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I went to Prime Outlets today in Williamsburg. Without realizing it, I had been walking around the outlet for over 3 hours! 3 HOURS!!! No breaks or stopping to sit; ok a bathroom break. I didnt feel tired, nor did my feet hurt!!!!

I'm shocked!! Last year this would have been IMPOSSIBLE!!! WOW!!!

I am 3.5 months out and I am starting to experiment with different foods; chips, breads, steak, chinese food. Yes, CHINESE!!! Of course, no dumping! That is scary, very scary! OH and popcorn! I popped popcorn last night in my wok. I used EVOO and I Cant Believe its Butter spray. It was sooooo good! These are all foods that I've been craving (of course before PMS). I tried everything while at home just in case there was an issue.

I bought a $.99 bag 2.5oz of chips and divided them up into .5oz. That way i wouldnt feel guilty (HA). When I ordered Chinese food, i did go a little overboard; a pint of shrimp&stirfry veggies AND sesame chicken w/broccoli. I had a little of both mixed together for 2 days. Then I froze the rest. A part of me feels guilty that I'm "cheating" on myself. BUT, I realized I'm just satisfying my curiosity. How will I know if I can or cant tolerate something.

Another thing going through my head is during excercise class I still feel FAT. Go figure! I've gone from 265 down to 193 and I still feel FAT! Its just when I'm in class, I feel like I cant keep up. Instead of running in place or doing jumping jacks, I either walk in place or step side to side. I feel great!!! I think I'm just scared that I'll end up catching cramps in my feet or legs (which I did when I was heavier). Maybe if I wear something more fitting I can physically see that I'm not the 265 pound person I was last year. Currently, I wear a baggy tshirt and baggy sweats. That maybe a thought huh?

Ok, after doing some brief research and trying to understand what Dr. Mann was saying yesterday. It appears that I have Esophageal Spasms; go F*ckn figure!!!  Now how I got it I'm not sure, but i recall it started with me drinking diet lemonade. I found an article that pretty much explain this. I guess I'm the Official guinea pig (however you spell it). Enjoy the reading!!
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Esophageal spasm is a condition characterized by irregular, uncoordinated, and sometimes powerful contractions of the esophagus, the tube that carries food from the mouth to the stomach. These contractions should be present but well coordinated, moving the food through the esophagus and into the stomach. It is easy to understand that they are very important because they can prevent food from reaching the stomach, leaving it stuck in the esophagus.
Esophageal spasms are a very rare condition.

The problem is that symptoms which may suggest an esophageal spasm are often the result of some other condition such as:

•    gastro-esophageal reflux disease (GERD)
•    achalasia- problem with the nervous system in which the lower esophageal sphincter (LES) doesn't work properly
•    anxiety or panic attacks

The cause of esophageal spasm is unknown. Many doctors believe it results from a disruption of the nerve activity that coordinates the swallowing action of the esophagus.

Types of esophageal spasms

Generally speaking, esophageal spasm can be subdivided into 2 distinct entities:

1.    Diffuse esophageal spasm (DES), in which contractions are uncoordinated. Several segments of the esophagus contract simultaneously, preventing the propagation of the food.

2.    Nutcracker esophagus, in which contractions proceed in a coordinated manner, but the amplitude is excessive.

The most common symptoms

•    Chest pain - Most people with this condition have chest pain that may spread outward to the arms, back, neck, or jaw. This pain can feel similar to a heart attack
•    Difficulty or inability to swallow food or liquid
•    Pain when swallowing
•    The feeling that food is caught in the center of the chest
•    A burning sensation in the chest (heartburn)

Possible causes of esophageal spasms

Although the etiology of esophageal spasm is unknown, there are several possible scenarios:

•    Increased release of acetylcholine appears to be a factor, but the triggering event is not known.
•    Gastric reflux or a primary nerve or motor disorder.
•    Micro-vascular compression of the vagus nerve in the brainstem has been demonstrated in recent researches as the possible triggering event.

Esophagus physiology 

The esophagus is comprised of 2 layers of muscle, the inner circular and the outer longitudinal layers. The esophagus can be divided into 3 zones, each with separate anatomy and physiology.

