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Pre-Op & Post-Op FAQ
Motility & 24 Hour Monitoring
Is it going to hurt?
Insertion of the motility catheter and pH probes is moderately uncomfortable. Of course, everyone has varying levels of tolerance so it is impossible to say how each individual will react. For most individuals, it is moderately uncomfortable. There is discomfort and a pressure sensation as the catheter is passed through the nose. A topical anesthetic jelly is used to numb the mucous membrane of the nose, but you will still feel pressure. It is normal to gag when the catheter is at the back of the throat, but this sensation soon passes. You will always feel like something is "caught" in the back of your throat, this is normal and you will gradually adjust to the sensation.
Will I choke or will the tube interfere with my breathing?
You will always be able to breath. Your airway and your esophagus share a common passage for brief amount of space. The way the tubes are inserted is designed to protect your airway. So it is important you do as the nurses instruct you while the tube is being inserted. You may gag, which is normal but you will not choke. Once the tip of the catheter is passing the back of your throat, the gagging sensation eases relatively quickly. Even if you have asthma or any other type of lung disease you will still be able to tolerate the test as it does not interfere with your breathing.
Why can't I be sedated for the test?
There are two main reasons why you are not sedated for this test. First, you need to be able to swallow small amounts of water during the test. You can't do this if you're sedated. The second reason is that your esophagus is a muscle, and any of the medications we could give you will affect the function of the esophagus. The test is designed to assess how your esophagus functions under "normal" conditions, so to take any medication that would affect your esophagus affects the results of the test.
Why can't I take my usual stomach medications?
We ask you to stop taking any medications that may affect the functioning of your esophagus. Again, this is so we can obtain an accurate test of your esophageal function. You are generally asked to stop these medications 72 hours before the test. This time period is based on the time it takes the drug to be excreted from your system.
If you're having a 24 hour esophageal pH study, in most instances your doctor wants to know how much acid is actually getting into your esophagus from your stomach. In order to measure this, your stomach needs to be producing acid. You will be asked to stop taking proton pump inhibitors (i.e., Prilosec, Prevacid, Aciphex) 2 weeks before the test. You will be asked to stop taking H2 blockers (i.e. Tagamet, Zantac, Pepcid, Axid) 72 hours before the test. You will be asked to stop taking antacids 24 hours before the test. Again, the time frames are based on how long it takes for the drug to be excreted from your system and the amount of time required for you stomach cells to begin producing acid again.
We know you will be uncomfortable without your medications. However, it is very important to stop taking them as directed so that a good, valid study can be obtained.
Occasionally your doctor will wish to know your esophageal pH while taking medications, if this is the case you will be given specific instructions regarding taking the medication.
Why do I have to follow a "special" diet? Why can't I eat what I normally eat? Why do I have to eat during the test?
During the study we ask you to avoid foods that have a high acid content. This is to try and avoid any low pH readings caused by food or liquid instead of acid. You will be able to eat most food that you would normally eat. The only restrictions are to have no carbonated beverages, alcohol, and fruit juices. We also ask you to avoid an acidic fruits or foods that have a tomato base or spicy sauce. The most important aspect of your diet is that you eat a good, normal size meal. Many times what happens in your esophagus depends on what is in your stomach. If you don't eat at all, you will have affected the results of the test as a large number of people have the most problems after they eat.
Why do I have to eat a hamburger, French fries and milk shake?
This type of fatty meal will challenge your stomach and esophagus and is a good way to assess the amount of acid reflux you may be having.
Why can't I smoke during the test?
The nicotine in cigarettes affects the functioning of the valve between your stomach and esophagus. We want to know how your esophagus works when any drugs don't affect it. We will ask you not to smoke during the test, however if you absolutely must have a cigarette, we will ask you to write the times down on the diary. This way if some event occurs during that time, we can see if it was related to the cigarette.
Can I cough, sneeze, blow my nose, and vomit while the tube is in?
Yes, you will be able to cough, sneeze, blow your nose and vomit while the tube is in. You will not vomit the tube out. We don't expect you to vomit because of the tube, however, vomiting may be one of your symptoms.
Can I drive myself home after these tests?
You will not receive any sedation so there is no reason you can't drive yourself. Some people feel more comfortable having someone else drive them, but this is entirely up to you.
Why does my nose run all the time during the test?
The irritation of the catheter causes your mucous membranes to
make more mucous, so your nose will run.
What if I need some help during the test?
One of the nurses is available by pager while you're having your study. If you need to talk with her or have any questions you can page her.
Why do I have to sleep with my bed flat during the test?
Again, this is related to monitoring what normally happens in your esophagus at night. Gravity helps to drain anything out of your esophagus; it also helps stomach contents from getting into your esophagus. We want to assess what happens when you don't have gravity helping you out. We know it can be difficult, and ask that you do the best you can. If you do not lie flat, it will affect the outcome of the test and will not give your doctor an accurate idea of what is happening in your esophagus.
Endoscopy questions
Why does someone have to drive me home?
You will be receiving sedation for the endscopy. This sedation is usually a narcotic analgesic and an anti-anxiety/sedative agent. These drugs affect your judgment and your reflexes (just like alcohol). It is unsafe for you to drive while under the influence of these drugs and it would be negligent on our part to let you drive after receiving these drugs. It doesn't matter what has happened in the past or at other institutions. You will not be allowed to drive yourself home after receiving sedation. The procedure will be cancelled if you fail to bring a driver or fail to make arrangements to be driven home, there are no exceptions. It is also best to bring a friend or family member with you even if you will be taken home by a driver.
How long will I be there for the endoscopy?
The minimum time is usually two hours. The procedure is only about 15 minutes, but getting you ready, doing the procedure, and you waking up afterwards usually takes two hours. Our physicians are usually on time, but occasionally there are delays. We do everything in our power to ensure your procedure happens on time, but there are always exceptions.
Why can't I eat and drink before the procedure?
Two reasons, if your stomach is full of food and/or liquid, the doctor cannot see the condition of your stomach and cannot do a thorough exam.
Secondly, when you are sedated, your reflexes slow down. If you have a stomach full of food or liquid and vomit, you are more likely to get some of that food or liquid into your lungs. This is called aspiration and is very bad. We want to be sure you are always protected during this procedure, so we will ask you to have nothing to eat or drink for at least six hours before the procedure. In certain instances, that time may be longer. In either case you will be given specific instructions regarding how long you must go without eating or drinking before the procedure.
If you fail to follow the instructions regarding eating and drinking before the procedure, the procedure will have to be delayed and/or cancelled.
Questions for VideoEsophogram
What is a VideoEsophogram?
A VideoEsophogram is like an Upper GI Series X-ray; the main difference is that the x-ray is recorded on videotape. You will be asked to drink barium (a strawberry flavored liquid). As the barium travels down your esophagus and into your stomach, the x-ray picture is recorded. This way the radiologist and your doctor can have a motion recording of how the barium travels down your esophagus and into your stomach.
What is a "barium burger"?
This is a hamburger that has a dollop of barium on it. You will be asked to eat and chew several bites of the hamburger so that the radiologist and your doctor can see how your esophagus and stomach handles solid food.
How long does the test take?
Once the procedure starts, it takes about 45 minutes.
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