"Small hiatal hernia present" (September 2005) And what might have been..

What If?
I think lack of EC awareness contributes to a lot of what if's. Reading these posts it seems like many general practioners take the approach of "acid reflux".....take two Tums and call me in the morning. I am T3N0M0 and currently taking chemo and undergoing radiation but it was almost like pulling teeth to have my primary care manager refer me for an endoscopy. I started having chest pain and pain between my shoulder blades in 2008. When I researched my symptons on the internet it pointed to my heart although I found one reference to esophaegal cancer. I went through the cardio thing and they did find an 80% blockage in Dec 2010 and put in some stents. Beginning mid 2020 I started feeling it hard to swallow (only on occasion, mainly with things like bread). I didn't pay much attention to that and thought it was normal...i.e, maybe I'm just trying to stuff my mouth too full. After my stents, I kept having the same pains (chest & shoulder blades). My cardiologist assured me it wasn't my heart so it was back to the internet. I then discovered hiatial hernia and I had 90% of the symptoms, but shoulder blade pain was not on that list. I told my doc and he said it could be a hiatal hernia and agreed with me I needed a scope which I had on 04/07 and was diagnosed with EC.

I can't help but think, what if I had the scope done in 2008?

But in 1972 Dandy Don Meredith told Howard Cosell on Monday Night Football, "Howard, if if's and but's were candy and nuts, we'd all have a Merry Christmas."

Another one I like is, "Yesterday's history, tomorrow's a mystery, today is a gift.....that's why it's called 'The Present'

sandy1943 said:

I was like dodger--same
I was like hopper--same symptons, hurting in chest and shoulder blades. Twice over a two year period checked for heart. It was fine. when I would check on the internet, I didn't seem to have enough symptons to be worried--No acid reflux after I ate or at night, but I did have heartburn occasionally. My doctor obviously didn't think my symptoms were bad enough for a scope, until my food stuck. I also had a hietal hernia I didn't know about. Fortunately it was stage 111. I believe some of our doctors are not aware how rampant adiocarcinoma is becoming in the U.S. Wake up medical world!
Sandra

HIATUS HERNIA LINK
It comes as no surprise to see these postings. Below is an extract from my brother Peter's medical history>>>> EC4B, deceased 2 weeks.

Medical History : Hiatus Hernia diagnosed six years ago. No medication or interventions required. Advised to use an extra pillow at night. Very occasional restricted swallowing over six years. Careful diet for short periods appeared to resolve any issues. Until being diagnosed with cancer in 2010 no illness. I have never required a day off work due to illness.

>>>
He tolerated his hernia for 6 years and even adjusted his lifestyle to live with it - for example by asking hotels for extra pillows while on holidays. His Doc did not see this as an issue when he had his regular medical checks and Peter did not count his HH as an illness!!!
If we could turn back time.............

ecourtney said:

HIATUS HERNIA LINK
It comes as no surprise to see these postings. Below is an extract from my brother Peter's medical history>>>> EC4B, deceased 2 weeks.

Medical History : Hiatus Hernia diagnosed six years ago. No medication or interventions required. Advised to use an extra pillow at night. Very occasional restricted swallowing over six years. Careful diet for short periods appeared to resolve any issues. Until being diagnosed with cancer in 2010 no illness. I have never required a day off work due to illness.

>>>
He tolerated his hernia for 6 years and even adjusted his lifestyle to live with it - for example by asking hotels for extra pillows while on holidays. His Doc did not see this as an issue when he had his regular medical checks and Peter did not count his HH as an illness!!!
If we could turn back time.............

I complained to my primary
I complained to my primary for three years of a shooting pain from my left chest to the center of my back between the shoulder blades. Twice I had stress tests and tested normal. I never smoked in my life, exercise every day, ate right, never had reflux and would have only a couple of beers on the weekend. I guess with all that said my primary never thought I was a candidate for EC. Then I started to complain of pain between the shoulder blades when eating and was finally sent in for the scope and diagnosed with stage 2B EC. The first thing I asked my surgeon was how long he thought the tumor had been growing. You guessed it 3 years, big surprise.

Joel

ecourtney said:

To JoelC
Joel, how are you now? are you still doing well?
Regards
Maurice

Hello Maurice,
I read your
Hello Maurice,

I read your profile with your brother’s situation and I’m very sorry to hear what he has been going through.

