stephbg | Don't feed me after midnight (Reply)

Tomorrow I'm going into Glengarry day ward to have an endoscopy. Because I'll be under a sedative and (we trust) blissfully unaware of the process I have to fast, starting at midnight tonight. Food shouldn't be an issue, but I might get a bit thirsty. I've no concerns about the procedure itself. At worst I'm looking forward to a temporarily and slightly sore throat. Most of this post is a summary of my relevant clinical history in prep for talking to the specialist tomorrow, so beware TMI and vomity badness.

I've been to this place before to get an endoscopy/colonoscopy double, so at least I know how the place is run. Sausage factory describes it best, with bodies coming and going at regular intervals, and the usual hospital background of random screaming and moaning, but fewer machines that go ping. Some people are not entirely pleased with the prospect of internal investigations, it seems. We shall see if that is any different tomorrow.

I'm going to take a moment to organise my answer to the inevitable and perfectly reasonable question "Why are you here?"

It goes something like this:

I have always had issues with swallowing and randomly choking on my own spit, but it's been only inconvenient, albeit with the odd bit of chest pain and coughing. Last year when I was on multiple supplements I started to experience reflux, at first only when lying down, and then at other times. Later in the year I started having problems swallowing in the morning – pills or the first mouthful of breakfast would get as far as mid chest, then I would regurgitate them at short notice. I'd be breathless and it was a bit unpleasant, but it didn't really feel like nausea or illness. I was immediately able to swallow again, and it almost never happened later in the day. It used to feel like my throat didn't "wake up" properly, and the swallowing action stalled half way. I developed the habit of breathing deeply and stretching my neck, and taking the first mouthful carefully and waiting to see if it settled. Late last year I suspended all these supplements.

In recent months I started to semi-regularly vomit from deeper in the gut, with traditional nausea. Again at first this was primarily in the mornings, but then extended to any time of the day. It could also happen multiple times in a single day. By this point I was experiencing near constant right-side abdominal tenderness. My doctor ordered a liver ultrasound and found a single large gallstone, but no signs of inflammation. My liver function tests have been abnormal (but not seriously so) for a long time, and my most recent one was unremarkable.

One day was particularly bad for nausea and multiple vomits, and I thought I might have contracted a mild dose of food poisoning from imperfectly heated chicken. On one of those times I produced dark clumps of something I couldn't recognise and thought might be blood. That is what prompted the referral for this endoscopy. I've vomited a couple of times since, but there's been no repeat of the dark clots. I would have waited for a repeat or better confirmation, but my GP insisted that I have this endoscopy.

Around the same time as all this I overdid exercise and had a bad fibromyalgia flare. I took a larger dose of codeine than usual (60mg) and 50mg of amitriptyline, also larger than usual. The flare made my ribcage stiffen and I also felt internal pressure from my upper abdomen and apparently behind the sternum. I also started to feel tenderness at the back right, just around the waistline. Codeine has never agreed with my digestion but this time was very bad. I'd also previously noted that amitriptyline seemed to worsen the reflux and expect this was a contributing factor. When the worst of the pain stopped I also experimentally stopped taking paracetamol, which seemed to further settle the abdomen. I've been taking paracetamol on a regular basis for some years now without problems, but evidence suggest it no longer agrees with me.

In the last few days I've had almost no paracetamol, made possible by the mild weather conditions and being largely confined to bed with extreme fatigue. On the odd occasion I've needed relief and taken some there's been a small but noticeable increase in abdominal discomfort. As I write this on the night before the test nothing feels particularly wrong, although I am in considerable pain from the fibromyalgia.