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The 48-Hour Bravo Esophageal pH Test: A Probe to Study Acid via Monitoring Capsule

Published on May 18, 2009 in Health and Fitness and Life. 64 Comments

My throat. It burns. And it’s been burning for far longer than I’d like to remember. Thing is, my doc isn’t so sure that my GERD (gastroesophageal reflux disease) is really caused by too much acid splashing my esophagus. At one point maybe, but not anymore. No, he believes what I have is NERD, or non-erosive reflux disease. (Poetic justice?) To find out, he had me go through a study called the Bravo pH Esophageal Test.

Academic Overview

The 48-Hour Bravo pH Esophageal Test monitors the esophagus (the tube connecting the mouth to the stomach) for 48 hours in order to determine whether the heartburn I’m feeling is really acid or something else. In this case “heartburn” actually means the burning in my throat, as if I’d just swallowed battery acid, rather than in my chest, as if my heart had burst into flames. (This might indicate another condition entirely, one called LPRD, or laryngo-pharyngeal reflux disease. It’s sort of like GERD, but felt in the throat, not in the chest.)

During the test, the doctor puts a 26mm capsule down the throat and sticks it to the side of the esophagus. A monitor is then given to the patient which records the capsule’s pH readings. These will, in theory, help determine if the person has GERD. Two days later, the monitor is returned. A week later the capsule will detach itself and go through the digestive track.

For more details on the test, including getting ready, check out the Cleveland Clinic’s information site on it.

My Experience

I went over to Tampa General Hospital to get implanted with the Bravo pH capsule. I got there, as per instructions, at 1:30 P.M. Got checked in, found the waiting room which overlooked Tampa Bay and Bayshore Blvd. The Wife, there with me, cracked a smile when she realized she “could see [her] old high school from here!” The soft music playing in the background made the scene like something out of a travel video. A few minutes later we looked at one of the nearby televisions and realized it was playing a travel video.

After an hour of watching, waiting, and enjoying the aroma of hot chocolate–especially aromatic considering I’d not eaten anything in almost 24 hours–the nurse stopped by with a device the size of a small-to-medium camera which I would, for the next two days, wear around my neck. This would be the external monitor, which would record all the transmissions sent from the tiny device which I would soon have implanted in me. Additionally it had three buttons which I would press every time I felt I had heartburn, regurgitation (food coming up to the back of my throat) or chest pain. Then she gave me a diary and told me to write down all my symptoms along with the time they occurred, making sure to use the time shown on the device itself, and not any other time piece. Beside the time, I would later find out, there was also a display of my current esophageal pH. I would later find this a very useful tool with which to experiment.

With all that said and done, I was brought in for the procedure. I laid down on a bed, clothes and all, and my gastroenterologist came in. He told me to gargle some numbing liquid–”DON’T SWALLOW IT!” he repeatedly reminded me.

“Aren’t you going to put me to sleep?”

“Nope. The procedure will take about a minute. The stuff you just gargled will numb your throat to quell your gag reflex.” As he said that, the nurse stuck a plastic ring in my mouth to keep it open, then strapped it to the back of my head. (Frighteningly S&M-ish.) Then he continued, “Alright, now I’m going to put this down your throat.” It was at that very moment that he pulled out this long, thin hoobajoob, about the size of my arm, out from under some desk. Oh, shit, I thought, as he asked me to turn to my side. “To make this a bit more comfortable I’ve lubricated the device with a bit of water-soluble KY-jelly.” Seriously, I didn’t need to hear that.

As I lay on my side, the doctor stuck the device in my mouth. When he got to the back of my throat he ordered me to swallow. As soon as I did he shoved the hoobajoob all the way down to just above my stomach. That’s when he turned the suction machine on. “Alright, now this will take about a minute, so just relax.”It took everything I had not to start heaving. All I could do was count. Seventy-two seconds later, he pulled out the hoobajoob. A monitoring device about the size of a #2 pencil’s eraser and ferule had been implanted in my esophagus. It would take about a week for it to dislodge itself and go through the Chamber of Doom.

The whole process, the laying down–the gargling stuff, the implantation–all took about ten minutes. It would be an hour before I ate or drank anything, as per doctor’s orders, seeing as the numbing agent I gargled also numbed the control valve which keeps food from accidentally finding its way into the lungs.

