hospital. He was able to check Ian out before we even got to Raleigh.

Liquid diet on Sunday; no driving for 24 hours; soft diet starting on Monday for an entire week. Yesterday morning he texted me and said, "I'm kind of hungry." LOL! Poor kid.

We took him to get his prescribed meds; Prilosec, 40 mg, twice a day. The insurance company denied the Rx because the dosage was more than they would allow. So we just bought boxes of the OTC stuff to supplement what insurance "would" allow. Sheesh!
Later that night, after we took him to the library to study, and picked up his car from where he left it, we took him to the grocery store to buy him soft foods for the week. He'll still be hungry, I'm sure. Yesterday he said he had some sores in his mouth and his neck was sore. I told him he probably had sores in his throat too and that's why he's on soft foods for the week. He understands all this and I'm sure he'll comply.

And he's already called the Gastro and set up his follow-up. What a good kid!!! I love that boy!!! I went online to a local Raleigh forum and found some recommendations for an allergist, so I sent him that info this morning. The kid's such a hypochondriac that I'm sure he's elated that he now has a verified reason to see an allergist. LOL! I expect to hear that he's made that appointment, too!

Anyway, he's doing alright now. Just need to find out what he's allergic to (probably milk. and who knows what else.) And he'll need to either avoid the food or live with the prilosec and a steroid that asthmatics use. Once we see what the culprit is, then we'll decide on the way to deal with it.