...no, not that one...the one at the top of the stomach.
It's been confirmed today, at the second clinic appointment in two days, that I do need the operation to tighten up the sphincter/valve arrangement at the bottom of the oesophagus/top of the stomach. You'll remember that I had an oesophageal manometry and Ph study a while ago, and the results are in. They score the whole study using a number of factors, where anything less than about 14 is normal, they worry if the score gets to 20, and mine is 41. So yesterday at my scheduled clinic appointment Jas said that I should have the op, and could I come back today for a joint clinic with the gastro doctor from Addenbrookes (big hospital in Cambridge). By the way, my PFTs were further improved at yesterday's clinic which is great. Things are looking good with the lungs so far.
So Vicky and I trogged back to Papworth this morning and met with a room full of doctors and nurses. The consultant from Addenbrookes led the discussion and outlined the results of my ph study in more detail. They test for the sequential contraction of the muscles lining the oesophagus, to check the swallowing thing is working well, and that was ok for me. They then test the strength of the sphincter muscles, and mine was on the weak side of normal. The acid readings, however, were way up and there was lots of reflux recorded. I take omeprazole to control the production of stomach acid so generally this is kept under control. The test is done without omeprazole to help show up the reflux, but they say that even with the omeprazole the reflux will still be happening, even though you may not notice it. The acid and enzymes that come up are then breathed into the lungs in vapour form and do their damage. There is strong evidence that patients with reflux correlate with those who have the early onset of OB (bronchiolitis obliterans), which is the main symptom of chronic rejection.
The doctor said that I ticked all the boxes for the op. People who respond well to omeprazole (like me) tend to respond better to the operation. The swallowing muscles need to work well to push the food through the tightened sphincter, and mine are ok. The downsides of the operation are that for 4-6 weeks post op the diet is 'slops' - so lots of soups and easy to swallow foods. Things get better as the inflammation from the operation subsides. (Side note: Anyone with inventive and tasty recipes for sloppy foods please let me know!). As a result of the tightening it is basically impossible to vomit and very difficult to burp. This means a fizzy drink ban (to a Coke lover like myself this is particularly harsh!) and an increased propensity to pass wind as you can't burp the gas up...
So, some down sides but these have to be balanced with the long-term survival benefit. Basically it is a no-brainer when you think - just a real pain to have to go through another procedure just when I feel like I'm on an even keel and Vicky and I are starting to enjoy life. I guess it will be a lot less traumatic than the last operation - it is just keyhole surgery and a couple of days in hospital after all. The tightening is done by wrapping a bit of the stomach around the bottom of the oesophagus.
Other than the anticipation of all that, everything is going very well. I am feeling fitter every day and have started doing a few days a week at work. Work feels a lot easier than it did pre-op and I'm looking forward to being able to do the job more effectively and being able to maintain more enthusiasm. Wishful thinking? We'll see!
3 months ago