life

two months ago, i had a consultation with a new gastroenterologist. i was due for an upper gi scope and decided to stop putting it off.  having moved a year ago, i didn’t have a gi in this area. i found him through swedish medical and the barrx (or bârrx) directory of practitioners who’ve licensed the technology. i scheduled an appointment.  he’s based in seattle on first hill, in a building that adjoins a swedish medical facility.  when the mid-day appointment arrived, i drove into seattle and found the building and office remarkably easily.

after the typical new patient foreplay… filling out forms, blood pressure, heart rate, etc., i spent 45 minutes talking to my new gastroenterologist. he was very well read on barrett’s esophagus and 80% of his practice is treating the condition.   i’d intentionally used medical terms (“7cm segment of intestinal metaplasia with no dysplasia observed” instead of “i have barrett’s”), when completing the forms, to avoid being talked down to. it’s incredibly frustrating to have to explain that you don’t need an explanation.

after a minute or two of gauging my knowledge and interest, we discussed bârrx (he prefers “halo”, as bârrx medical is the name of the company while “halo90″ “halo360″ are the names of the procedures/products). note that i’ve been putting off this surgery for some time now. immediately following my diagnosis, i made up my mind that this was a course of treatment i wanted to pursue. he explained that treatment of barrett’s patients who have no or low grade dysplasia isn’t something he does often. he explained his reasoning behind it. he quoted some much lower figures than i’d heard, for the probability of developing an invasive carcinoma, in any given year. i explained why i was still interested, despite the fact that it’s not the american medical association’s ‘standard of care.’  he seemed to understand and said, “let’s just get a scope and talk after that.”  fair enough, so back in the lobby, i made a date with a camera on a stick.

being treated like an educated adult by an educated adult, in this circumstance makes all the difference. i learned a ton, felt like my opinion mattered, and came out if the conversation with a degree of trust for my new doc.  did i mention that a doctor spent 45 minutes in a consultation?

the process of prepping for an “egd” (short for: esophagogastroduodenoscopy – best word ever) is pretty simplistic and the instructions on the photocopied sheet they hand you fall into a few areas:

• keep your stomach empty (no food or drink for ~8 hours beforehand)
• don’t mess with your body’s ability to heal wounds (no blood-thinners or anticoagulants including aspirin)
• before you start fasting, don’t eat anything that would confuse the doctor (mostly this is defined as “no purple or red staining foods”. the examples they give are red jello and kool-aid.)

no problem, right?  these are easily followed directions, right?  only a moron could screw this up, right?

went out for dinner the night before.  spur of the moment, we went to the barking frog in woodinville.  great menu and it just seemed like the right thing to do that night and with my appointment mid-morning, leaving 8 hours between food and scope was going to be easy.  the place was pretty empty, even for a thursday night, so we managed a small table near the fireplace.  we enjoyed the meal so much that a couple at the table next to us literally said, “we’ll have what they have.”

their menu is always great; i had:

Seared Hudson Valley Foie Gras
House Made Beignet, Strawberry ~ Vanilla Drizzle

Baby Beets & Arugula
Laura Chenel Chèvre Crottin, Aged Sherry Vinaigrette

Wild King Salmon
Pan Fried Tomatoes, Cucumber & Dill Créme Fraîche,
Roasted Romanesco Broccoli with Dry Aged Jack & Roasted Poblano Cheese Fondue

amazing meal, but see any problems with it?  i had a minor freakout, when i realized that the (quite tasty) beets quite easily met the “red or purple foods that might stain your insides” criteria.  a call to the surgery center in the morning assured me it was not the crisis i’d imagined, mostly because my appointment was mid-morning.

the scope was uneventful.  the drugs are great. after spraying your throat with lidocaine, a healthy dose of versed is pushed through the iv catheter. in addition to the euphoric “please shove that 4 foot long hose down my throat, i won’t mind” state it leaves you in, it has the tremendous side effect of partial amnesia. apparently i insisted that i needed a bagel sandwich, on the way home… don’t remember it. as with my past scopes, i slept for the rest of the day.

got the results in the mail, a couple weeks ago. along with a fairly graphic image of my food tubes, a brief and barely legible note that reads “10cm segment no dysplasia some ulceration sched. followup.”

given that, the punchline is that the segment has grown some (30%) in the past 24 months, i don’t have dysplasia (more significant probability of developing cancer), and the symptoms of my reflux/gerds are not completely controlled.

i’ll likely schedule a follow-up appointment for the week after new year’s.