Swallow This

I had the dubious pleasure of donning a theatre gown again yesterday but thankfully, only briefly on this occasion.  Some weeks ago, I attended my GP with intermittent discomfort in the centre of my chest. The pain had gradually worsened over a period of days and as there is a strong history of hiatus hernia in the family and I was otherwise feeling well, I felt sure that a hernia must be to blame. Following examination, my doctor agreed that a hernia was a possible explanation for the symptoms but refused to prescribe treatment until first ruling out other potential causes. Despite my protests about not wanting any more medical intervention, he put me on the waiting list to have a gastroscopy performed at our local public hospital.

These days, GP surgeries are able to bypass the consultant system to fast-track patients for endoscopic investigation. In the past, a patient had to be referred to a consultant before a decision could be made to proceed with further investigation. Nowadays, family doctors have set guidelines to follow and if the patient fits the particular criteria, they are referred via a direct access scheme for endoscopic examination. This speeds up the investigation process and eliminates unnecessary specialist consultations. The endoscopy unit is consultant-led, it’s highly staffed so that it runs efficiently and the waiting list is the same for everyone regardless of health insurance or medical card status.

I only had to wait three weeks for the gastroscopy appointment and attended the hospital yesterday having fasted overnight as instructed. I’ve undergone this procedure before so I knew exactly what to expect.  There was no delay, I was assessed immediately by a nurse and asked to change into a theatre gown.  Following a short wait, I was escorted to the examination room to meet with the doctor and his assistant. I was given the option to have light sedation for the procedure and I didn’t hesitate in accepting. I’ve seen enough of hospital procedures to know I’d rather not see any more. I lay up on an examination trolley and following the insertion of a cannula into the back of my hand to administer the sedative, I was asked to lie over onto one side. A plastic mouth guard was placed between my teeth to protect them and stop me biting the endoscope. The next thing I knew was when I awoke in the recovery room feeling relaxed and sleepy following the sedation. An hour later, I was ready for home having received the diagnosis. I was informed that I have a significant peptic (gastric) ulcer in my stomach and shown the pretty pictures taken during the procedure. This news came as a surprise as I was expecting to hear I had a hernia but No, there was no evidence of a hernia seen.

The leading cause of a gastric ulcer is currently believed to be infection of the stomach by a bacteria called “Helicobacter pyloridus” (H. pylori). Another major cause of ulcers is the chronic use of anti-inflammatory medications, commonly referred to as NSAIDs (nonsteroidal anti-inflammatory drugs). I had two biopsies taken yesterday which will show if H. pylori is the cause of the problem and in the meantime, I’ve started on a six-week course of tablets to reduce acid production and aid healing of the ulcer – yet more pills to add to the daily pile!  If H. pylori infection is found, I will be commenced on two different antibiotics to eliminate the bacteria.  It’s quite possible that NSAIDs are to blame in my case as I’ve been on various types for years (though always in conjunction with a gastro-resistant medication), to control the joint pain I experience from my connective tissue disorder (EDS). Whatever the cause, I have to return in two months time to have a repeat gastroscopy performed to assess the situation.

I’m really in favour of this direct access scheme for out-patient care as it’s an equitable system which is efficiently run. I left the hospital yesterday feeling lucky to have received such good attention. The only difficult thing to swallow now is the fact that when I next return to see my GP, I have to admit that he was right and I was wrong.

14 Responses to Swallow This

  1. Baino says:

    Aww Steph, God you have a rough trot! There go the Champagne lunches for a while but good to see you were taken care of in a relatively short period of time. I’ve heard that about NSAIDs and also cortisone. My sister has crohn’s deseas and takes a lot of cortosoid tablets . . I sometimes think they do more damage to the mucuous membrane than good but what’s the alternative! I hope you heal quickly, you’ve had enough to deal with!

  2. Steph says:

    Cheers! Baino

    I don’t need any sympathy for this really but thanks anyhow. This is only chicken feed compared to the other stuff I’ve faced.

    I’d like to draw your attention to the following:

    “Contrary to popular belief, alcohol, coffee, colas, spicy foods, and caffeine have no proven role in ulcer formation. Similarly, there is no conclusive evidence to suggest that life stresses or personality types contribute to ulcer disease.”
    http://www.medicinenet.com/peptic_ulcer/article.htm

    Bring on the Champers! 😀

  3. Bendy Girl says:

    Ouch! Glad to hear it all went well Steph. I believe this kind of problem is even more common amongst EDS’ers not because of the use of NSAID’s, which you might like to know are generally advised against by the leading experts in EDS (the inflammation doesn’t occur in us, typically because our bodies become so used to our unstable joints they don’t inflame as a result of trauma in the same way as others) but because of the inherently weaker tissue we have. After all, the problem is in our collagen and most of your body is made up of collagen in one form or another!
    Hope you’re feeling back to normal soon, BG x

  4. Madsadgirl says:

    So they probed you from the other end to my probing? Good that you know what the problem is now, and that it is something that can be relatively easily fixed.

    Keep well.

  5. Grannymar says:

    I didn’t know you were modelling those gowns! 🙄

    Glad it all went well.

