On Tuesday, September 30, we left our house at 6 am to be at Carlisle Regional Medical Center by 7 am, for an 8 am endoscopy. It's a little nervewracking going to a new facility that we're not familiar with, but all of the staff was very nice! Usually when Collin has anesthesia at PSHCH, we stop into clinic first for a nurse to access his port; then the anesthesiologist can administer the anesthetic right through the "tubie" instead of using gas to put Collin to sleep. This is our preferred method, since Collin really doesn't like the mask and gas. However, this time I expected the anesthesiologist to use the gas since we didn't have the luxury of being accessed in clinic beforehand. I spoke to the anesthesiologist before the procedure and shared with her Collin's dislike of the mask. I was very pleasantly surprised, and very grateful, when they called a nurse over from their Cancer Center nextdoor to access Collin's port! When they saw how well Collin handled his port being accessed (he didn't even flinch) they were amazed! Then, even though it's not standard procedure for them, they got me scrubs to put on and they let me accompany Collin into the OR for anesthesia. As long as he knows I'm with him, he remains very calm, and it's just easier on everyone. I was very grateful they bent the rules for me.
The procedure was over in less than an hour. Dr. Qureshi found a few areas that are very inflamed in the esophagus and stomach, and he found an ulcer in Collin's esophagus. He took biopsies from five areas to check for allergies, infection, etc. Then after the endoscopy was finished, he placed a pH probe. It looked like a feeding tube coming out of Collin's nose, and was connected to a little monitor. Collin wasn't too happy when he woke up and realized there was something in his throat. He doesn't remember having a feeding tube throughout his treatment in 2010. I can tell you from when I learned to place the feeding tube (by doing it on myself) that it's a pretty uncomfortable feeling to have a tube going down your throat. But in true Collin fashion, he adjusted to it as the day went on, and he handled the whole experience amazingly well! We had to keep a journal and push certain buttons on the monitor when Collin ate or drank something, layed down flat, or had any reflux symptoms. Then we had to return the following day for the pH probe to be removed.
Today we followed-up with Dr. Qureshi. As we knew, Collin definitely has a reflux problem. As for what is causing the reflux, Dr. Qureshi said it could be one of three things. 1) Collin's stomach may be producing too much acid; 2) his stomach may produce a normal amount of acid but his esophagus and stomach are very sensitive to acid; or 3) it's an injury from radiation that hasn't had a chance to heal and has become more and more irritated. He ordered a fasting blood test to check Collin's gastrin level, which indicates the level of acid production.
Thankfully the biopsies were negative for allergy or infection. The plan is to treat with medication for six months, and then Dr. Qureshi may decide to repeat the endoscopy to see if everything is healed. Collin will continue on the Prevacid twice a day, which will prevent stomach acid from being produced and give his digestive tract time to heal. He will also start taking a medicine called Carafate, which is a liquid that he will take four times a day. Carafate will coat the inflamed areas, creating a barrier to any irritation.
One test came back showing Collin's lactase level is low; a normal range is between 15 and 45.5, but his was 13.4. Dr. Qureshi said that if Collin has increased belly pain, gas, or diarrhea after having dairy products, it means he's slightly lactose intolerant, and we can give him a pack of lactaid before he has dairy products.
Dr. Qureshi will call me when he gets the results of the pH probe test tomorrow.