My recovery has gone pretty well. I spent last summer into the fall receiving 28 rounds radiation and six rounds of chemo followed by MIE on 11/18/10. I had my first follow up CT scan about a month ago and it came back clean. Recovery and adjustment to my new self has been a challenge but I guess it’s going as well as it can. For me living with the statistics is just as hard as the recovery. I hate to say it but I’ve always been a my cup is half empty type of guy so when I read the mean survival time for stage 2B EC is 18 months post surgery I can’t help but feel a little bewildered. I’m 49 years old with a wonderful wife and two great children in college so in the mean time I just keep pushing on.

I see that your brother is only 50 years old. How is he handling his situation emotionally? Like I said for me that is the hardest part.

Best regards,
Joel

linda1120 said:

Survival rates
Dear Joel,

Do remember that the survival rates you are reading about on the web are a few years older. Jim is a stage III survivor, responded extremely well to his chemo and radiation, with his MIE January 5, 2011. The oncologist told him his survival for five years is 40%. He did believe his survival was even better due to his cancer being gone with the chemo and radiation. I hope this helps alleviate some of your concerns.

Enjoy each day! I am a ovarian cancer survivor that had a 10-15% chance of surviving five years and it is 12 and a half years later! Only God knows our time.

Linda

Thanks linda


Thank you Linda for the kind words of encouragement. It’s funny, one day I’ll be feeling good and just living my life and the next I’ll be beating myself up with dread thinking about what could be around the corner. I guess it’s the engineer in me that wants to understand why things are what they are but the problem with this disease is there are no real answers. When I started on my journey I had to know everything but the more I learnt the less I understood, it was driving me crazy. I’ve had several nurses tell me engineers make the worst patients.

I’m happy to hear that Jim had a complete response to treatment. What a relieve it is not to have to face additional chemo post surgery.

Thanks again,
Joel

esophagus cancer

how r u doing now??i too have a small hiatal hernia and heartburn alll the time..the drs just ignore me!

Rabiya said:

esophagus cancer

how r u doing now??i too have a small hiatal hernia and heartburn alll the time..the drs just ignore me!

Rabiya~Hiatal hernia & Heartburn Info 4 U~U need an Endoscopy!

Dear Rabiya:

First let me say welcome.  You have a valid reason for writing here, but seems you have been reading comments from quite a few years back.  In past years, William and I have spoken with everyone on this particular link.  There is much valuable information to be learned from going back to some older posts to see how they progressed from their first posting till whenever.  But if you desire an answer, it would be good to “start a new topic forum” since there hasn’t been any “recent activity” on this post for quite some time.

A careful read of this topic forum link you will notice that “ecourtney” (real name Maurice) is answering “JoelC” and telling him that Peter, his brother, a Stage IV EC patient has died.  Maurice last posted here May 15, 2012.  Unfortunately Peter was a Stage IV Esophageal Cancer patient.  So that answers your question about Peter, but it doesn’t make your condition any better as to your constant heartburn.

And YES, HEARTBURN can lead to cancer.  My husband wears a “periwinkle blue” (EC’s color) wrist band.     It says, “Heartburn can cause cancer!”  People are amazed to hear that.  So often, and in your case as well, one has heartburn—goes to their doctor but an Endoscopy is never ordered.  Usually, something like Nexium or Prilosec is prescribed and the patients are sent home.  And in many cases, those same patients end up with Esophageal Cancer.  So while that may surprise you, I hope it will prompt you to insist that you are referred to a Gastroenterologist where an Upper endoscopy can be performed.  If I were you, I would not rest until that happens.  You should ask for a SECOND OPINION if your regular doctor will not pay attention to your concerns.  Or else try to find a gastroenterologist who does not require a direct referral from another doctor. 

Sadly, often this cancer can spread quickly, even to other major organs and in that case it becomes Stage IV.  With a Stage IV diagnosis, usually there is no surgical operation that can offer a potential cure, rather only a prolonging of a “progression free survival” (PFS) time.  This is referred to as “palliative care and can take many forms like chemo/radiation/feeding tubes, etc. but no surgical remedy.