The Testing Period

Normal esophageal pH is somewhere between 4 and 7. If it goes lower it indicates that acid is being refluxed, since the stomach’s pH is between 1 and 2. If it goes higher it might indicate bile reflux, although the stomach sometimes as alkaline periods. (The pH of bile is above 8.) Sudden drops of pH (from 7.1 to 5.3, or 6.1 to 3.8) indicate acid reflux. During the testing period my pH went as low as 1.8 and as high as 8.6, possibly 8.8. All this as per the pH display in the Bravo monitoring device I now had hanging around my neck. (It really did look like a camera.) The vast majority of the time it stuck between 4 and 7, usually between 5 and 7. What this means, I have no idea. I will when I get my results back.

I was told to eat foods which would cause my symptoms, so the first thing I did was head to my parents’ house, where my father, a pizza restaurant owner for years, would be making pizza. It was delicious. Deeeelicious. I topped the pizza off with a small Starbucks frappuccinno. Yes, evil, I know, but these are foods I KNOW would bring about symptoms. There was one small hitch with my plan, however…

Did I tell you I have a bad gallbladder? Yeah, I do. Having it taken out sometime soon (probably in the next week). Runs in the family. Also doesn’t help that I spent more than my fair share of time pigging out to crapstacular food. Mia culpa, mia culpa. Problem now was all those highly acidic foods were also fatty enough to cause problems.

My gallbladder took its revenge on me not immediately, but rather the next day. (It holds grudges.) While I had heartburn after the pizza (the pH reading dropped as low as 2.0 for brief periods, but stayed mostly above the 4.0 mark), it wasn’t until the next morning that the problems really started. After my breakfast–a sandwich made of egg whites, wheat bread and kale, followed by a cup of vanilla almond milk–I started feeling bloated. Real bloated. Then suddenly I started having pains. I was having a gallbladder attack. This was at 9:30 A.M. It would be almost 7:00 P.M. that night before the attack passed. In the meantime, my pH fluctuated between way-too-acidic (pH 3) and way too alkaline (pH 8). Since I wasn’t able to eat or drink during this time, the test was pretty much ruined.

I tried to salvage the situation on the final day. I was feeling well enough to eat what I would regularly eat, including low-fat foods that would cause me symptoms, foods like barley, oats, and juice (although it never dawned on me to try out BBQ sauce). For the most part the worst food of the bunch was the barley, which always gives me problems after a while. Don’t know why, really. It goes down fine, but then about an hour later I start burning up. Same with oats. The pH monitor corroborated this observation.

Anyway, the test ended at 4:00 on the dot; that’s when the monitor shut down. I dropped it off at the hospital and was finally rid of the thing. I should be receiving the results sometime this week. At that moment all I cared about was that I could finally go back to doing things like sipping water throughout the day and eating mostly fruits and vegetables, things which I know keep my heartburn at bay, medications or no.

The hardest part of this test, gallbladder problems aside, was that I couldn’t take anything for the discomfort I felt. I couldn’t chew gum, couldn’t suck on hard candies, couldn’t drink water to wash out the acid, and certainly couldn’t take antacids. Hopefully, however, this test shows that things aren’t as bad as I thought they’d be, even though they’re obviously not good. Now that it’s over I’m only concerned with one thing: getting rid of the bad, un-salvageable gallbladder. That’s a story for some other time.

Midnight Love Taps

Published on May 4, 2009 in Featured Posts and Life. 0 Comments

I was in a park. I don’t remember much of the goings on around me other than being at the park, having fun and being agitated, a fun agitated, as if playing a game of hide and seek and always being “it”. Suddenly, I feel a hard punch at my arm. Did someone just run past me? This wasn’t part of the dream; it hurt. I looked over at her, and saw her moving. Not quite knowing what to do, not quite knowing the distinction between dream and real at that point, I thought “what the heck?! She just hit me. What did I do?” then punched her back in the arm, turned, and fell asleep.

She was describing something she was excited about. Not just speech, but also lots of hand motions. Lots. Suddenly she whacks me with her elbow; doesn’t know whether the hit lands in the head or what, but she starts inspecting me. That’s right before a punch to the arm jolts her out of sleep. “Ouch! Did he just punch me?”, she thought, turning to me and seeing me fall asleep with my back to her. Was he dreaming? What the heck was that all about?

Next morning we talked about what happened. She told me about her dream, how she thought she beaned me. I told her about my dream and how after she beaned me I, still in my dream state,  did the knee-jerk thing and punched her on the arm before going back to the park to hide and seek or whatever.

We called it even, and now tell the story to get a laugh, the story of the night we beat each other up in our sleep. Anger issues? Maybe. Not likely. For now we’re going with love taps.

