Zenker's Diverticulum
by Len Nasman
In March of 2008 I was diagnosed with Zenker's Diverticulum. In my case, the major symptom was that whenever I tried to go to sleep I would cough myself awake. I also gave up eating grapes or chopped nuts because I could cough up grape skins 5 or 6 hours later.
On June 12, 2008 I was operated on at the Duke University Medical Center. The operation seems to have been successful and as I write this, (three days after the operation) I have a mild sore throat, but have had my first decent all-night sleep without coughing for several years.
Zenker's Description
Zenker's diverticulum is a pouch that develops in the walls of the lower throat. It usually occurs in people over age 50. With every swallow, some food ends up in the pouch until the pouch fills. Once filled, the pouch presses on the upper esophagus, making it difficult for solid foods to pass. The filled pouch also spills food into the throat, causing coughing and spitting up of food swallowed many hours before; this especially happens when lying down at night. The pouch also causes problems for patients taking medications, because pills can get stuck in the pouch and are not absorbed through the stomach. The cause of Zenker's diverticulum is unknown, but it is thought to be due to a weak spot in the lower throat muscles.
The story
Several years ago, just before Diana retired from OSU and we were still covered under her health insurance, we went through a series of check-ups including hearing tests. When I mentioned my sleep/cough problem to the ENT Doctor, he stuck a camera up my nose and down my throat and casually pronounced that I had reflux. He prescribed Nexium, however, Nexium did not seem to help. We had decided this doctor was not very good based on his follow-up report that had so many typos Diana nearly sent back a graded version. The report also had factual errors... like mixing up my mother and Diana's mother in the family history. We did not know it at the dime, but he completely missed the diagnoses.
I tried several other things, like raising the head of the bed, but nothing seemed to help. The night coughing was not consistent, with some nights worse than others. I could not relate the night coughing to anything like diet or behavior.
In the spring of 2008, I discussed the problem with my family doctor who referred me to a doctor Myung at the Adena Medical Center in Chillicothe. This doctor first did a serious examination of my throat using a camera. This was done under anesthesia. The result of this exam was the initial diagnosis of Zenker's. A follow-up examination was done using a barium swallow – X ray. The X-ray confirmed the Zenker's and provided information about the size and position of the diverticulum.
It turns out the the average ENT doctor might see a case of Zenker's every year or two. In other words, this is not a common problem.
Once the diagnosis was made, I did a bit of Internet research to learn as much as I could about Zenker's. A traditional solution is to cut the throat and stitch up the diverticulum. This requires being on a feeding tube for a week or more and several weeks of recuperation. An endoscopic approach was developed at Duke University. In this approach, endoscopic equipment is used to place staples to clear the diverticulum. The endoscopic treatment typically takes less than a hour and the patient is drinking fluids within a day.
A referral was made to a doctor Koegal at St. Ann's in Westerville, Ohio. This visit was unsatisfactory. This doctor was familiar with Zenker's. When asked how many Zenker's operations he had done, he replied that he could not remember. He said that he and his partner would be willing to try the endoscopic approach, but because of my jaw structure it would be difficult, and that if they could not complete the operation with the endoscopic approach they would go ahead with the incision surgery. My general impression was that this doctor was not enthusiastic about the operation. I left his office determined to find an alternative.
Internet searching showed possibilities at the Mayo Clinic, a hospital in California, and a Doctor in Connecticut (who had studied at Duke University with the doctor who developed the endoscopic treatment). It turns out that we have a retired doctor here at Bristol Village who has a copy of the Duke doctor's referral book. He provided me with the name of Dr. Scher. Further Internet searching revealed that Dr. Scher has published extensively on the endoscopic treatment of Zenker's.
I contacted Dr. Scher's office via email and was encouraged to transmit my medical records for review. I managed to get my records there (on the second try, since UPS lost the first set). Upon review of the records, Dr. Scher indicated that my diverticulum could be treated endoscopically. An appointment was made for a pre-operation meeting with the doctor on June 11, and an operation on June 12.
BTW, the Adena Medical Center supplied the barium x rays on a CD. Apparently this is now common practice. Fortunately, I was able to make a copy of the CD on my computer since the first copy was lost.
The meeting with Dr. Scher went very well. He provided much more confidence than the Ohio doctor. He has done around 700 endoscopic Zenker's operations and is probably the leading doctor in this field at this time. Following the meeting with the doctor, I had to meet with several people in the Duke pre-operation section. The personnel were excellent and they took my medical history, blood samples, and ran an EKG. The results provided the go ahead for an operation the following day. (BTW, one of the Nurse Practitioners who interviewed me said that I was probably the healthiest person she would see in a year. Most folks who end up there have much more serious problems than mine.)
Around 7AM on the morning of June 12, Diana and I walked to the Ambulatory Surgery building in the Duke Medical Center complex. We stayed at the Brookwood Inn which is close to the center. By then we had traveled back and forth between the Brookwood Inn, the Duke Hospital , where we had meals, and the Clinic building where we met Dr. Scher. We were starting to feel familiar with the complex, and could navigate from our hotel across the street to a parking garage, go down a level and take a people mover to the hospital, and transfer to another people mover to ride to the clinic. The first evening we were there, we wandered into the Ambulatory Surgery building looking for food service, but discovered that there was no cafeteria there, but learned about the cafeteria at the nearby hospital. Rather than messing with the hotel shuttle service, we decided to walk.
After the normal check-in process, and after laying in the pre-op bed for a time, about 8:30 someone came in and injected some magic fluid into my IV. The next thing I knew I was in the recovery room with a mask over my face. After I proved to the nurse I was breathing OK, the mask was removed. Diana soon appeared, and I was soon back into my street clothes. About 11AM Diana and I walked back to the Brookwood Inn.
I had a sore throat, but not much worse than when I had a bad cold or strep in the past. I decided to try and get along without taking any of the jar of pain relief pills that had been prescribed. In addition to the sore throat, my tongue was messed up a bit. It felt like a bad day in the dentists office. This was the result of all the tubes and equipment that had been jammed down my throat, both the anesthesia equipment and the cameras, cutting and stapling devices. Actually I never saw any of this stuff.
By afternoon the throat was a little better and the swelling of my tongue had gone down some. I drank a little Gatorade and ate some gelatin. The next morning I felt good enough to start the drive home. It is a little over 400 miles from Duke to Waverly and th drive was uneventful. Along the way we stopped at a Flying J truck stop where I treated myself to some apple pie and ice cream.
The following day my throat was a lot less sore. Also, my front tooth, which I discovered would not be happy of I tried to eat corn on the cob, was feeling a little less sensitive. In my research on the endoscopic treatment for Zenker's I had learned that chipped teeth and sore jaws were common side effects. So the bit of 'collateral damage' I had was not unexpected.
The third night after the operation I slept through without any coughing spells. So, at this point I am ready to declare the operation a success. I am also ready to recommend Dr. Scher to anyone who is suffering from Zenker's, and I would not hesitate in recommending the Duke University Medical Center as a place for treatment.
Followup: As of 2021, many years after the operation, there have been no side effects. I have not coughed myself awake once since the operation. In other words, I am happy to report that the treatment of my Zenkers went as well as anyone could expect.