So briefly, I will tell you, and briefly needs a smiley face beside it for sure,  because it is not my nature to be brief, my husband has now entered into his 15^th year from having been diagnosed with Esophageal Cancer, Stage III, (T3N1M0) meaning that all four walls of his Esophagus had been infiltrated with cancer as well as 2 local lymph nodes.  Ironically, his only symptom was a “pesky” hiccup.  He would hiccup one time he began to eat—then nothing else would happen.  He never complained of heartburn.  However, after a couple of months, I noticed that this was a “habitual hiccup”.  I said, “We’ve got to go to the doctor and see what’s wrong with you?  I haven’t had the hiccups since I was a kid.”  So off to our wonderful doc of 30 years and his answer was, “I think it’s something of a gastric nature, and I will recommend you have an Endoscopy.”

Indeed, the Endoscopy indicated that my husband had Esophageal Cancer.  We were scheduled to have surgery here after the pre-op (neo-adjuvant) chemo/radiation workup.  It would have been the oldest kind of surgery that required 2 massive incisions, the “Transthoracic Esophagectomy aka “OPEN.”  Just before we were to have surgery here, we learned about a new laparoscopic procedure that had been pioneered by Dr. James D. Luketich at the University of Pittsburgh Medical Center (UPMC) in the mid-90s. 

The Great news is that we went to the University of Pittsburgh Medical Center and had a 2^nd opinion by Dr. James D. Luketich.  William then had a successful MIE surgery May 17, 2003, and is still cancer free today as of this writing.  This totally laparoscopic procedure, MIE, is the surgery of choice, but often patients who write here have never heard of it.  It consists of band-aid cuts and results in less morbidity, less blood loss, shorter hospital stay and quicker recovery without massive incisions, just to name a few.  No need to discuss the actual MIE procedure at this point. 

So since you written here in answer to a post that is now 6 years old, and no longer active, I will suggest that when you write back, if you wish to, that you start a new “forum topic” posting.  Usually, I answer in a new separate post for people like you, but because of the important comments by others on this topic, and some who are still alive and may occasionally check in here, I will put my answer here at the bottom. 

Here’s hoping that the comments from others here and the information I’ve listed below will spur you on to insist on an Endoscopy.  You need the peace of mind, and an Endoscopy will certainly be needed to know for sure if that heartburn and hiatal hernia should be dismissed as nothing to be concerned about, as it seems that this is your current doctor’s opinion.  How would they know if they haven’t looked inside?”  My husband’s hiccup was so much more.  The preliminary endoscopy showed both a hiatal hernia and Esophageal Cancer.  And the rest is history as they say.

1.  http://www.gomn.com/news/mayo-clinic-says-get-a-second-opinion-first-ones-are-frequently-wrong/

MAYO CLINIC SAYS GET A SECOND OPINION – FIRST ONES ARE FREQUENTLY WRONG

by Melissa Turtinen - April 4, 2017 12:17 pm

If you’re diagnosed with an illness, you might want to get a second opinion.

The Mayo Clinic in Rochester did a study (published in a medical journal Tuesday) and found as many as 88 percent of patients who came to the clinic for a second opinion for a complex condition left with a new or more refined diagnosis, a news release says.

2.  http://www.post-gazette.com/home/2011/08/01/Heartburn-meds-tied-to-cancer/stories/201108010183

“Heartburn meds tied to cancer

Popular drugs may mask risk for disease

August 1, 2011 12:00 AM - By David Templeton Pittsburgh Post-Gazette

Drugs such as Nexium, Prilosec and Prevacid that control production of stomach acid and treat heartburn, reflux, peptic ulcers and related conditions are some of the most popular medications on the market.  But long-term use of these drugs, known as proton pump  inhibitors, can have unexpected consequences, a new study shows.

Blair A. Jobe and his research team at the University of Pittsburgh School of Medicine say the severity of symptoms for GERD, or gastroesophageal reflux disease, has an inverse relationship with the presence of Barrett's esophagus, a precursor to a lethal form of esophageal cancer known as adenocarcinoma.  The concern is that good symptom control does not reduce cancer risk but actually increases it.

The study, published online by the journal Archives of Surgery, also raises questions whether proton pump inhibitors might cause the cancer, whose incidence per million has risen six-fold from 1975 to 2001, a time when PPIs came on the market with increasing use. It's the fastest growing cancer in the nation, outpacing melanoma, breast and prostate cancers.  In the Pitt study, patients taking PPIs who reported no severe GERD symptoms had significantly higher odds of having esophageal cancer as compared with medically treat patients who reported severe symptoms.

