Hi All:
I am the ENT who suggested to Haley that this was more likely and oral problem rather than esophagus or stomach. Her symptoms are described more as spitting up of blood rather than vomiting. I also pointed out that upper GI endoscopy because of the nature of the scopes used is poorly designed for looking at the area between the teeth and the opening of the esophagus. Nevertheless, unless an obvious ENT site is found the other endoscopy is needed. The problem with any examination is that if the bleeding is from a break in a vessel, unless it is bleeding at the time, the chances of finding the spot is very slim. At times there is ?irritation around the site that tips one off. This differs from benign or malignant growths that have a tendency to bleed because their surfaces are friable. You may not find bleeding, but the lesion is visible. Although usually large, I have found tumors (i.e. growths without any distinction between benign and malignant) as small as 1/16 inch that caused bleeding symptoms.
I have a comment about the order of the TEE and GED that was done. Granted there may in some hands be different types of anesthesia used for each study but I think they should have been done together. So does the insurance company. The ?rules? of medical billing are such that if done together, the insurance company says that since you had to pas through the esophagus to get to the stomach, the charge for getting to and examining the stomach INCLUDES the charge for the esophagus. So, if you do both on separated days, you can bill for two procedures rather than one. If this is the ethical mindset of the MD who did the procedures, then trusting someone like that to try to examine the mouth etc is questionable.
I spent seven years as the part time medical director of the hospital trying to improve care and monitor physician behavior. All I got out of it was a reduction in referrals because doctors don?t like to be called to account for poor or unethical behavior.
There have been several inaccurate comments on this site regarding sinus disease in relation to bleeding. First of all bleeding from the nose is rather obvious in that it drips or pours out of one or both nostrils. In some case, when the bleeding is from far back in the nose, it drips into the mouth and patients spit it out. However, if one tips ones head down until it touches your chest, then it will also drip from the front of the nose. Bleeding from the sinuses even with severe infection or a large tumor is rare. When it does occur one sees blood mixed with mucous sinus secretions. The color tends to be dark rather than bright red. Nothing in Hayleys?s history suggests this as the cause. Unfortunately the American public is brain washed by the TV ads for sinus medications to believe that the much more common symptom of nasal congestion is that of sinus disease. Yes, the two often go together, but believe me most of what the public and non-ENT doctors think is sinus disease is rhinitis.
I agress with imhaley, for my input, this is the end.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
