# how this eosinophilic esophagitis effects my status



## Bones (Mar 27, 2008)

Was wondering if anyone had some medical background that would know how Eosinophilic Esophagitis might effect re-enlistment or the finishing of my contract or even if it would disqualify me from anything such as flight school etc.

I havnt talked to anyone in my unit yet.

Thanks


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## 8'Duece (Mar 28, 2008)

GERD-Gastroesophogeal reflux disease. Yours is basically an inflammation of the esophagus. 

Eosinophils are luekocytes, or basically a white blood cell that is approx 3-4% of your total  blood cell count. Involved in the digestive enzyme production. 

Basically heart burn but can be more serious such as developing into esphageal cancer. 

I'd talk with the docs about just how serious yours may be, or not be.

I would suggest seeing if you can get a consult with an Gastrointerologist.  You may have to be scoped and or cultured, but it's worth your time to examine what seriousness or lack their of with your condition. 

I'm not a doctor, but I'v been studying this stuff for the last two years in prep for a medical career.


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## Bones (Mar 28, 2008)

Mines not GERD, I had the biopsy and had my esophogus dilated.  I know its not heartburn because ive have been regurgitating food everyday or every other day for the last 6+ years until i had that dilation.

I also use the Asthma inhaler and swallow it, I took GERD meds at first but I dont anymore as they dont think I have it.

I had to have surgery to remove a piece of food a few months back and thats when they did it all.  My esophogal rings are swelling shut.  I believe the doctors words to my wife were something along the lines of " a man of his age should not have a throat that small".


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## 8'Duece (Mar 28, 2008)

Bones said:


> Mines not GERD, I had the biopsy and had my esophogus dilated.  I know its not heartburn because ive have been regurgitating food everyday or every other day for the last 6+ years until i had that dilation.
> 
> I also use the Asthma inhaler and swallow it, I took GERD meds at first but I dont anymore as they dont think I have it.
> 
> I had to have surgery to remove a piece of food a few months back and thats when they did it all.  My esophogal rings are swelling shut.  I believe the doctors words to my wife were something along the lines of " a man of his age should not have a throat that small".



Are you taking any steroidal med for inflammation ? Prednisone, Decodran ??

Again, I'm not a Doc, but just interested in hearing what meds and how they've treated you. We probably need EMSDOC in here.

Another note to add is that if you ever have an alergic reaction and go into anaphlaxis, your throat is probably not going to be easy to intubate and or it's going to close to rapidly unless you've been tested for alergic reactions and can epi pen your way out of not being able to breath. 

Just a thought about your medical chances for flight school.


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## HoosierAnnie (Mar 28, 2008)

I'm with 82nd on this one. As a nurse, my concern would be the potential for swelling and resp difficulities at altitude and with pressure changes.  Never mind if you actually made a 'chute jump.  Flight surgeons are VERY picky on what they will allow through on flight level physicals. And justifiably so.  My guess is at best you at least have several medical hoops to jump in order to get flight status.  Just my :2c:


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## Bones (Mar 28, 2008)

I take Aerobid (flunisolide) from an inhaler.  My throat doesnt swell shut to the point i cant breath, its just so constricted that food cant get through.  

The condition is believed to be caused by unknown allergies, if you google it theres plenty of info that basically says. "We don't know what causes it, but we think its an allergy either inhaled or ingested". 

So basically little is known about the condition.

I've jumped outta airplanes, done the long flights in route refuels and jumped in other countries and never had a problem.  

I also wonder if this has any rammifications for normal duties on the ground in uniform period, not just flight physicals.


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## 8'Duece (Mar 29, 2008)

Bones said:


> I take Aerobid (flunisolide) from an inhaler.  My throat doesnt swell shut to the point i cant breath, its just so constricted that food cant get through.
> 
> The condition is believed to be caused by unknown allergies, if you google it theres plenty of info that basically says. "We don't know what causes it, but we think its an allergy either inhaled or ingested".
> 
> ...