This finding, it says, may explain the failure of current screening procedures that dictate when primary endoscopic examinations are done. Those exams that involve a scope to inspect the esophagus usually are prescribed based on symptom severity. But Dr. Jobe said only 5 percent of patients who develop esophageal adenocarcinoma are detected by screening efforts, with the remaining 95 percent having symptoms related to a more advanced and less curable cancer stage.

Doing a screening endoscopy on patients with GERD even for those without severe symptoms, might be a wise choice, the study concludes, because PPI medications could be masking the severity of the problem…

3.  https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults

Acid Reflux (GER & GERD) in Adults

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4.  http://www.mayoclinic.org/diseases-conditions/hiatal-hernia/basics/tests-diagnosis/con-20030640

Tests and diagnosis

“A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain. Such tests or procedures include:

• Blood testing. Your doctor may recommend a complete blood count to check for anemia due to blood loss.

• An esophagram (barium swallow). During this procedure, you drink a chalky liquid containing barium that coats your upper digestive tract. This provides a clear silhouette of your esophagus, stomach and the upper part of your small intestine (duodenum) on an X-ray.

• Endoscopy. During an endoscopy exam, your doctor passes a thin, flexible tube equipped with a light and video camera (endoscope) down your throat and into your esophagus and stomach to check for inflammation.

• Manometry. During this test, a thin, pressure-sensitive tube (catheter) is passed through your nose, down through the esophagus and into the stomach. The catheter then measures pressure and movement inside the esophagus…”

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  5.  http://www.upmc.com/patients-visitors/education/gastro/pages/gerd.aspx

  “GERD: Gastroesophageal Reflux Disease

  What is GERD?

  When we eat, food passes from the throat and into the stomach through a tube. This tube is the esophagus (ee-SOFF-uh-gus). Sometimes it’s called the food pipe. At the bottom is a ring of muscles that acts as a valve between the esophagus and stomach. This is the lower esophageal (ee-soff-uh-GEE-ol) sphincter (ss-FINK-ter).

  These muscles in the lower esophagus can become weak. Food, smoking, and alcohol may weaken the sphincter, so it may stop closing properly. The contents in the stomach then may leak back, or “reflux,” into the esophagus. This problem is called “GERD.” GERD is short for gastroesophageal (GAS-trow-ee-soff-uh-GEE-ol) reflux disease.

  GERD’s Most Common Symptom

  Heartburn is the most common symptom of GERD. When acid in the stomach refluxes, it touches the lining of the esophagus. This can cause a burning feeling in your chest or throat. We call this sensation heartburn or acid indigestion. You can have heartburn once in a while without having GERD. But if you have heartburn more than twice a week, it’s likely you have GERD.

  Other Symptoms of GERD

  If you don’t have heartburn, you can still have GERD. Some other symptoms of GERD are clearing your throat often, trouble swallowing, feeling like food is stuck in your throat, burning in your mouth, and pain in your chest.

  When to See a Doctor

  GERD can lead to more serious health problems over time. If you have any symptoms listed above, or if you use antacids more than 2 weeks, call your primary doctor or internal medicine specialist.

  How GERD is Treated

  Treatments for GERD include lifestyle changes, medicine, and surgery. Your doctor will prescribe the treatment plan that is best for you…”

  __________________________________________________________________

  6.  http://www.upmc.com/Services/esophageal-lung-surgery-institute/conditions/benign-esophageal-diseases/Pages/barretts-esophagus.aspx

  “Barrett’s Esophagus

  Barrett’s esophagus is a serious complication of gastroesophageal reflux disease (GERD). With this disorder, stomach acid damages the esophageal lining and causes it to become similar to the lining of the intestine.

  Approximately 15 percent of those with chronic GERD symptoms go on to develop Barrett’s esophagus.

  Diagnosing Barrett’s Esophagus

  Experts aren’t sure of the exact cause of this rare disease. Patients may have symptoms like those of GERD, but Barrett’s esophagus doesn’t have any specific symptoms of its own.

  People with Barrett’s esophagus have an increased risk of developing esophageal adenocarcinoma — a serious, potentially fatal esophageal cancer…”

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  7.  https://www.youtube.com/watch?v=4E-V9kmjmnA&t=207s

  Hiatal Hernia - Mayo Clinic - Published on Aug 24, 2009  Dr. Stephen Cassivi, a thoracic surgeon at Mayo Clinic in Rochester, Minn., discusses hiatal hernia and treatment options.

• _____________________End of references______________________