Pencast: Zombie Monkey and the Killer Gallbladder

Published on March 16, 2009 in Life and Typecast. 0 Comments Tags: .

zombie Monkey Post

The World According to the Bottom Bunk

Published on February 9, 2009 in Featured Posts, Life and Memoir. 2 Comments

We didn’t have beds when we first moved to the US. The four of us shared two small chair beds my parents got, probably from Goodwill. (I should really ask them about that.) Both were broken, so instead of folding out into a bed they sort of split into two pieces.The lucky one that night got the end with the pillow/back attachment. Between my me and my brother, I was usually the lucky one. Anyway, he was a lot shorter, so he needed less space. Still, it wasn’t long before getting real beds became a priority.

A few days after our arrival, we picked up a couple of wooden-frame bunk beds from either a garage sale or some of my dad’s friends, I can’t really remember, although I still remember–vaguely–the neighborhood from where we picked the beds up. To me the area looked like the typical American neighborhood: large yards and two-story homes with gabled roofs, wooden accents, no window or carport bars, and neutral colors, mostly browns. This in contrast to the flat-roofed, bright colored cement houses with, tiny yards, barred porches and car ports we had been used to until that point. It was the kind of place I would see on TV, not one where I expected to find myself in, riding a bicycle around, which I did.

Even before the beds were in the house, I was excited. It wasn’t because the mattresses themselves were blue with a spaceship theme. It wasn’t even because we finally had full beds again. It was because these were bunk beds! Bunk beds! We… had bunk beds! I always wanted to sleep in one of those. Having seen them on television and at friends’ houses, I always imagined they were a world of fun.

While it seems to be customary to fight for the top bunk, I was always more interested in the bottom. My brother lept to the top bunk and claimed it for himself, while I was more than happy taking the bottom. In fact, I’ve always preferred the bottom, for which I can think of only three reasons: First, I like small, enclosed spaces, provided they’re at least tall enough to let me sit comfortably. Second, I have a fear of heights. No, let me rephrase that: I have a fear of falling. More than once, I envisioned myself falling from the top bunk during my sleep, even though it had a guard rail. Third, I’ve always been bigger than my younger brother, and was afraid that my weight would one day snap the bed’s frame and in the process kill him. A fat kid’s worst nightmare. It also almost came true, though not because of me.

My younger sister and brother were either playing or fighting once (I don’t remember which, and one eventually led to the other anyway), with her at the top bunk and him at the bottom. With his legs, he was lifting and dropping the top bed. During one push, the bed became dislodged and fell on to the bottom. A yell went out, and mom, my older sister, and I raced into the room.

“I din’t kill him!” my younger sister yelled. “I didn’t kill him!” She was crying, shaken, repeating the innocence plea. My mom raced to the bunk and we lifted the fallen bed. Because it had fallen at an angle, my brother was able to roll into the empty pocket between the edge of the bed and the wall. He came out of there laughing.

The thing about the bottom bunk is that it was my own space, my room within a room. Here I covered the walls with drawings of the Ninja Turtles and the various starship Enterprises, decorated the bed frame with action figures, and stacked the space below the bed with books. In a three bedroom apartment of four kids and two parents, this personal space was priceless.

After we moved from our first apartment into the house where we’d spend our second and third years in the country, the bunk beds were sawed in half in order to make two separate beds. We always thought about putting them back together, until the day I broke the frame by tossing myself onto the bed, trying to imitate a move I saw Razor Ramon do on WWF. The damage was irreparable. That bed frame was eventually replaced with a box and a wooden frame which would last me until college.

The next time I had a bunk bed setup was in college, where I roomed with an old friend from high school. The bed configuration changed on a regular basis, so that sometimes we would have bunk beds, and others he would have a bunk-desk setup, with the bed on top and the space below it occupied by a desk. I, on the other hand, never once spent any time with the bottom of my bed higher than about a foot from the ground. Again, fear of falling, fear of breaking the bed. (Fear of breaking furniture comes with being fat, and by now I was fatter than when I broke the other frame a few years earlier.)

My college roommate was in the Naval ROTC program in high school, graduating the most decorated member in our school’s history. That always stuck with me, and I couldn’t help but wonder whether he’d one day end up in a submarine. What would it be like to be in one of those tiny rooms, where the bunk beds had barely any headroom? I wondered about this for years, even after he switched from Navy to Army. I remember seeing how many of them kept pictures, books and lights in there, some even keeping curtains in order to have some proper privacy, in addition to being somewhat self sufficient. I tried, therefore, to decorate the bottom bunk in such a way that I could do almost everything I needed in that tiny bedroom (by which I mean a room that is also a bed). I built a magazine rack, kept my books and instruments under the bed, and… well, really, that was about it. I never got to adding a curtain, and everything else, other than eating, was done outside of the dorm.