I guess that's why they refer to conditions as yours as "idiopathic" 

Aerobid, a corticosteroid inhaler, is basically an asthma inhaler. It opens up the alveoli in the lungs and allows the user to take in more O2, but it's an steroid for inflammation also. 

Any side effects from this ???


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## Bones (Mar 29, 2008)

none that I've noticed.


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## JustAnotherJ (Mar 29, 2008)

PMed EMSDOC, maybe he'll have some time to help out.


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## EMSDoc (Apr 1, 2008)

Hey Bones/everyone,

Was out of town, then have been working night shifts sorry for the delayed response...

Eosinophilic esophagitis is often seen in patients with "allergic" conditions such as asthma, eczema, or chronic rhinitis or in those who have a family history of atopic disease.

Your endoscopic findings are fairly classic for the condition.  Endoscopy may reveal a ringed appearance or linear furrows. Standard biopsy findings reveal severe eosinophilic infiltration; more than 15-20 eosinophils per high-magnification microscopic field are necessary for diagnosis.  Eosinophils are specialized immune cells (white blood cells) that modulate the allergic response and originally evolved to help to fight off parasites.

In contrast to GERD, eosinophilic esophagitis involves the mucosa, submucosa, and, possibly, the muscularis.  GERD typically only affects the mucosal or submucosal layer.  In your case, you have inflammation that goes into the muscular layer, which explains your issues with swallowing as described.

Multiple food antigens (eg, eggs, nuts, beef, wheat, fish, shellfish, corn, soy) can induce eosinophilic esophagitis; cow's milk protein is the most common precipitant.

The exact pathophysiology of eosinophilic esophagitis is unknown, but contact of the allergen with the esophageal or intestinal mucosa is thought to be the initiating event. In recent years, animal models of oral and respiratory eosinophil-associated GI disorders have been developed. In these models, oral antigens induced the recruitment of eosinophils to the GI tract, including the esophagus and Peyer patches (immune areas like lymph nodes in the esophagus), and promoted GI inflammation and motility dysfunction. Interleukin-5 (IL-5), interleukin 13 (IL-13), and eotaxin-1, a chemokine specific to eosinophils, play a major role in eosinophil recruitment and T-cell proliferation and polarization in the tissues.

The treatment of eosinophilic esophagitis is still widely debated.

Evidence shows that food allergy is the most common cause of EE, and different approaches to removing the causative food antigens are available. You might want to see an allergist or rhematologist to assist with this.

Patch testing can help determine the allergen (most commonly milk, eggs, nuts, beef, wheat, fish, shellfish, corn, and soy).  Selective elimination of implicated foods based on allergy testing, or, in certain cases, initiation of elemental diet is required. 

For 1-3 months, patients are placed on an exclusion diet or an elemental diet, and repeat endoscopies with biopsies are often necessary to determine both improvement and the time to start progressive reintroduction of foods. Elemental diet has found to have a higher success rate than testing-based elimination diet.

Other treatments, such as anti-inflammatory medications, mast cell stabilizers, and leukotriene receptor antagonists, have also been used.
Oral corticosteroids were demonstrated to be effective in treating symptoms and normalizing the histology, but the disease recurs when these agents are discontinued.  Since 1998, multiple studies demonstrated effectiveness of swallowed topical corticosteroids delivered from a metered dose inhaler in treating clinical symptoms and abnormal histology associated with eosinophilic esophagitis.  This is likely why they have you treating your condition in this way.

Your condition will not induce an "allergic reaction" in the anaphylactic sense.  This is a chronic immune mediated inflammation of the tissues of your esophagus that affect the way your muscles function.  I don't know army rules, but I don't see any reason it should affect your qualifications as a pilot.  As for your condition, I would recommend having a gastroenterologist and a rhematologist or allergist that can work on decreasing your allergen exposures to improve your symptoms.  You may also want to work with a nutritionist if they recommend any special diets.

Also... I'm an ER doc so this is not my specific area of medical expertise, I did use emedicine for some of the info in this post.