•    Upper zone
Made entirely of striated muscle, this zone initiates the contractions that propel the food down the esophagus. The upper esophageal sphincter is located in the upper zone. It prevents food from returning the same way up.
•    Middle zone
Middle zone is made of striated and smooth muscles. It is made of the inner circular muscle layer and the outer longitudinal muscle layer which work in conjunction to propel the food.
•    Lower zone
The lower segment is the lower esophageal sphincter. This circular muscle is a thickening of the smooth muscle that is contracted to prevent reflux. The pressure in the LES should normally be 15-25 mm Hg.

Esophageal muscles

Upper esophageal sphincter

When functioning properly, the esophagus can detect the presence of food at the upper esophageal sphincter. It coordinates progression of the food down the esophagus to the stomach.  Evaluation of the upper esophageal sphincter reveals constant spiking activity. When a person starts swallowing the food, the tonic contraction of the UES is inhibited, opening the UES in order to allow passage of food. To propel the food, the longitudinal muscles must contract, which is followed immediately by the contraction of the circular muscles. That’s how the initial wave starts, propelling the food down to the middle zone.

Esophageal middle zone

The middle zone of the esophagus propels the food from the upper zone to the lower zone. This segment consists of 2 muscle layers, an inner circular and outer longitudinal layer.

There is only one but very important difference - in the middle zone, the striated muscle transitions to smooth, or involuntary, muscle. If the muscle contraction of this part of esophagus is not orderly, the food bolus cannot progress.

There are two forces that propel the food:

•    First, gravity pulls the food caudally.
•    Second, the organized contractions of the muscles propel the food caudally. 

Lower esophageal sphincter

The lower zone is comprised of the lower esophageal sphincter. This is a condensation of the smooth muscles. This muscle is contracted and must relax to allow food to pass. Failure of the LES to relax and allow a food bolus to pass is termed achalasia.

Diagnosis of esophageal spasms

Physical examination and patient’s history

Doctor can often determine the cause of esophageal spasm by doing a physical exam and asking a patient a series of questions. These include questions about what foods or liquids trigger symptoms, where it feels like food gets stuck, other symptoms or conditions she or he may have, and whether a patient is taking medications for them.

Laboratory studies

Laboratory evaluation usually does not help in the diagnosis if patients' history and physical examination are unremarkable for other diseases mentioned in the differential diagnosis.
Blood sugar and hemoglobin A1C should be checked to rule out diabetes. However, patients can have esophageal spasm and diabetes concomitantly. The findings discovered by monitoring a patient's pH can demonstrate reflux, which can present with somewhat similar symptoms. 

Barium swallow test

It is important to point out that barium swallow is the best possible imaging study to help in the diagnosis of esophageal spasm. Barium swallow images show characteristic appearance of multiple simultaneous contractions. This is often referred to as a corkscrew appearance.

CT scan

The hypertrophy of the muscle wall is the cause of the increased thickness that is observed on CT scan images. The normal thickness of the esophagus is less than 3 mm and in cases of esophageal spasms it is much thicker.

Many other disease processes, including malignancy, can cause thickening of the esophagus that can be seen and that’s why it also helps to rule out some of these conditions.

Even in patients with symptoms of esophageal spasm, thickening seen on CT scan images should not be dismissed as muscular hypertrophy secondary to the esophageal spasms without further investigation. That’s why further analysis is necessary!

Manometry

Manometry in patients with nutcracker esophagus demonstrates contractions that progress in an orderly manner, with an excessive amplitude. Amplitude greater than 2 standard deviations above the normal value is considered diagnostic for nutcracker esophagus.

Endoscopy

It is a very good diagnostic tool to examine the condition and function of the esophagus. Tests measure acid levels in the esophagus as well as the strength and pattern of muscle contractions in the esophagus.

Treatment of esophageal spasms

Esophageal spasms are difficult to treat.

Medications

Medications that are being used commonly are:

•    Calcium channel blockers

These medications can reduce the amplitude of the contractions. In patients with nutcracker esophagus, calcium channel blockers effectively reduce the amplitude of the contractions, but the chest pain may not always be reduced. Traditionally, calcium channel blockers were thought to decrease the contractions.

•    Nitrates

They have also been used with some success. The mechanism of action is unknown but may be related to decreasing vasospasm in the brainstem, similar to calcium channel blockers.

Some patients have tried sublingual nitroglycerin for acute symptoms of esophageal spasm.

•    Tricyclic antidepressants

These medications, specifically imipramine, have been shown to decrease chest pain with no apparent cause on angiogram. 

Balloon dilatation

This method is commonly used to treat achalasia, but it has been used to treat esophageal spasms and nutcracker esophagus too. The problem is that the studies are limited, the relief is not uniform, and symptoms recur.

