It Might Get Messy

My lower esophageal sphincter muscle (LESM) doesn’t work… . 

Ooh. I heard about a third of you wallop your head onto your desk, a third of you choke back a good spew, and a third of you say “huh?” Personally, the last time I thought of my LESM was in a high school summer biology “enrichment” class. We dissected one out of a preserved shark. You can get a good picture of the esophageal sphincter situation at [1]. 

But that’s not why we’re here. Oh, wait. Yes, it is why we’re here. But before we deal with my LESM, let’s think a bit about hemorrhagic viruses. Because climate change has been getting a lot of press lately, and one of the potential downsides to climate change (remember that I have a quirky personal take on climate change. I think a warmer earth is a better earth considering net outcomes) is that a long list of illnesses traditionally thought of as “tropical diseases” by those of us in the smug north temperate zones are likely to spill across borders and hammer our pale, overfed, overwatered carcasses in an orgy of illness making the medieval “black death” look like a sniffle-nosed kindergarten class. 

The viral pathogens causing “hemorrhagic fevers” are little globs of fat with a strand of RNA inside [5]. The diseases are your standard science-fiction plagues where people deconstruct in a matter of hours, collapsing from fit physical specimens into gelid goo as the small town sheriff’s deputy frantically dials the governor’s office, trying to mobilize the National Guard. 

Hemorrhagic viruses are endemic in animals of various kinds. They make the jump to humans when people intrude on their habitats or domesticate the mammal vectors (a couple hemorrhagic viruses were “discovered” by western science when they showed up in research populations of monkeys). 

Recently, a particularly nasty hemorrhagic virus, ebola, has been emerging at the interface of modern, global society and African wilderness [2]. The big problem in today’s world is ecological linkage. That is, people now go from outback landscapes to major cities (and vice versa) in a matter of hours. Given the take-no-prisoners epidemiology (the viruses spread fast and easy once a population has been infected) of these bugs, this is a disturbing development. French doctors have taken to stationing themselves in the one international airport in Guinea, hoping to spot infected individuals before they transit to the clean world of the north temperate zones in Europe, Asia, and America [3]. 

Even more disturbing, if you’re inclined to conspiracy theories, is the emergence of hemorrhagic viruses in the 1950s, at the height of the Cold War when massive investments were made in biological weapons of war [4]. If you want to have some fun sometime when you’ve got time to invest in a quick read, Lab 257 by Michael Carroll is worth a look [you can find it on Amazon at 6]. Carroll builds a convincing (to me, anyway, his work has taken a beating in the comments on Amazon and in reviews) case that Lyme disease had its American origin at a government microbiology laboratory on Long Island in the 1950s. This conclusion is given some legs by what is probably a careless exposition of the history of hemorrhagic fevers on the CDC web portal [5].

Anyway. Back to my dysfunctional Lower Esophageal Sphincter Muscle. The esophagus has a sphincter (tightly wound loop of muscle that closes and opens the tube) at both ends. In my case, the Upper Esophageal Sphincter Muscle went the way of the rest of my mouth and throat hardware. That is, it was pretty much destroyed in place by the radiation therapy, and then hacked out and sent to the incinerator with the other body parts that were problematic when the surgeons deconstructed and then reconstructed my throat. This wreckage at the top end of my gastrointestinal tract was expected, closed and done. 

But the lower sphincter, I sort of casually assumed, would be there for me when I recovered from the radiation and surgery. It turns out that the LESM is really critical to comfortable functioning in the modern world. Specifically, it would keep the intensely acidic digestive fluids in place in the gut, where they belong and where they can do their work in cheerful quiet, out of sight and out of mind. 

However. For whatever reason, my LESM is missing in action. I’ve discovered this recently as my recovery has proceeded. Mucous production has been declining, allowing me to move around and do more stuff. Like cooking, for example. Where you have to periodically bend over to check items roasting and/or baking in the low oven of the stove. Turns out, if your LESM isn’t performing as designed, when you tip your digestive tract over so the top end is lower than the bottom, the screamingly acidic liquids spill out and over the sensitive (because of surgery and radiation) tissues of the esophagus itself. It’s a simple display of high school physics. And it is incredibly painful. And once the acid has been smeared over the plumbing, it takes quite a while for the effects to dissipate. Causing further irritation via coughing, which inflames things to the point where they bleed. 

Oy. It’s never easy. But, of course, the fact that I’m here to actually feel the acidic burn in my throat is a major triumph. So I’ll stop whining now. And I’ll also try to remember to drop to my knees, rather than bending over, when I check to see if the chicken is achieving crisp roasted perfection. 

Thank you all for being here. Spring still seems to be coming, although it’s taking its time getting here. Rock on, everyone. Live ‘em while you got ‘em!

Notes

[1] http://www.webmd.com/digestive-disorders/picture-of-the-esophagus

[2] http://www.nbcnews.com/news/world/medical-staff-scanning-ebola-guineas-airport-n72766

[3] http://www.nbcnews.com/news/world/medical-staff-scanning-ebola-guineas-airport-n72766

[4] http://onlinelibrary.wiley.com/doi/10.1002/jmv.23856/abstract

[5] http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/vhf.htm

[6] http://www.amazon.com/Lab-257-Disturbing-Governments-Laboratory/dp/006078184X/ref=sr_1_2?s=books&ie=UTF8&qid=1396770359&sr=1-2&keywords=laboratory+257