Thursday, August 22, 2013

On Tubes and Testing

So some of you beautiful breathheads have been asking about something I've mentioned a couple of times in recent posts, at least in passing. Namely, the impedance study. Many of you, it seems, have never heard of such a thing and have no idea what it's for or how it works.

Man, am I ever jealous.

An impedance study (or 24-hour probe) is a very uncomfortable form of torture -- um, make that "medical procedure" -- designed to test for acid reflux, or GERD. Reflux, as I'm sure many of you already know, is a pretty common issue for folks with CF, and many CFers take pills like nexium or Prilosec to help manage the symptoms of this uncomfortable but generally tolerable issue. Personally I've been pretty lucky on that front, all things considered. I didn't take any sort of medicine at all for reflux until after college, which is really the first time I ever experienced any symptoms. Since then, whatever reflux I have has been pretty well controlled with medication, and I've simply had to adjust to the extra pills and move on. 

Or so I thought, anyway.

Turns out the reflux, the annoying little bugger, is a pretty big deal in the world of lung transplant. In fact, many great doctors believe that reflux can play a significant role in chronic rejection, because of damage to the lungs caused by accidental aspiration of the acid. Lovely, right?

Because of this concern, I had a different test, known as the Bravo Study, done a little over a year after my tx. This test involved a trip to the endoscopy suite at my hospital, where a wonderful doctor inserted a tiny little chip into my esophagus and gifted me with a little beeper to wear, on which I could record GI "events" like heartburn or Indian food. After a day or so of this fun activity, I returned the beeper. I never saw the microchip again, though I'm told it left my body of its own accord. As medical tests go, that one was both painless and easy -- a definite win/win. The results showed more or less what everyone expected of an adult CF patient with manageable GERD symptoms: some reflux, well controlled with medication. My team decided it was mild enough not to be too worrisome from a transplant perspective. 

The impedance study, by contrast, was not placed via endoscopy. Rather, it involves a soft but not insignificant plastic tube inserted up the nose, down the esophagus, and into the stomach, then taped into position for 24 hours. It was inserted by a nurse in a regular old exam room, proceeded only by the snorting of some rather potent lidocaine solution. And now it is in my nose, sticking out like a little nostril antenna, until it gets removed tomorrow morning.

I can feel your envy, all of you.

In fairness, the tube doesn't actually hurt in the traditional sense. It's uncomfortable and makes me want to cough and/or just pull the darn thing out, but it isn't painful. The main sensation is just that there is something at the back of my throat (there is) that won't move (it won't). Not exactly pleasant, for sure, but not the end of the world either. In fact, the best/worst part of it is really the look of the whole thing -- "best" only because of the amusement value and the fact that they told me to just "go about my day" normally with this thing. Because really, who wouldn't want to just pop on in for some shopping or a nice stroll through town with a taped-up tube sticking out of their left nostril? I mean, seriously.

And what will we do with the results of this fun little style experiment? Well, I'm told this will help determine if I need further, possibly surgical treatment for reflux down the road. Yes, the very same treatment previously deemed unnecessary, which is why my team is hopeful that this new test may give new information. The surgery itself is also pretty common for post-tx people, and involves a simple procedure that most people tolerate well. I say, if it will help my lungs and doesn't involve any more tubes down the nose then bring it on.

And in the meantime, I'm ready to get back to a more normal look and all "normal" activities, which currently include moving into my new apartment and hopefully even being seen in public again minus the nose candy. Because I know that ultimately this new approach could help keep Donor Bob's wonderful lungs alive and kicking. I know it will be worth even the most uncomfortable of tubes and tests to get me where I'm going.

And this, my friends, is just a little impedance.


  1. Ugh. I had an NG tube for a bowel obstruction once. The thing was HUGE, made me gag and throw up. It scraped my esophagus all the way down and I was sore down the middle of my chest (on the inside) for a week. I'm so not looking forward to this test. Of course I had no lidocaine for the big tube. That might have helped. My nurse said, "I'm not gonna lie, this will make you gag, you have three gag reflex spots." and she was right. I threw up three times.

  2. The first time I had a pH probe down (I've done it 3 times.. and had surgery now.. never again! Did I just jinx myself?) I'll never forget that the person who put it down said 'No one will notice... It just looks like you're carrying a Discman!'(that probably shows the era I first had it). Yep.. A discman I was listening to through my nose. Subtle.

  3. My son had an pH probe done about two years ago now....he was 3 at the time. It was placed under sedation because he was having another procedure done at the same time. Apparently it doesn't work well doing it that way, because the x-ray to confirm placement showed it had kinked. It is better when you can swallow and help it get down. So they had to pull it and do it agin bedside, then another x-ray. Unfortunately, we were not so fortunate to leave the hospital after that and had to stay 24 hours, and he had to drink apple juice every 4 to show some baseline something. We also had a little device which we used to input his eating, non-eating, and laying, sitting up position.
    The result was he received a nissen. I am assuming that is the surgery you are referring to. It is not pleasant and it was several weeks before he felt comfortable enough to eat anything. It was a big deal to us, not as dramatic as a lung transplant I'm sure, but he was in the hospital for 3 days and on heavy duty pain meds for several weeks. It also means he can never drink soda as you are generally unable to burp and vomiting becomes almost impossible although he does retch. The doctors made it seems like no big deal, but the healing process was a lot longer and more intense than I thought.

  4. I'll be doing that study soon. Just waiting to schedule it. Ugh..
    Good luck to you!