Surgical treatment

•    Myotomy

This operation relieves symptoms eliminating the effectiveness of the contractions by  cutting down some layers of muscles. Traditionally, a thoracotomy, the opening of the chest, was required to obtain access to the esophagus, but now, a thoracoscopic approach can be used. Myotomy is, although very radical, also very effective in treating esophageal spasms. The myotomy should extend to the entire length of the involved segment, which should be determined preoperatively with manometry. The problem is that myotomy usually reduces the amplitude of the contractions, but does not consistently improve symptoms, especially if the primary complaint is pain.

•    Anti-reflux procedure

Anti-reflux procedure should be performed concomitantly, by either a partial wrap or a floppy wrap.
Myotomy should be used with caution in patients with nutcracker esophagus because it may worsen the symptoms.

•    Esophagectomy

As a last possible option removal of the esophagus called esophagectomy can be used to relieve symptoms. The esophagus is usually removed completely, except the extreme upper part, and the stomach, small intestine, or colon is used to restore the continuity of the GI tract. Morbidity and mortality of esophagectomy are substantial. Therefore, it should be performed only after other treatments have been exhausted. It is a very complicated procedure that sometimes last for couple of hours.

Important notification about information and brand names used in this article!

Author's biography

SirGan is doing his specialization in neurosurgery at Portugal. He is interested in expertise for radiosurgery, as well as treatment of brain tumors, and currently he is studying interventional radiology. He gained significant operative experience that is done under the supervision and guidance of senior residents.

Just when I thought I was getting better and over the sinus issues here comes yet another issue; ACID REFLUX!!! And yes I'm taking my medicine religiously.

At first I thought it was b/c I was drinking lemonade, so I stopped. The whole weekend I havent had anything with acid; unless SF KoolAid has it. This morning I have my usual drink of water as I'm travelling to work and WOOOOOO it hurt going down. So I thought hummm I need to go ahead and take my medicine, so I did. And that hurt going down. Right now as I type this "vent session", I am unable to drink anything b/c if FREAKN hurts!!!

At 2:30 I have an appt w/ the surgeon and on Thurs an appt w/my PCP (to check my sinus issue). A co-worker told me it could be anxiety; which attacks the weakest part of your body--in this case my digestive system. So who knows!!!

I'm sooooo thristy right about now!

I just came back from my follow-up appt. I have lost six pounds since June 3rd. To me that's big since the pounds came off this past week!!!! BUT that wasnt good enough for my surgeon. I told her what I was eating and drinking; all good stuff. Well come to find out, I'm suppose to drink a protein drink as a meal supplement NOT as a "drink"; which is fine. Now the part that gets me is all this time I thought we are suppose to eat until "satisfied/comfortable".  Apparently that's not the case! You are suppose to stop BEFORE you get to that point (according to my surgeon). So, instead of me eating 5 lil turkey smokies (which btw is 1 serving & 8g protein), I'm to eat 3!!!! All this is fine, but its a little frustrating esp. when you are doing your best (so you thought).

Its definitely a challenging task, as long as I'm healthy and looking good I'll continue making the changes that I need to make. Gotta love the decision we made to have this surgery!

It's been a while since I've written. I have gone through A LOT of changes in my personal life since the surgery. Luckily my faith has not allowed me to be consume by all the issues that are going on in my life.

Well, I have hit the STALL; 2 weeks and no change! I can see why this is so frustrating. AND on top of that, I havent had my period for the month; usually around 6th-11th. So far NOTHING! I'm going through the motions but nothing is showing up. I tell you. On a good note, I keep getting compliments on how good I look. At this time in my life, those compliments mean the world to me.

I went shopping yesterday. Its amazing how I was feeling reluctant in going into a store, but I broke down and went into several stores. I'm very particular on how much I want to pay and the quality of the clothing. Well, JCP had both!!! The avg. price of what I bought was $6 (1 pr jeans, 1 pr jogging pants, 2 dress slacks, 4 rib tanks, 2 tops, 1 jean jacket). Pants size is btwn 18/20 and shirt size is 1x or XL in Misses!!! When I got home that's when I decided to try them on. THEY ALL FIT!!! I was in hog heaven last night.

I told someone that I have more weight to lose. That person looked at me and said "Why? You're not comfortable with your size now?". I just laughed. This is the same person who is always trying to get me to eat something sweet!

Let the Journey continue!

