Life before LINX

I have been suffering with acid reflux for the past 5 years. Prior to this I was a fit, young 29 year-old doctor embarking on a fledgling career in ophthalmology. Life seemed pretty good; I had just bought my first house, I had become an ophthalmology registrar and everything was in order. However, unknowingly this was about to change and my world would start to spiral into a living nightmare.

In October 2008, I began to experience a sore throat, hoarse voice and deep ‘smoker’s like’ cough. Initially I put it down to a viral illness or bronchitis and was prescribed 2 courses of antibiotics. Despite this things were getting worse and my voice was getting increasingly hoarse, to the point I couldn’t hold a sentence together. My cough was uncontrollable and colleagues at work had noticed a change. My nose felt bunged up and I began to develop shortness of breath. My atypical symptoms had never made me think that acid reflux was a perceivable diagnosis, even as a medic. I had always thought acid reflux to be indigestion and heartburn, which are the classic symptoms however a whole myriad of other symptoms exist.

I saw an ENT consultant privately and to my surprise I was diagnosed with acid reflux for which he prescribed me high doses of oral acid suppression tablets as well as Gaviscon Advance. My naivety kicked in and I went away thinking that by taking these tablets I would be cured; again I was wrong. As soon as starting this high-dose regimen I was getting instant relief and things started to look up. By 3 months I was gradually weaning off the tablets, however as soon as I did so, BANG, my symptoms would return! A deep cough, worse in the mornings, a sore dripping nose and a painful throat. It was becoming increasingly apparent that from a fit, young individual I was possibly destined to a life of high acid suppression that my symptoms only partially responded to. I had made all the lifestyle and holistic changes every textbook under the sun had recommended; to a point I became a living zombie. Whilst all my friends were out enjoying themselves and drinking etc, I had to make excuses why I couldn’t eat out late or I couldn’t enjoy a beer with them, trying to keep a lid on a diagnosis I was finding hard to accept. The dichotomy in lifestyle was quite apparent.

I couldn’t go on like this, the tablets themselves were making me feel ill and I began to pursue other avenues of treatment. Between September 2009-October 2012, I had seen 2 ENT surgeons, 2 upper GI surgeons about the possibility of a Nissen fundoplication and had undergone 24 hour pH manometry twice as well as an endoscopy and barium swallow, in order to seek answers on what was becoming an awful condition to live with. I was very concerned on having a fundoplication as I was aware of the possible complications and had read a lot of medical papers on the surgery. However, by this point I had psyched myself up to any possible eventuality, destined to improve my wellbeing. Luckily for me the upper GI surgeons were unkeen to perform the surgery as they felt there was not enough evidence on all the tests, and with my age, to proceed. This was to prove a blessing in disguise…..

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‘Stumbling across LINX’ – the final LINX in the chain

Fast forward to August 2013, by which point mental fortitude was my sole driver. All other systems had been extinguished; hope, ambition and motivation had come and gone. I had pretty much tried every recommended holistic formulary, lifestyle change and medication possible. I was still taking relatively high dose acid suppression tablets, but they were becoming less and less effective. Chronic shortness of breath had engulfed me, for which I was using a steroid inhaler to control the airway reflux. I also had relentless belching which could be embarrassing to say the least! By this stage I had climbed the ophthalmology career ladder and with that came more and more responsibility with higher expectations to perform, but my acid reflux was holding me back. Again, in search of answers I began to trawl the Internet. A new wave of intensity had hit me.

It was one day through sheer coincidence that I stumbled across an acid reflux discussion forum stating how a few of the users had undergone a LINX procedure  – a small titanium band, made of magnets that fits around and augments the lower oesophageal sphincter. The moment I started to read about it, I thought that this could be the best thing for me! I started reading quicker and delving deeper into the possibility that this may help. I felt my medical background helped me in understanding my condition better, but at times the more I read the more worried I would get about things. Sometimes in life, ignorance is bliss. However the LINX seemed to good to be true. The fact that this simple device restored/augmented physiological function with much fewer complication risks than a fundoplication was the major selling point for me. My grandpa once told me ‘Simplicity is the best form of sophistication’. He may very well have been right. At this time there were a limited number of medical publications on the device, all of which I read. My gut feeling was that I had to take a ‘chance’ and see if this would work for me despite the surgery being in its infancy. I had exhausted all other options.

After some more homework, it appeared there were a limited number of centres performing this surgery in the UK and the surgery was only available privately. This did not deter me, after 5 years of suffering I could not put a price on my health. As an eye doctor, I had seen some terrible cases of patients having LASER eye surgery by surgeons without any NHS history and working in private ‘pop-up clinics’. With this in mind I wanted to see a surgeon with an established, robust NHS and private practice. I came across Mr Boyle as one of the UK pioneers of this surgery, and with one of the largest series of patients that had undergone the surgery. His website and video were very clear and my gut feeling was to see him.

