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Undecided on POEM or dialation

Posted , 6 users are following.

thor_1313
thor_1313

I am one of the lucky ones compared to others my A (type2) was caught quickly and I am not very advanced. Through diet, eating habits, water, elvated sleeping etc.. I am able to control my sysmptoms for the most part.  I do regurgitate daily (good days only a couple times, bad days alot more) but mostly liquids come up now, not alot of food. I am able to keep almost all of my food down now I know what I can and can't eat, eat slow and lots of water. I still have spasams, the bad ones are few and far between. I dropped a little weight in the begging but now I am fine. I actully can afford to lose more. 

I have an appointment on Feb 10th with Dr Pellegrini at the University of Washington. The staff there have performed alot of of HM's and POEMS. 

I intially was thinking POEM but with my A not that advanced I was thinking dialation first if that doesnt work then the POEM. I am torn on it and wondered what those of you who have been through it think.

Thanks!  

0 likes, 6 replies

6 Replies

  • Robert13450
    Robert13450 thor_1313

    Posted

    Hello Thor, I went through dialation two times and it just didn't last. I had POEM in June and wish I had done a HM. Reason being that doing poem they won't do a wrap at the same time , they wait to see if the acid is going to do a problem and with me it is so I'm headed back for another surgery. If your acid ph tests have been high you might want to have the talk with your doctor about the option of doing a wrap after removing the muscle to block the acid. In my case I believe the acid has gotten up and damaged my vocal cords and would hate to see it happen to anyone else.

    My doctor never told me I was going to have these 6 clips inside my throat hold the incision closed until after the surgery so best advise I can give is have long detailed talks with your doctor and really plan out the best solution for you! Ask a lot of questions, ask if the nurses in the hospital are trained to treat poem patients, mine were brand new and knew nothing about it. I had mine at a major hospital in Manhattan so I was very surprised. Good luck whichever road you choose.

    Bob

  • kayla19404
    kayla19404 thor_1313

    Posted

    For the most part it would be best to get a professional opinion. Generally dilation doesn't last long and results in having to do repeated ones. Too many of these can result in your esophagus becoming scarred or mutilated. Because a dilation is literally breaking the muscle. Now as for surgery it will last longer than dilation but it takes longer to recover than if you just did a dilation. So in the end its best to get different professional opinions. Talk to someone that would do dilation then to a specialized surgeon that does HM or POEM. Listen to what they have to say. Also im assuming that a barium swallow, manometry, and endoscopy has been done on you so present that information to each person. Think about what you want and what would be best, considering what they tell you. Then you can make a decision. I personally am in no position to tell you whats best for you but I as well was diagnosed with type 2 and I am going to do a HM in 2 weeks. My decision was based on listening to what the doctors had to say and then deciding which was best for me personally. I wish and hope the best for you.

  • AlanJM
    AlanJM thor_1313

    Posted

    Dr Pelligrini has an international reputation on achalasia and the short answer is that you can have great confidence in his advice.

    I think the issue with POEM is how the reflux is going to be controlled in the future when the lower oesophageal sphincter is more relaxed. If the control is to be with medication you will need to be on PPIs indefinitely. The myotomy and fundoplication recreates the valve effect of the sphincter. On the other hand, POEM might be possibly calculated so as to get the new tension exactly right, but I am not sure this always happens.

    • thor_1313
      thor_1313 AlanJM

      Posted

      I had my appointment at the University of Washington on Friday, I met with Dr Wright who does the HM's. I was pretty set on POEM but he recomended a HM with a wrap. He said ultimatly its my decision and I am a candidate for either one. Dr Oelschlager does the POEM surgerys, hes doen less than 50 evidently. I am not sure how both have pros and cons...I will email Dr Oelschlager and see what he has to say before I decide. 

  • Finally17
    Finally17 thor_1313

    Posted

    I ultimately chose the POEM over dialation because i felt they had more control over how the muscle would be cut and could be more personal in the operation based on the shape of my esophagus. The dialation seemed riskier.

    However i have type 1 achalasia and i am 29 years old. My symptoms were pretty bad and they recommend surgery over dialation for me.

    My uncle had a dialation done about 30 years ago and it worked for him. His symptoms were not as bad as mine. I do not believe he has had any repeat dialations.

    • AlanJM
      AlanJM Finally17

      Posted

      Glad you have made the decision - and all the very best for a good result!
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