Like my previous bunking experience, this had not just ups, but also downs. One of the downsides of taking the bottom bunk in college is hearing your roommate and his girlfriend at the top bunk do things they hope you don’t know about because they think you’re sleeping. The noise level was low, but there’s no mistaking the bed’s rocking. Although she was a looker–and I mean seriously, the guy did far better than I expected–I still considered this one of the biggest downsides to having a bunk bed, mostly because I didn’t know whether I should have been offended or mounting a camera. I never said anything, thinking that maybe, eventually, I’d stop being so sensitive about such things. I never did. Still, it didn’t matter: their relationship didn’t last long, and eventually it was just me and him in the room, watching Patton, burning popcorn, and prank calling the university radio station, pretending to be Bill Clinton or quoting lines from Full Metal Jacket.

I wasn’t all alone in there all the time, mind you. That bottom bunk was where I first slept with a girl. No, I don’t mean sex. I mean actual sleeping. A friend, I’ll call her Brandy, had this thing about going to sleep hugging. She didn’t sleep around, mind you–coitus or otherwise–she was just really, really friendly and very touchy-feely. The first time she asked if I’d ever done that I answered with a quick, “Uhm… no. I wish.” So she invited herself to stay over at my place. She felt like hugging and just wanted to lay down and hug. Of course, I decided to give it a try. The fact that she was beautiful, tall, slender and shapely had nothing to do with my saying yes. I just liked hanging out with her. Really. Stop laughing.

Before that night she had warned me of one thing: “I tend to be a spider in bed. I just sort of take over and end up in weird positions. The only person I don’t do that with seems to be my boyfriend.” Wait, boyfriend?

As you can probably guess, I didn’t sleep very well that night, waking up 37 times, each time in a strange, usually uncomfortable position. She seemed to do fine, a bit like a rock with arms and legs. At least that’s what I thought, until I woke up at about five in the morning. She was gone, with a note that said, “Sorry, not enough room here. Hope I didn’t disturb you. I’m going to my place to be a spider.” Next time I saw her she apologized for leaving, and invited me over to her place “sometime”. I never took her up on that offer. Couldn’t help but wonder of sleeping with someone else on the bed would always be that uncomfortable. I wondered, too, if it was the height: she was almost 6-feet tall, just a couple of inches shorter than me. Or maybe it was my girth.

Two days of marriage would later teach me a valuable lesson: never try to spend an extended period of time sharing a bed with someone if the mattress is either a single or double, not unless both of you are very slender. If both of you can’t be described as “skinny” and also “short”, you should at least make it a full size. Queen is preferable. Also, when you’re still getting used to having someone on your bed, depending on how much you move around, there’s a fair chance you’ll end up in different Y-axis positioning than when you first stared, so make sure you have both head and foot room, something I didn’t have at that point. But yeah, back to bunk beds.

It was during that semester that another one of my fears regarding bunks almost came true. My roommate was trying to get down from his bunk, not totally awake. A sudden thump followed by an “Aw, crap!” woke me (and his girlfriend, who’d been in his bed) up in an instant. He was OK, limping a little, but had it been me, I might have broken my knee. Again.

After that semester, I moved back in with my parents. My exposure to bunk beds was incidental from thereon out. The only place I steadily encountered them was at J & A’s  dorm. (J was my best friend during college, and A was her roommate.) J was the artsy, lively kind and A was a free and calming spirit. This combination made for great room ambiance, including individualistic, but subdued decor; incenses of a hundred different smells, and a constant soundtrack that included Tori Amos, Dead Can Dance, DJ Shadow and Loreena McKennitt. Of course, I never slept over at their place, so I never again slept at a bunk in college. In fact, only visits to my then girlfriend, a long-distance affair that lasted about two years, would have me sleeping in a bunk, always the bottom.

Everyone fights for the top bunk. Everyone but me, it seems. The fact is that although the top bunk gets all the glory, the bottom bunk offers a room within a room, a quiet place dedicated to only one person, and can also double as a couch in some cases. I’m a fan of small offices and private spaces, and without a hesitation I will state that almost nothing beats a well designed bottom bunk. At least, that’s what you realize if you take the time to look at the world according to the bottom bunk.