In November 2013 I got the ball rolling and made an appointment to see Mr Boyle through his secretary. The appointment was made quickly and the consultation was clear and very positive. Finally some hope, I thought. I required a repeat endoscopy and 24-hour pH manometry, to see if I was eligible. By this stage I was very familiar with these tests!  The endoscopy is a day-case procedure, which is performed by Mr Boyle himself. It involves putting a camera down the oesophagus and into the stomach. The main objectives are to look for any physical cause for the reflux, like a hernia, as well as any tissue damage caused by the reflux. The below picture shows my lower oesophagus with the volvano-like appearance in the centre thought to be a small hernia.  The 24-hour manometry is performed on a separate day and involves placing a small tube through the nostril and down to the junction of the stomach and oesophagus (see picture). The tube is connected to a monitor, which you wear and press every time you feel you’re experiencing reflux. During these 24 hours, you throw the rulebook out the window and engorge on all the foods and drinks that aggravate your reflux. For me these were alcohol, breads, pizza, spicy food, just to name a few! I was relieving my youth

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There are certain inclusion criteria patients must fulfill on the tests to be given the green light. The tests were performed very efficiently and I fitted all the criteria. I was trying to keep a calm head and after a long discussion with Mr Boyle we both agreed that LINX would potentially benefit me. I had no hesitation, It was now or never. It had only been 2 months since seeing Mr Boyle, that now I was being lined-up for the LINX. I couldn’t believe it, I felt my world had spun 180 degrees. In my head I had set clear success criteria, which I would have been happy for. These were a 50% improvement in symptoms with no shortness of breath.  These criteria were very personal to me, as I felt at this level my quality of life would be sufficient to live relatively normally. My main objective in all this was not perfection. I wasn’t expecting some sort of miraculous paradigm shift in my symptoms. All I wanted was to gain control of my symptoms, that’s all, simply control.

The last 5 years had been turbulent with a lot of dark moments. Finally I could see light at the end of the tunnel and begin to lick the lid of life, reflux free……

Preparing for LINX

By now I had developed a relatively thick skin to adversity. My decision to have surgery hadn’t been taken now; it was taken 4 years earlier during all my initial investigations. Over this period I had mentally conditioned myself, and whilst my friends and family expressed concern, I remained relatively calm. The last 4 years were spent searching for the golden ticket, which I felt I had found at last. I was now on a one-way express train away from this miserable existence. The LINX surgery didn’t faze me. A fundoplication may well have, but the LINX didn’t. With my surgical background, I know that in the right hands most routine surgery is exactly that, routine. I had full confidence in Mr Boyle and his team at Tunbridge Wells. My only concerns was with the post-operative rehabilitation, as this was unchartered territory, but having read about other people’s stories it reassured me. Obviously with any form of surgery there will be a small group of people for whom it is less effective, but for me I felt I had more to gain then to lose with the LINX. The gods were finally smiling down on me. I was lucky being at a transitional phase between 2 jobs and hence had a few weeks off to recuperate from the surgery. In hindsight I think 3 weeks off from a non-physical job is sufficient.

I required a pre-operative assessment a few days before the surgery. This entailed making sure my vital stats were within acceptable range, a few swabs and blood tests. The nurse told me what to expect on the day etc. As I was self-funded, it was now time to pay. There have only been 2 occasions in my life where I have had to handover a large sum of money; now and when I had to put a deposit down on my house. Funnily enough, I was 10 times more nervous about the house then the operation!

D-Day- 5th February 2014

The big day had finally arrived. I was now entering a world, able to rub shoulders with my bionic counterparts. I was filled with nervous excitement; nervous about the unknown and excited because I could see the finishing line on the horizon. The surgery was in the afternoon and I was asked to have had a light breakfast before 6am and clear fluids up to 10am. The reporting time was 12.30pm, at which point I turned up, was very kindly greeted and shown to my room. Although I was on my own, the room had plenty of space for family members. I realized that mobile phone reception was very patchy in my room and I was more worried about how I was going to call home after the operation, then the operation itself! I might be coming across a bit blase about my surgery, but all the groundwork had been done much earlier, I was merely on autopilot by now. I was greeted by the nurses looking after me. They were great and took my mind off things. More formalities were completed. I met Mr Boyle before the operation, really to iron out any last minute issues. Also the anesthetist was great, my main request from him was plenty of postoperative pain relief! It was now a waiting game until my turn came. A combination of candy crush saga, angry birds and daytime TV filled the time.

Finally the call came. Everyone was so pleasant that I felt very calm about things. It was slightly surreal being on the other end of the stick. I had seen so many patients wheeled into theatre during my career, that now it was the other way around. I was literally experiencing it all first hand from the patient’s perspective. Going back to work, I will now know how they all feel and hopefully I’ll be a better doctor for it.

