So I’ve been doing pretty well. I had my Achilles tendon surgery last fall and, combined with my new Simponi Aria treatments that seem to actually be working, I’ve been feeling generally good. I am out walking (miles) most days and the fatigue is practically non-existent. While there have been a few down days and a few painful joints here and there over the past six months, overall I’ve actually felt really human. I have had the opportunity to travel and to meet up with other advocates on several occasions and am looking forward to some similar trips and some great vacation plans with husband. After worrying for months, I recently found out that Medicare is going to cover 100% of my infusions. Life has been good.
In addition to RA, I also have Sjogren’s. If you don’t know, one of the major symptoms is dryness — dry eyes, dry mouth, dry everything. I take medication for it which really helps. One of the things that has happened over the past year or so is that I have very occasionally gotten food stuck in my esophagus. I pretty well narrowed it down to breakfast (before I take my Sjogren’s medication so I’m dry) and when I eat something dry like toast and don’t drink enough liquid with my food. When I take my medication, or eat something moist like cereal and milk, or make sure I drink something with every bite of food, it doesn’t happen. To me, it’s been a case of, “Doctor, doctor it hurts when I do this — so don’t do it.”
A couple of weeks ago I had a really bad instance of this happening. Usually, if I take sips of water or simply wait long enough, the food jam will resolve itself. But this time, it felt like it was getting worse. I literally felt like I was having a heart attack. I eventually got sorted out but my husband insisted I go see our GI guy about it. He told me if it were him having the problem, I’d be telling him to go. (I hate it when he uses my words against me.)
So yesterday was my appointment. Love my gastroenterologist. Excellent doctor medically. Very thorough. Very practical. Very funny. Actually listens. All my favorite attributes in a doctor. He agreed that my Sjogren’s analysis could very well be the issue, but that there were a couple of other things that could be happening. He suggested (as I knew he would) that we do a barium swallow study followed by an endoscopy (where they stick a camera down your throat and look around) just to make sure. One of the primary things that could cause the issues I am having is an esophageal stricture. That’s where a band of tissue forms a ring in the esophagus and keeps it from expanding to let food pass. (Portentous music here …) Turns out that a disease related to this condition is RA … !!! (along with other inflammatory / autoimmune disorders).
We scheduled the endoscopy (which is done under anesthesia) for two weeks out, but the imaging center doing the barium study was right down stairs and it turns out, they could do it while I was there, so that’s what we did.
The neat thing about these studies (or at the least the few that I’ve had) is that you can actually watch what’s going on as you drink the barium solution. The radiologist watches the esophagus and stomach as you slowly drink the solution and he can see how everything is working and if there are any obstructions and things of that nature.
At the last part of the study, the radiologist gave me a barium pill to swallow. It’s small, less that 1/2 inch — about the size of a regular Tums tablet. So we all watched on the monitor as the little white pill meandered down my esophagus and stopped just short of my stomach. And it just sat there. So the radiologist had me drink the rest of the water, and we watched as the water went down, slithered past the tablet, and the tablet just sat there. So the radiologist then had me drink the rest of the (very thick, nasty) barium solution to see if the thicker liquid would push the pill down. Same thing happened. The solution wandered down, slid past the pill, and the pill just sat there.
The pill was much smaller than a normal bite of food and actually much smaller than several of the medications I take. I’m amazed that I hadn’t had issues every day. And the radiologist agreed.
He confirmed that it was a ring stricture right above my stomach. It also appears that my esophagus isn’t working correctly. Instead of smoothly pushing food down into my stomach, it gets out of sequence. That’s called esophageal motility disorder. Not sure how that’s addressed.
But I have to admit, I am really pretty bummed. I have been feeling so well and to find out I have something really wrong with me (not just some transient pain), is just plain demoralizing. And now I’m paranoid about eating anything denser than water. And I’m going on vacation out of the country (on a cruise ship) next week, and what happens if I have issues there? The situation can get bad enough that it becomes an emergency surgical event. (Sigh.)
The good news is that the stricture is a pretty easy fix. During the endoscopy in a couple of weeks, my doctor will stretch out/dilate the stricture by expanding a series of increasingly larger balloons until the ring is released. There is always a possibility that it can come back but I’ll deal with it then if it happens.
And while this is yet another example of how RA affects your entire body, not just your joints, the really better news is now I know there is a real problem (which could be really serious) and I now have a real solution.
I hope that if any problems appear in your life today, that they also have simple solutions. Thanks for checking in.