  6. Steph says:

    Hi! Bendy

    I agree entirely with you that joint inflammation is not an issue with EDS’ers but remember, I’m in a much older age bracket than you and some of my joints are now suffering from arthritic changes which do require NSAIDs to reduce pain. It’s interesting what you say about the lack of inflammation with EDS as I’ve often wondered about that. I suspect that NSAIDs are to blame for my ulcer although my GP has always been very careful to change my prescription regularly, in keeping with the safest ones and has always insisted on a gastro-resistant medication as well.

    Hello! MSG

    Don’t worry, I’ve had the other end scoped many a time too and I was more than happy to escape that fate yesterday. In fact, I think I’ve had every orifice probed at this stage and when they run out of holes, they stick the scope through my tummy button!

    In many ways yesterday’s outcome was the best one as a stomach ulcer is eminently treatable whereas a problematic hiatus hernia or worse, a malignancy would spell much bigger trouble. I have a brother who died 6 six years ago from cancer of the oesophagus which sadly was not diagnosed until it was too late (in UK) so when I developed central chest pain, I knew it made sense to get checked out fairly quickly. I’m the lucky one really.

    Grannymar – thanks! There was huge pile of gowns to choose from in the changing room and most of them looked like they ‘d been to theatre once too often. I had a good rummage to find one that covered my modesty nicely 😀

  7. Baino says:

    Haha well that’s good news all round! Must be the week for probing, my brother made me laugh this week when he said he had to have a ‘tube up the Garry!”

  8. Steph says:

    Hi again, Baino!

    Just been over writing an essay at your place. I’ve fallen very behind with commenting elsewhere lately thanks to the train station that my home has become.

    When I’m REALLY ancient like Grannymar, I’ll probably wish I never said that! 😉

  9. Oh I don’t envy you the gastoscopy at all – ghastly procedure. Knew about H Pylori butiInteresting that NSAIDs cause gastric ulcers – didn’t know that (worry, worry, worry) – but it’s good that the ulcers are so treatable – despite the treatment being antibiotics – hate, hate, hate antibiotics!

  10. Steph says:

    Thanks! AV

    A gastroscopy is a doddle once you have sedation. I don’t think it’s too bad either without being knocked out as these days the endoscope is much easier to swallow but I wasn’t prepared to wait to find out!

    If you are taking NSAIDs long-term, make sure you also take a gastro-resistant type medication (proton pump inhibitor) to line your stomach. I’ll let you know next week which is the culprit in my case.

  11. Steph says:

    A belated update on the gastric ulcer:

    I was right this time! The biopsies came back negative for the H. pylori bacteria and therefore antibiotics were not required to treat the ulcer. It’s now presumed that the NSAID’s are the cause of the problem.

    The hospital had already started me on a powerful dose of gastro-resistant medication to heal the stomach ulcer but this medication had the effect of making me ‘trot’ to the loo rather too often! My GP changed the medication back to what I was on while awaiting the scope and I haven’t had an ounce of pain/discomfort from the ulcer since. I now must await a repeat gastroscopy next month to re-assess the situation.

    In the meantime, I’m back on powerful antibiotics to treat an infection in my head. Is it any wonder my stomach is protesting!

    btw When I last saw my GP, I did award him a ‘high 5’ for his vigilance!

  12. Barbara says:

    I went to my local hospital (Wirral) yesterday for a gastoscopy. After the preliminary checks I was asked to go in for the gastroscopy and treated very badly. I was asked to lie straight on the bed fully clothed and a nurse put a tourniquet on my arm whilst she fiddled with equipment. My arm swelled up and became very painful so I commented and she loosened it a bit. The endoscopist (another nurse) could not find my referral and did not even know which consultant had referred me. After a fairly long delay and a high, uncaring attitude from the staff, they started the procedure.

    Something I could not see was thrust into my mouth and someone then said that that was the mouthguard. The next thing was that I had a very severe pain at the back of my mouth. I could not cope with the pain so the tube was removed and I was taken into recovery (no attemt to find out what the problem was) I was highly annoyed – especially as nobody told me what was happening and why – comunication at any stage was obviousy not a Wirral Hospital endoscopy unit thing to do!!!! When having a cup of tea later it seems three of the five patients present had not had the procedure completed. The Sister of the unit had eventually told me that the nurse who holds the mouthguard in place may have pushed it in too far (so it seems the pain was caused by the mouth guard being thrust against the back of my mouth), and made a repeat appointment for next Monday. Is this a one off, or has anyone else had an experience like this – I am very wary of my return trip!!!

  13. Steph says:

    Hello Barbara and welcome.

    I’m sorry to hear of your experience. I would suggest that you visit your GP to discuss what happened yesterday. I am very surprised to hear of the high failure rate you describe at the unit and it should be queried.

    The problem with units like endoscopy units which churn through dozens of patients everyday, is that the staff can become immune to the needs of their patients and as a result, communication breaks down. If you had been reassured by a sympathetic nurse and had the procedure properly explained to you beforehand, I’ve no doubt that your scoping would have been successful.

    I would like to correct one thing you said. It’s highly unlikely that a nurse would ever carry out an endoscopic examination, it’s much more likely you were under the care of a female doctor.

    You might like to consider having sedation the next time you undergo the procedure and I’m sure your GP could request this for you. The best of luck anyhow.

  14. Barbara says:

    I did have sedation and the endoscopist very clearly introduced herself as a nurse -the hospital are specially training nurses up to do the job – it does seem the problem was with the nurse who was responsible for holding the mouthpiece in place. The pain was totally unbearable.

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