Hope this helps.  Good luck and feel better.

EMSDoc :cool:


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## herksrus (Apr 1, 2008)

Im definatly no doc but I do play one on TV......just kidding.  I hope they can fix this problem for you.  I am however a AF flightcrew member and I really dont think that they would let you fly with something like what you have.  The Army may do things a little differently though. 

 I hope Im wrong, and good luck.


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## Bones (Apr 1, 2008)

Ok doc, thanks.  Now... Anyone that can translate that into basic english! lol. 

I cant afford all the doctors bills right now, so ill have to keep that in mind when i get my feet back under me. Just have to decide what my career path is going to be soon with the National Guard.  They have already been bothering me for months about going to school, re-enlisting, or whatever.  

The information is most helpful, as I was out of it the last time I saw the Gastroentologist(DOCTOR!) and Groggy as I drooled and pointed my wife towards the pharmacy when I did start to wake up, as I didnt get much face to face time with that particular doctor.

Thanks again.


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## EMSDoc (Apr 1, 2008)

Haha when we graduate from medical school they always forget to give us that medical-ese to english dictionary.

Hope you feel better... if I can help answer any other questions let me know.  As soon as you can... follow up with your primary and the specialists as I mentioned as they may be able to treat it for you and help with the symptoms.

Doc :cool:


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## LibraryLady (Apr 1, 2008)

Bones said:


> ... as I was out of it the last time I saw the Gastroentologist(DOCTOR!) ... as I didnt get much face to face time with that particular doctor...



I learned it helps to have someone with medical knowledge to be at your side post anesthesia to hear what the doc has to say and retain it.  

I just don't understand why docs think a patient will hear OR retain anything when you're in that condition.  

Good luck Bones, I hope you get it worked out!

LL


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## EMSDoc (Apr 1, 2008)

Library Lady,

Unfortunately for a long period of time med schools taught the science but not the art of medicine.

Med schools like the University of Rochester where I studied are now teaching a biopsychosocial approach to medicine... where you must consider the patient within their social/environmental context, not just "treat the disease."  This more wholistic approach to patient care is now in the forefront of medical education, so hopefully within a few years this kind of scenario will be a lot more rare.

Doc :cool:


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## DoctorDoom (Apr 17, 2008)

You'll need to be cleared by the gastroenterologist Bones.  This disease is highly variable in presentation and only a specialist will be able to give you the advice you need.  You'll have to be a bit pushy here.

Good luck man.


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## HoosierAnnie (Apr 17, 2008)

EMSDoc said:


> the art of medicine. Doc :cool:



One of my fav quotes  " The art of medicine consists in amusing the patient while nature cures the disease." Voltaire


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## LibraryLady (Apr 17, 2008)

EMSDoc said:


> Library Lady,
> 
> Unfortunately for a long period of time med schools taught the science but not the art of medicine.
> 
> ...



I'm a bit more of a pessimist than you.  I'm glad to hear the schools are teaching the holistic methods, but a 'few years' seems a bit short.  Until it's embraced by ALL docs, and the administration of hospitals, and society, oh and let's not forget the insurance industry, I don't think you'll see the scenario change drastically.  Maybe in a few lucky places. 

It's a bit like customer service, you can't quantify it for the number crunchers so therefore it's hard to analyze.  If they can't analyze it, they don't like it to happen.  The number crunchers, when it's all said and done, run the world.

LL - the supreme pessimist


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## DoctorDoom (May 18, 2008)

Good doctors and bad doctors, G... not everyone has common sense, and holistics ain't everything either.


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## LibraryLady (May 18, 2008)

DoctorDoom said:


> Good doctors and bad doctors, G... not everyone has common sense, and holistics ain't everything either.



Damn few people have common sense! 

That's why it pays anyone to educate themselves on what's going on with their bodies.  Doctors don't always give you ALL the options, they give either their favorite or the one they think works.  It might not be the best for you.

Speaking more for the general reading of this post, not for you, D2... I know you're a doc with common sense!

LL


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