@jlharsh I am putting off all invasive procedures until my next life and possibly many more lives. As far as manometry they wanted to do it. The reason was unclear as it is a teaching hospital and they had just obtained new equipment. I am on a PPI and asymptomatic, I am not going to have more surgery or Botox. The appointment with the atending was brief they don’t even have a chair that’s how brief. I was told I might be able to go off the ppi was the residents reason or they might be able to send me to a dietitian for a reflux diet if they do manometry with ph impedance. They did a nasal video laringscopy for losing my voice and I entered the vortex. She used a 3.1 mm probe and it’s was a complete blood bath with both nostrils. I don’t have GI bleeding and the upper GI was completely normal no erosions. They did not have a care plan so it’s hard to understand things with 4-6 fellows involved in my care. Unfortunately they cannot afford probe covers. My friend had it and she has CPRS I found out after I canceled mine she is on fentanyl patch and she fainted from the pain and bleed. They did it again and she fainted again and bled. Where we go according to the nurse most patients cannot endure it and they place it under general anesthesia. I am not sure if that is because they don’t use the probe covers. For procedures here there are a great number of learners who observe for one there were 35 observers not GI. I couldn’t get enough air I had people around me head to toe and I think they forgot a patient was there I fainted from the stress. This was a study and it was before my surgery. These people were there to watch my IH surgery and this is common there are a lot of learners. Not enough patients to go around. It is procedure heavy diagnosis low. My insurance at the time was good everything fully covered. I am on DNR and a major reason is I have done what I can to rehab. I want quality of life more. My friend was just at Rochester for Mayo he got some great help neuro. He said things ate more diagnosis not just procedures and tests like here. We get some great doctors and they stay while in contract then it ends and they leave. I had someone from out of state evaluate the need for manometry with PH impedance. She said that it would give a numerical value of the reflux and that would not make sense for me given that I am well controlled and not wanting treatment beyond ppi.