Anthony Bray MD : Hello!
Anthony Bray MD : Is this immediately upon trying to swallow?
Anthony Bray MD : do you have problem with liquids?
Anthony Bray MD : symptom sounds potentially concerning for problem such as esophageal stricture.... Has this been occurring for some time or just this AM??
Customer: It is when it goes down the wind pipe is where it feels like it get stuck. And a couple times a day after drinking i get coughing spells
Customer: I had a motility study. It showed that i high lower esophaheal pressure. And i had an upper gi series that showed i have a esophageal diverticulum
Anthony Bray MD : You may be aspirating... You should see a gastroenterologist .... It sounds that you need a modified barium swallow study to evaluate this problem further....
Customer: I have a gi dr
Anthony Bray MD : OK --I see --- it sounds then that you are symptatic from the esophageal diverticul then...
Anthony Bray MD : symptomatic ...sorry typo...
Customer: Will it just fix itself.
Anthony Bray MD : No not exactly.... More a matter if severity... Bad enough may need surgery....
Customer: How do i tell its severity
Anthony Bray MD : I would suggest that you follow up with your gastroenterologist...
Customer: I dont see him until the middle of may
Anthony Bray MD : well if you have severe trouble with your swallowing that is getting worse then contact the GI's office or be seen at ER....
Customer: Also my reflux has been horrible lately. Im burping up vomit. And my chest fels like its on fire constantly
Anthony Bray MD : Are you taking medication now for your reflux?
Customer: I dont know that i would say that i am having severe trouble swallowing
Customer: Im taking pantoprazole abd carafate
Anthony Bray MD : Are you on reflux precautions? --- Elevate head of bed 4 to 6 inches.... Wait 1.5 hours after eating before going to bed ... Avoid hot spicy foods or acidic foods... Tomatoes, citrus fruits, peppers, onions--- avoid coffee and alcohol ...
Anthony Bray MD : you already said you were restricted off of anti- inflammatory MEDS ...
Customer: He didnt tell me any of tgat. But my head is elevated. And i wait aftwr eating. And i avoid them foods. I am ordered to never take nsaids because they gave me multiple ulcers
Anthony Bray MD : OK you are on a good combination to help with reflux....
Anthony Bray MD : It sounds that you are doing all that you can to help but procedures to help prevent reflux( ex Nissan fundiolication) and procedure to fix the diverticula may need to be considered ...
Anthony Bray MD : Fundiplication
Customer: The gi dr i see now said hes done everything he can for me. He wants me to go to the mayo clinic
Anthony Bray MD : I see--- referral to surgeon whom performs the fundiplication
Anthony Bray MD : Procedure would also be an option ... This may be part of what your GI doc has in mind with referral to Mayo clinic...
Customer: I had a 24 hour ph and according to the gi dr i didnt have enough episodes of reflux to consider surgery
Customer: We have surgeons at our clinic who do that procedure
Anthony Bray MD : Ok it sounds that he has been thorough...
Anthony Bray MD : I would think he would refer you to one of your more local surgeons that perform this procedure....
Anthony Bray MD : I hope this helps some... Good luck in getting this taken care if!!
Customer: My gi dr wont refer me to a surgeon because im not having enough episodes of reflux in a 24 hour period
Anthony Bray MD : hmmm... What about the condition of your esophagus on most recent EGD??
Customer: It showed inflammation
Customer: Every egd ive had has shown inflammation
Anthony Bray MD : well that sounds expected... No diagnosis of Barrett' s esophagitis ???
Anthony Bray MD : It sounds to me that you would need procedures that we discussed....
Customer: Nope. They have all been basically normal besides inflammation. Besides the one that showed numerous ulcers
Anthony Bray MD : OK well that's good..
Customer: But i think maybe my symptoms could be from ulcers again. When i throw up there is blood. My hgb went from 15 something to 11.2 in less than 2 weeks. It was up to 12 something but now is down to 11.2
Anthony Bray MD : Wow ---you have so many problems going on! Yes you need to have the vomiting blood followed up and the anemia!!!
Customer: I was pretty healthy until this past year. Im sorry that i have so many things going on. My gi dr said he wont scope me again to check for ulcers. My uncle who is a surgeon said i need rescoping and he offered to do it
Anthony Bray MD : Right-- I agree that you need scoping again... Surgeons often do this procedure as well so hopefully you can get this checked soon!
Anthony Bray MD : how much blood have you been throwing up?? Bright red or coffee ground appearing??
Anthony Bray MD : do you have black tarry stools??
Customer: Ive been throwing up both red and coffee ground gunk. No black stools
Anthony Bray MD : if you have signs of severe ongoing blood loss then you may very well need to go to ER for this!!
Anthony Bray MD : The tachycardia of last PM could be a sign of blood loss as well but if this were the case then I would not expect your heart rate to be in the 50s today even with the Atenolol...
Anthony Bray MD : Still your vomiting blood now as you are is very concerning. I think you would be best to go get this checked more immediately at ER . ( based on previous discussions I suspect that you won't do this but seriously consider if you should do this!!!)
Customer: The er has never done anything before anout it
Anthony Bray MD : Well it would be a protective measure if your blood loss were ongoing... You could potentially need to be admitted for acute upper GI bleed and may potentially need transfusion
Customer: Im not throwing up a lot of blood. And my hgb isnt that low. http://s1280.photobucket.com/user/Kate_Miller2007/media/image-2_zpsf5e5f017.jpg.html
Customer: Do you still think er is a good idea
Anthony Bray MD : Hang on.... Only your last question is showing on my screen now... I guess I'll try switch to Q an A format....