Achalasia and Recovery from Surgery(Long Read)

I wanted to share my experience after dealing with a diagnosis of condition called Achalasia and the surgery that was used to treat it. I’m hoping my experience can be helpful to someone because it is apparently a pretty rare condition and when I researched what would happen post surgery there is very little info in regards to how it would effect training, racing, and participating in other activities. This is going to be a long read but like I said there is very little info out there and I want to share my experience so someone in my situation has an idea of what to expect.

Achalasia is a condition where the muscles in the esophagus stop working correctly and swallowing becomes difficult and in some cases next to impossible. It started for me slight difficulty swallowing, especially if I ate or drank too much or too quickly but it wasn’t a daily problem. I can remember some problems going back a couple years prior to seeing a doctor.

It was in June 2019 when things really started to be a problem. I would wake up at night choking on what I thought were stomach acids at the time. This would happen almost every night and would happen multiple times. I started self medicating with over the counter drugs for acid-reflux and tried to elevate my head when sleeping.

After I didn’t see any improvement, I finally went to a gastro doc and we continued with prescription strength Nexium after I told him my symptoms. I also had an endoscopy shortly after that first appointment.
The endoscopy showed nothing.

I did the meds for a couple months with no improvement in the reflux at night and the swallowing problem was actually worsening. I had to take care with what I was eating or food would get stuck in my esophagus and I’d have to use liquid to force it down.

By November 2019 the swallowing problem was happening daily. When I went back to the doc for a follow-up, he decided to send me for a test called esophageal manometry. This was probably one of the worst things I have ever experienced medically. They insert a long tube through your nose and down the back of your throat and into your stomach. Then you swallow gatorade and they measure the pressure that the esophagus muscles are putting on the sensors in the tube. This is all done while you are awake.

I went in for the test in December '19. Prep is easy. No food or drink after midnight. I did have a some wine the night before which was ok according to what I needed to do for prep. I went in for the test early in the morning and they explained what they were going to do. They started to insert the tube and when it hit the back of my throat it triggered my gag reflex. Some of that wine that I drank the night before was still sitting in my esophagus and came back up. The nurses/techs would not continue with the test after that because of fear of aspiration. They told me in order to redo the esophageal manometry test I would be put under and they would also and endoscopy to make sure my esophagus was clear.

The second attempt happened in January '20 and that was probably the second worst medical thing that has ever happened to me. When I was brought out of the anesthesia, I was basically choking on a long straw down the back of my throat and had to wait 30 minutes until they felt I was recovered enough to swallow the gatorade to do the test. Once the test was done, the doc in the room told me the unofficial diagnosis and it achalasia. I was dreading this diagnosis because the only long term solution was surgery and I was at that point looking at losing my entire spring season due to this.

When I met with my gastro doc following that test, he said he was going refer me to Temple University Hospital in Philadelphia. I also did a swallow study at my local hospital where I swallowed barium and they measured how quickly my esophagus drained which also helped confirm my diagnosis.

I went to Temple in early February and met with a gastro doc there who explained my condition and wanted to rerun some of the tests but I knew at that point that I needed surgery and told him no more tests. He then referred me to a thoracic surgeon. I met with that doctor about a week later and he discussed the two surgical options I had. One was called Heller Myotomy and the other has the anachronism of POEM. Both involve cutting the muscles that control swallowing but POEM is less invasive and has a shorter recovery time. I chose POEM so it wouldn’t effect my racing season which was quickly coming.

My surgery was scheduled for March 13 2020 and by now eating was a major issue. I couldn’t eat a meal without having issues. I had planned on doing the POEM procedure but due to it being considered experimental, my insurance wouldn’t cover it and I had to get the Heller Myotomy surgery instead. Both surgeries involve an overnight stay but with the Heller Myotomy I would not be racing or doing intense training for 3 months and was restricted to lifting no more than 15 pounds during that time. Fortunately, I was allowed to run and do less intense workouts on the trainer.

I went in on Friday March, 13 2020. This was also the day that Pennsylvania announced a shutdown due to Covid-19 and ended the midadlantic spring and early summer XC races. My experience was great and the surgery was performed without any complications. I was finally given liquids after midnight that night and ate 3 meals the next day and discharged that night with 5 new scars across my belly and a bottle of tylenol with codeine.

For the most part there was very little pain after the surgery but I would get some intense spasms where I could only lay down and wait for them to pass. They happened once or twice a day after the surgery then slowly disappeared about 2-3 after the surgery. I did have to take care getting up so I didn’t strain the muscles in my abdomen as well.

The best thing post surgery was that I could eat again without choking on my food. I did have a soft food diet for 2 weeks and had to abstain from carbonated beverages (including beer) for a month but I could finally eat without choking on my food.

I started up on the trainer 4 days after the surgery with Pettit. I stuck to endurance rides for the next two weeks but was up to 2 hour endurance rides by the end of those two weeks. I then added running 3 days a week into my schedule and did a modified SS Base Mid/High plan until June.

I tried an outdoor ride in April. I planned on an easy Rail-Trail ride with limited climbing but that wasn’t a good idea. The extra stress of balancing the bike put a lot of strain on my core and I could really feel it after the ride. I decided to stick with indoor rides for another month to give my abdominal muscles more time to heal and then added road riding on the weekends at around the 2.5 month mark to limit how much stress I put on my core.

Once I hit the 3 month mark post surgery and was given the ok, I started mountain bike riding and yoga(gyms were still closed). I’m a teacher and by then our virtual school year was over and I stuck to mainly outdoor riding because I was sick of the trainer. I tried to do 1 HIIT indoor workout per week because I noticed that that my high end just wasn’t there and it really showed when racing started in July '20. I had decent endurance but anything at or over threshhold burned lots of matches and I just didn’t have that kick that was needed to do well in a MTB race.

During the recovery process, I lost about 20 watts off my ftp and lost some of that high end kick. But my fitness levels are back to where I was last year when I look at my history. My final followup showed that the surgery was a success. I do still have problems with dry food and bread but that’s what beer and water are for.