The prenuptials had been made, vows exchanged and hopefully this was going to be a happy lifelong relationship between me and my LINX……

The honeymoon – ‘Our first night’

I remember waking up in the recovery room and being bought back to my room. This part was all a bit of a blur. I hadn’t heard anything adverse about the operation, so I presumed everything went okay. No news was good news. I was hooked up to a drip, which was to stay with me overnight. The abdominal pain was not as bad as I thought, it was similar to the day after 50 abdominal crunches at the gym. I felt pretty good. The nurse came to see me and checked up on me regularly. I had a cheeky peak at my dressings, which I enclose a ‘selfie’ of. They weren’t the blood shed battle sites I had imagined; quite the opposite. The absence of a muscle-bulging washboard abdomen was due to my lack of gym activity from my shortness of breath. Well that was my excuse anyway!

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I had a mild degree of shoulder discomfort, which I had been warned about. This is normal and is related to the air they use to inflate your abdomen in order to gain better access. I was told it will wean off within 2 days and it did. Later that evening Mr Boyle came to see if I was okay and said everything had gone according to plan. He explained some of the intricacies of the operation and said he would see me in the morning. I was relieved at this stage and on the road to recovery. By now it was 7.00pm and time to take the leap of faith, my first meal as a bionic man. Obviously this was a light meal consisting of soft foods. I plucked up the courage and went for it. I had to retrain myself to eat and started off with baby-sized portions.

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Forty minutes later I had completed step 1 of the challenge. I was really pleased! Obviously it was far too early to be commenting on reflux, I hadn’t eaten all day and this was a light meal, so overall a very artificial situation. I texted my family and friends of my wellbeing and they were all relieved as well. I wanted to get an early night as I had been up since 5.30am. By 10.00pm I was dozing off. The man in the next room was having a few issues overnight, which woke me up a couple of times. You might want to bring earplugs if you’re a light sleeper.

A new dawn

At 7.30am, Mr Boyle kindly provided me with a personal wake-up call. We talked about the postoperative recovery. He stated that pain on swallowing might escalate and worsen over the initial 6-week period as scar tissue migrated around the implant. He stressed the importance of ploughing through this and eating as normally as possible. I had suffered for quite a few years, a few more weeks was not going to matter. I realized the importance of the early stages of the recovery; they could potentially dictate the success of the implant. Too many soft foods and the implant could heal too tightly rendering a higher risk of long-term swallowing issues. I was also aware that being young and of Indian origin, I could be prone to a more aggressive healing reaction and so be potentially at higher risk of painful swallowing. I was ready to go into battle, I wasn’t going to let something the size of a 10p coin defeat me. This was the last I was too see of Mr Boyle until my 3 week follow-up. I was able to self mobilise and go to the bathroom to freshen up. Breakfast and some Jeremy Kyle soon followed.

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30 minutes later…….

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Done. Step 2 completed. By this stage it had occurred to me that I had no shortness of breath and no sore throat?  I had to double check, taken a step back and checked again. Yep, definitely no shortness of breath and no sore throat!  Was this proving to be an omen?

Mr Boyle’s secretary also visited me to arrange the follow-up. She handed me an envelope, which contained the appointment date, a discharge letter from Mr Boyle and a plastic card. The card was the size of a credit card to fit in your wallet/purse. It’s by way of means of proving that you have had a metallic implant fitted in such cases of airport security or medical appointments in the future. It was time to unhook from the drip, dress and start to look to the future. I said goodbye and thanked everyone for their care. My chauffeur was waiting. We drove off and I reflected on the events of the past 24 hours……..

Home sweet home

I arrived and instantly my mother and sister were at my beck and call. I felt like a king; like Eddie Murphy from the film ‘Coming to America’. A whole array of foods awaited me; dishes from all corners of the world. My initial plan was to season my palate with soft foods, with some short bursts of solid food to exercise my LINX. They say interval training is the best form of muscle conditioning and I had to recondition my oesophageal muscles to work in perfect harmony with the LINX. As mentioned I had to retrain myself to eat, and so I had to learn to walk before I could run. At the moment I was still crawling. I wanted to gain confidence with soft foods first. It was like being on ‘Top Gear’, placing the latest cars through their tracks. I was constantly assessing my LINX for handling of eating speed, safety against possible hazards like reflux, performance and durability during rough terrain i.e. solid foods as well as how good the bodywork looked i.e. my scars!

So I started light. This meant baby-sized bites of yoghurt, fish, soft vegetables Quinoa, prunes etc, but I also added in some buttered toast. I had to navigate each bite, my golden rule was CHEW, CHEW MORE, CHEW MORE, SWALLOW, WAIT, SIP WATER AND WAIT until I could feel the bolus of food pass the LINX gateway. At this point I would take another small bite and each successful swallow was like a small achievement in its own right. I could feel the LINX opening and closing, like a well-oiled machine. I was taking crushed paracetamol twice a day, as I knew I couldn’t swallow the tablet whole. What really helped me in each meal were small sips of warm water, not only before each bite, but also when I felt food was getting stuck around the LINX. I think the constant small sips enhance the contractility of the oesophageal muscles and thus opening the LINX. This would eventuality lead to long-term strengthening of the muscles, as discussed earlier.

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