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I Survive EGD / Schatzki's Ring

(This was originally written on 9/13/2003 and was entitled I Survive Esophagogastroduodenoscopy (EGD), or, my thoughts on Schatzki's Ring.. Click on any photo for a larger view.)

This is the actual Shatzki's Ring (aka Schatzki's Ring) before it is widened. I wish there was a little ruler to get a sense of scale, but I guess we'll have to pretend that hole is around 3/4 of an inch across.
About a year ago, there would be times where I had difficulty swallowing food; it felt as though my stomach had released an "air bubble" into my throat at the same time I was swallowing something, and the food and the bubble would have a shoving match in my esophagus. This struggle for throaty-domination would expand against my windpipe, conveniently located next door to the problem, and would give me the sensation of choking to death.

Needless to say, eating soon became a million laughs, until my good friend and medical doctor Jason Black was present when it happened at lunch one day. After the exciting eventsĀ  associated with the episode passed, he promised to speak to an associate, who immediately diagnosed the condition as Schatzki's Ring, also known as "Steakhouse Syndrome." Anyone who knows how much I hate vegetables will immediately smile at the irony of it all.

And this is the "bulb." I actually don't know what this is, but I assume it isn't referring to the light bulb I used to swallow as a part of a circus act. I think this is just inside my intestines, just past that valve. I'm assuming some M.D. pal of mine will correct me on this if necessary.
But what exactly is a Shatzki's Ring? Well, imagine that your esophagus is a garden hose 1 1/2 inches wide, connecting your mouth with your stomach. This flexible hose is held open by a series of rings along its entire length. When one or more of these rings starts to "close up" due to fibrous build-up, the sufferer starts to have trouble swallowing. Usually, the ring must narrow to about 3/4 of an inch before food starts to get "stuck" on its way down. Usually, drinking some water to
"flush" away the obstruction takes care of the immediate problem, but as the ring closes further and further, no amount of drinking water and thorough chewing will prevent a "clog." Usually, a trip to the Emergency Room is required to clear the clog, and the Ring is widened at 2am, a time of day when most doctors love performing medical procedures.

As a side note, before some yahoo writes and says "Warren, you should have seen a doctor for yourself, you idiot," I did see a doctor early on, and the best this quack could do was prescribe some medication that would relax the valve between my stomach and esophagus, and "see what happened." Well, that medication put me to sleep, which didn't really improve my writing (that much), which I need to produce to pay the rent. How this guy, when given the same symptoms that Jason's colleague had when he instantly diagnosed me, couldn't figure it out with me in his observation room, I'll never know.

No, this isn't the anus of a wet, shaved monkey. I hope. Instead, it is the valve at the bottom of my stomach, behind which is the top of my intestines. WOW!!
Anyway, yesterday I had the procedure, known as an "Esophagogastroduodenoscopy." For obvious reasons, it is popularly known as an EGD. This was a scheduled event, rather than a late-night emergency. What is the procedure? Well, they start by sedating the patient (me), and shoving an endoscope down my throat. Equipped with a camera, the doctor lowers the tube all the way down to the bottom of my stomach and the top of my intestinal tract. While down there, the doctor looks for any problems that might explain my symptoms, and as expected, the Ring was found.

For those that aren't squeamish, there are photos of my very own mouth, throat, stomach, and top of my intestines. Don't forget to click each photo to get a larger, more detailed image. Isn't technology great?

Once the Ring is located, a device on the 'scope is used to widen the hole (or "dilate it," as the M.D.s like to say), mashing the fibers of the ring against the esophageal wall. Sometimes the device is an inflatable balloon (much like an angioplasty balloon, but larger), and sometimes it is an armored metallic wedge, but either way, it can truly be said that my doctor reamed me a wider one.

As the date approached, I found I was wondering what to expect. Before my shoulder surgery last year, I had a vague idea of what I was in for: I already knew what having a surgical incision felt like (hernia and plastic surgery), as well as general anesthesia. Regular shoulder dislocations made me aware of what the joint itself would feel like after being torn apart and rebuilt. But this was different. I was also slightly concerned about allergies, as recent procedures seem to have increased the roster of medications and chemicals that can cause me harm.

So, this is the back of my mouth. That hole in the back is my windpipe, and the glossy grey area in front of that is my esophagus. Apparently. Isn't this fun?
I had never had a 'scope put down my throat, and I sure didn't know how that would feel. Would my throat be sore for days? Would my mouth be sore from being held open for so long? Would I feel any soreness above my stomach where the ring was forcibly stretched open? Did I even have the nerves down there to feel such sensations? How conscious would I really be through the procedure? What would I hear and see?

Well, in a nutshell, I was asleep through almost the entire procedure - or at least I think so. Another M.D. friend of mine tells me that Verced will remove unpleasant memories in patients when administered properly, so maybe I was completely awake. Who knows? I have a faint memory of trying to feel something sharp and large in my mouth with my hands, but that other hands guided me back to a relaxed and restful position. I don't remember feeling anything in or down my throat. I don't remember seeing or hearing any other people besides myself.

I became aware of things again in the recovery room. My mouth and throat weren't sore at all. The I.V. was out of my thumb and feeling better. My stomach and esophagus felt...fine. There wasn't any sensation of any change at all.
The biggest thing that had my attention was this feeling of being rudely awoken from a very deep sleep. It would take about 10 hours for the feeling of disconnected grogginess to lift.

Oh, and I was very hungry, for I was told to not eat or drink since the previous night. So Lisa and I went to Polly's Pies to sit down to an early dinner after we left the hospital. It was during this meal that I could tell, as I had my first sip of water, that there was a change. I hadn't realized, before the procedure, how long it took water to travel from my mouth to my stomach, since it had to swirl past an obstruction, until I felt it just fly down my throat afterwords. I know it sounds weird, but hey, this is my story.

It is now the day after, and things are completely back to normal in almost every way. I'll be back at work tomorrow, and telling people how it really wasn't a big deal at all. And really, it wasn't.

I'm told that I may have this to look forward to many more times in my life, as the ring re-closes, as it tends to do. Anti acid-reflux medications may reverse this, however. Fortunately, I know now that it really isn't anything to worry about. Thankfully.

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