Fundoscopy

Yesterday I had that pesky test they brought me in for, an endoscopy, or fundoscopy, as I like to call it. It really wasn't fun in any possible way, but I think, whenever possible, it's better to give these annoying things a more entertaining name. So fundoscopy it is.

For the last 18 months, I have been having increasing problems with acid reflux (heartburn). Every few months I complained to the docs that I was having pain despite taking my medicine to prevent problems. The docs would up the dosage of meds and send me away to see how I got on. Each time, I would be fine for a while, but then the pain would come back, leaving me eating tums or other chalky grossness like it was going out of style. So they would up my medicines again and wait to see what happened. Things continued on in this manner and I am now taking the maximum amount of medications twice a day.

Besides being painful, acid reflux can be a problem for a number of reasons. For example, if you get it too often the acid can eat away at your esophagus, cause ulcers, and in very severe cases, it can even cause cancer, to name a few. In some cases, you can have acid and non-acid (stomach contents) reflux and aspirate into your airways. And this is very bad. Little fact you may/I hope you know: lungs don't really like having anything in them besides air. Ever been eating or drinking and have something "go down the wrong pipe"? Not nice, right? Aspirating refluxed contents into your lungs is sorta like that; lungs don't really appreciate it. So bare with me while I try to explain how this applies to me.

This rolling year, as I mentioned a few posts ago, has stunk on a massive scale because I have spent A LOT of time being ill and on IVs (this is my 23rd week or so now), but I have also had episodes of tightness that have not been responding to bronchodilators (meds to open up the airways) and steroids.  This has been very frustrating and has left everyone scratching their heads trying to figure out why I am having problems with tightness and why I have had so many more and prolonged courses of IVs than usual.

Enter reflux.

The docs are thinking that the reflux might be causing the tightness. The idea being that my airways  close themselves off when I reflux as a protection mechanism, resulting in me feeling tight. So I have had a couple of investigations to try and see how bad my reflux is. I had a study done a few weeks ago called an impedance study.  They stuck a probe with various sensors up my nose and down my esophagus for 24 hours to measure how often I was getting episodes of acid and non-acid reflux.

Here is a picture with the probe in, not really having the time of my life. It was uncomfortable at times as I could feel the tube in my throat, causing me to gag and retch. And since the tube wasn't going anywhere, gagging and retching was a waste of time (I tried to explain this to my reflexes, but they wouldn't listen). Plus, there was a little computer to take readings attached to the wires. So every where I went, my very unfashionable little computer-on-a-shoulder-strap went too.

The study showed that, despite being on maximum amounts of medication, I am having episodes of acid and non-acid reflux. The acid bit is odd because the medicine I am on should neutralise it, so that when and if it does come up, it's not acidic. But I didn't have so many episodes that they could definitely confirm that the reflux is the problem. So they wanted to do the fundoscopy (endoscopy) to try and gather more information.

A fundoscopy is a test where they stick a tube with a camera on the end down your throat so they can have a look at your insides. In my case, they were checking out my esophagus (tube your food goes down) and stomach.  And what did they see when they stuck their giant tube down my throat while I gagged and retched and coughed like mad? Well they saw that I have something called a hiatal hernia and that contents from my stomach were coming up when I coughed.

The doctor who did the test concluded that surgery to fix the problem should be considered. Ah yes, meant to say that if the problem is bad enough, they have been considering surgery to fix the problem as I am pretty much out of options medication wise. So I thought, OK, no problem. At least now we know what the deal is and something can be done to fix it. I love a problem with a solution, after all!. 


After the procedure, I sat and waited for my knocked out tongue to regain consciousness and texted  Alastair to say that the doc had said surgery needed to be considered.  As I sat, the doctor who I had seen in clinic and had ordered the endoscopy, came up and asked how I had got on and to see my results. He looked at my impedance test and the endoscopy results and concluded that I did not need surgery and should just stay on my s*** load of medications. With this conflicting news, I stared wide-eyed at him. He said, "Do you want surgery?" I said, "Not particularly, but I do want a problem with a solution. If you are telling me that this is not the problem then that means I am still without an answer and the docs are running out of ideas. So I don't want surgery, but I do want there to be an obvious problem so that it can be fixed and I can get on with my freagin life." He looked at me, twitched his moustache around a bit, then wrote on the printed results that my CF docs were to call him to discuss.  And then I texted Alastair to say that apparently I was not having surgery after all, and waited for the sightly too touchy-feely transport guy to to take me back to the hospital from which I had come.

Back on the ward and feeling a bit deflated, a doctor came to say that it would be the decision of many, not just one doc, to decide whether or not surgery (known as a Nissen's Fundoplication) is required. Because this is very complicated and messy mystery they are trying to unravel and there are no clear-cut, black and white answers.  So now I wait for CF docs, GI docs, and (potential) surgery doc to have a massive pow-wow and ask themselves that age old question, to fundoplicate or not to fundoplicate?