This morning curiosity was killing this cat. I wasn't going to do it until Sunday morning, but I couldn't resist. I stepped on the scale and it read 245.2 . I'm down 20lbs since Dec. 10, 2009 ! And I'm 3 days away from surgery. I'm sure you know where I'm going with this. That question popped in my head; "Well, I don't have to have surgery. I can do this!"  Reality set  back in, "Yes Amy, you do need this surgery!" Then "The Sabotager" step in my head. I'm sure you know about this creature. "Since you lost some weight, why don't we go to Sonics and get those mozerella sticks you've been wanting ? You'll be able to "get rid of it" at least by Monday evening."  GET OUT OF MY HEAD!!!!! All of this happened from the time I got on the scale until I stepped off. (Of course the thought of mozerella sticks have been on my mind since Wednesday! BTW, this is my week to crave everything. I'm suppose to be coming "on" next week-GREAT!!!!)

I'm excited about the weight loss, please don't get it twisted. I have a size 26 pants that I had on yesterday and I had to go home during lunch to put a belt on b/c they kept dragging the floor. This morning I tried on a size 24 pants I had in the closet and I must say they were loose . But I'm still Morbidly Obese. OOOOOOOK, I'm snapping out of it. I suppose what I'm feeling is normal. And I wonder if we fought this Sabotager will we/I be in this position?

I decided I needed to get away for the weekend. I made an early trip to Greensboro, NC. I say early b/c I was suppose to be making this trip next weekend. All in all it worked out.

My mom & I spent time together (that's rare). I told her the "real" (somewhat) reason why I came down. I said to her that I'm having surgery on April 6th. She responded Oh ok. I told her what kind of surgery. Then out of the blue she said one of her friends had the lap band done.  My reaction exactly; she know something about the surgery! My mom gradually asked me questions and I answered them. So I decided to ask the "magic" question, "So are you coming up?" She responded, "I can come on that Saturday til Sunday"    WTH,F!!! She is actually coming to VA! The last time she was here was in 2003/2004 for my breast reduction surgery. Do we see a pattern? ummmmm so I guess whenever I have surgery she'll come up this way; lol.

I am glad she's coming, don't get me wrong. I have to practically beg her to come visit me in VA. It wasn't as bad as I thought it would be. I did however make her promise she wouldn't tell anyone in our family. We'll see!

I am so FREAKIN tired!  Is this normal? It feels like I'm "here", just here! I've been taking my vitamins, B12s, getting in my protein, etc...  

Now that I think about it. I had my therapist appt yesterday (non-WLS) and she brought some things to my attention. That through me off track big time . But her point was valid. After I thought about it, I realized my mom responds in the same fashion; "I Get It From my Moma" (the song) ha haaaa. Anyway, after I left her office I was very frustrated and confused. AND wanted to EAT! Yes, I wanted FOOD, alot of IT!!! I called a friend who has the same therapist and she knew how I felt b/c she had to go through the same process. By the way, I HAVE TO KEEP A FREAKIN JOURNAL  on my feelings! My friend knows about the WLS and when I mentioned food, she quickly said NO! Which made me feel good, but I still wanted something. Nevertheless, I didn't stray from the Liquid Diet . 

I was very emotional last night. I even had tears running down my face from watching the 1st part of the Biggest Loser; WTH? Could that be why I'm tired; just emotionally drained? Moma never said there will be days like these!

As you all know, I started my liquid diet early (was suppose to start tomorrow 24th). I started on Saturday the 20th. It has been going well. LIke I stated in my last post its a mind game, TRULY a mind game. I say that b/c yesterday I ate a plain bagel w/reduce fat cream cheese AND a turkey burger (you know ones I cooked on Sunday). I wasn't hungry. I didn't have a headache. But my HEAD kept saying go ahead you dont really start until Wednesday. It was my head!!! The bad thing is I didn't feel guilty.

This morning I got on the scale and I'm down 4 lbs. from Saturday morning! I'm happy! I actually feel lighter; like I can move more freely (if that makes sense). During these last couple of days, I haven't had any mood swings, hunger issues, or anything else that you hear people talking about. Maybe bc I prepared myself for this day. I had already cut back on my sweet teas, so no caffenine headaches. I have been eating healthy & majority of the time at home.

My advice to any & everyone making this life change, start NOW!!! Especially if you are pre-op, start making the changes to improve your life/health. Eat right, cut back, and exercise. GET MOVING!!!!