Mashkikiwinini: Facing the fear of the unknown

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By Arne Vainio, M.D.
News From Indian Country 5-08

Recently I had an EGD. What is that? It’s a surgical procedure where a camera on a brightly lit tube about the diameter of your little finger was inserted through my mouth, down my esophagus, into my stomach, then into the first part of my intestine. Dr. Vopat, the surgeon doing the EGD, was able to see everything through the camera and take biopsies (tissue samples) of any areas that looked abnormal.

Why would I let anyone do that to me? Because I have a fairly common condition called GERD, which stands for gastroesophageal reflux disease. This is like heartburn, only chronic and worse. It’s caused by stomach acid moving into and irritating the esophagus. The things that make GERD worse are caffeine, smoking, alcohol, age, obesity and eating big meals before lying down. Symptoms include any of the following: the sensation that something is rising up in your throat, voice changes, chronic heartburn, a sour taste in your mouth in the morning and sometimes a chronic cough. Sometimes it can be hard to distinguish it from heart related pain.

Four years ago I ended up in the emergency room in the middle of the night with pain in the left side of my chest. This had been there for about a week, and was steady and aching. It didn’t change with exercise or activity. As a physician, I knew this was not consistent with cardiac (heart) pain, but it was my chest. In the emergency room my labs, chest X-ray and EKG (electrocardiogram, or heart tracing) were all normal, but the ER doctor scheduled me for an exercise treadmill stress test.

This is a test where you walk on a treadmill and have an EKG done continuously as you walk. It looked easy, but this was a real workout. Every 3 minutes the treadmill speeds up and they raise it up so you’re walking up hill. By the end of the test, I was sweating like crazy and breathing hard, but I passed it with flying colors. My heart was fine.

So, since then I have been taking medicines for GERD. This is not a good long term solution without a doctor’s advice. As a doctor myself, I really should know better, but I was making excuses as I did not want to have an EGD. I finally went to see Dr. Jorde at our clinic last summer and he put me on a stronger medicine for GERD to see if that would help. It did, but not completely, so on a recent follow up visit, he set me up for the EGD.

The esophagus was never meant to be exposed to stomach acid on a chronic basis, and over time the tissue in the irritated area can change and become precancerous or cancerous. The precancerous finding is called Barrett’s esophagus, and needs to be monitored closely if it’s found. Cancer of the esophagus is bad and can spread to surrounding lymph nodes, or to the liver and lungs. This is difficult to treat, and needs some combination of surgery, chemotherapy and radiation. Unfortunately, these things don’t often cure esophageal cancer, but merely slow it down. As usual, preventing it is the key.

I was not at all looking forward to the EGD. Even though I knew what the test was like and have been present for them with patients, I was more than a little afraid of the anesthesia, of the procedure itself, and of what Dr. Vopat might find. I had to fast for the test, and had to skip my morning coffee. I spent a long time putting tobacco out before we left for the hospital.

After I registered, the nurse in the surgical area went through my list of medicines and my medical history. She checked my vital signs and started an IV. Then the nurse anesthetist came in, introduced himself and again reviewed my history and medicines. Dr. Vopat came in and talked with me and my wife to see if we had any questions before taking me to the operating room. He showed us the scope and how it worked, and again asked if I had any questions. I didn’t, so they sprayed in some anesthetic spray to numb the back of my throat.

Then they gave me a plastic block to put between my teeth so the scope could go in. The anesthetist told me he was going to give me a medicine to put me out and told me what to expect. As he predicted, my hand felt cold where the medicine went into my vein, and the top of my head felt warm. The next thing I knew, it was 10 minutes later and I was back in the pre-op area with my wife.

Dr. Vopat came in and told us that things really looked pretty good. There were some irritated areas, but nothing that looked like Barrett’s esophagus or cancer. He took some biopsies, but they won’t be back until next week. After most of the anesthesia wore off, the nurse made sure I could drink and walk OK, and we left the hospital. My wife drove as I wasn’t supposed to drive for the rest of the day. She’s so nice she even took me to lunch. What a sweetheart.

This procedure that I had been dreading for several years turned out to be nothing at all to be afraid of. Everyone at the Cloquet Memorial Hospital was very professional, caring and reassuring. I know Dr. Vopat very well and was glad he did the EGD, but I know the other surgeons there and would have been happy with any of them. I really feel much better knowing I don’t have anything to worry about right now and I feel somewhat foolish for putting off this simple procedure for so long. I watched my grandmother suffer for years with this problem, and remember her constantly drinking antacids right out of the bottle. She would have given anything to take the medicines available today.

I don’t smoke, and have not drank in over 10 years. I need to maintain my recent weight loss. I have cut back on caffeine, but still have one cup of coffee in the morning. I can continue the medicines I take right now and need to raise up the head of the bed by 4-6 inches to keep stomach acid from going into my esophagus when I’m sleeping. There is a surgical procedure that can be done if these things don’t work, but I want to avoid that.

I sometimes get frustrated when patients avoid screening tests, but I’ve been guilty of that myself. I understand the fear of the unknown, but sticking your head in the sand and avoiding diagnoses won’t make them go away, and waiting can make a small problem get much worse. But we all know that.

Doing this makes one less problem my family doesn’t have to suffer through because I avoided screening. That makes me a better father and a better husband. Someday, I’ll be a better grandfather. I can live with that.

Arne Vainio, M.D. is a Family Practice Physician at the Min-No-Aya-Win Human Services Clinic on the Fond du Lac Ojibwe Reservation in Northern Minnesota. He can be reached at: This email address is being protected from spambots. You need JavaScript enabled to view it..

 

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