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obesity and emaciation." One of these days, I will get a haircut, something I often thought<br />
I would never do again.<br />
I plan to work at Kaiser tomorrow morning, go for my procedure tomorrow afternoon, play<br />
bridge Friday afternoon and work Saturday morning.<br />
Posted by David Shuster at 06:57PM (-08:00)<br />
Pseudo-Achalasia: A New Diagnosis<br />
Friday, January 27, 2012<br />
Yesterday, after my repeat esophagoscopy, Dr Lewis came to the conclusion that I do not<br />
really have an esophageal stricture, but a form of achalasia. This is a condition where the<br />
esophagus does not contract and the sphincter at the distal end does not relax. In<br />
layman's terms, the esophagus does not propel food towards the stomach, and the<br />
muscle of the lower esophagus does not relax to allow the food to advance from the<br />
esophagus to the stomach. The result is accumulation of food and saliva in the<br />
esophagus that needs to go somewhere. When upright, it can eventually trickle into the<br />
stomach by gravity. When lying down, it can go back into the throat and even possibly get<br />
aspirated into the lungs.<br />
<strong>My</strong> search of the internet does not reveal much about this condition acquired as a result<br />
of radiation.<br />
Dr. Lewis will consult <strong>with</strong> a colleague at UCSF and get back to me on Monday.<br />
Possible treatments are:<br />
1. Drugs which relax smooth muscle. These may not be right for me as my blood<br />
pressure is already low and this might make it worse.<br />
2. BOTOX! This can be injected through the endoscope and might paralyze the sphincter.<br />
3. Some form of myotomy in which the sphincter is cut, probably also done<br />
endoscopically.<br />
4. Major surgery to remove the involved segment of esophagus and pull the stomach into<br />
the chest or replace the segment <strong>with</strong> colon. This would be a last resort. However, it<br />
might be best if there is no <strong>Merkel</strong> <strong>Cell</strong> Carcinoma lurking in my body.<br />
Last night, I did get some sleep, but today, the second bottle of Boost+ does not want to<br />
go down easily.<br />
Most people, when depressed, complain they can't eat and can't sleep. I am becoming<br />
depressed because I can't eat and can't sleep.<br />
It is amazing that this has all come on <strong>with</strong>in less than a month.<br />
Posted by David Shuster at 11:40AM (-08:00)<br />
I am Going to the Hospital Now<br />
Friday, January 27, 2012<br />
Nothing is going down, not even saliva.<br />
I expect to be admitted to the hospital.<br />
Posted by David Shuster at 06:06PM (-08:00)<br />
<strong>My</strong> <strong>Battle</strong> <strong>with</strong> <strong>Merkel</strong> <strong>Cell</strong> <strong>Cancer</strong><br />
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